Hospitals Medicare

News & Analysis as of

House of Representatives Approves Bill to Delay LTCH 25% Rule Implementation, Make Other LTCH Reforms, and Tighten Medicare...

On September 21, 2016, the House Ways and Means Committee approved H.R. 5713, the “Sustaining Healthcare Integrity and Fair Treatment Act of 2016” or “SHIFT Act.” The primary focus of the SHIFT Act is to provide an...more

House Approves Medicare ESRD Coverage, Rural Hospital Supervision Bills

On September 21, 2016, the House of Representatives approved HR 5659, the Expanding Seniors Receiving Dialysis Choice Act of 2016, which would allow Medicare beneficiaries with end stage renal disease (ESRD) to enroll in...more

The MOON Notification is Coming: CMS Publishes Final Changes

CMS is moving forward with implementing the Medicare Outpatient Observation Notice (MOON) as announced in its FY 2017 IPPS Final Rule [PDF] on August 2, 2016, and published in the Federal Register on August 22, 2016 (Final...more

D.C. District Ct Applies Prohibition on Administrative and Judicial Review to IRF PPS Rates

On July 25, 2016, Judge John D. Bates of the United States District Court for the District of Columbia issued a memorandum opinion broadly construing 42 U.S.C. § 1395ww(j) to prohibit administrative or judicial review of a...more

Loaned and Awarded GME Slots: When does the three-year rolling average and the IRB ratio cap apply?

Ever since Congress capped teaching hospitals' Medicare-funded residency positions to the number of "full time equivalent" (FTE) allopathic and osteopathic residents the hospital reported in FY 1996, there have been very...more

CMS Releases 2017 Medicare Hospital Payment Rates, Penalties for Poor Performers

Earlier this month, the Centers for Medicare & Medicaid Services (CMS) issued a final rule (Final Rule) modifying the Hospital Inpatient Prospective Payment System (IPPS) and Long Term Acute Care Hospital (LTCH) Prospective...more

60-Day Overpayment FCA Enforcement Action Results in $2.95 Million Settlement

On August 23, 2016, a New York hospital system settled False Claims Act (FCA) allegations that it violated the 60-day overpayment rule by improperly retaining Medicaid overpayments. The whistleblower alleged that three of the...more

Also In The News - Health Headlines - August 2016 #3

CMS Releases Medicare Outpatient Observation Notice For Public Comment – CMS announced that the public has the opportunity to comment on the Medicare Outpatient Observation Notice (MOON). The MOON is a standardized form...more

Manatt on Medicaid: Monthly Expansion Recap - August 2016

California - Medicaid Enrollees Are Largest Share of Newly Insured - A new survey from the Kaiser Family Foundation found that 33% of Californians uninsured in 2013 are now enrolled in Medi-Cal, the State’s Medicaid...more

CMS Releases the 2017 IPPS and LTCH PPS Final Rule, Including MOON Requirements

On August 2, 2016, CMS issued its final rule addressing new payment rates and policies under both the Hospital Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System...more

Another Blow to Medicare “Self-Disallowance” Rule

You can tell by its name that you won’t like the Medicare “self-disallowance” rule. The federal district court for D.C. didn’t like it, either, and gave a group of Banner Health hospitals summary judgment that the rule was...more

HHS Wins Summary Judgment Against Hospitals Disputing CMS’s Treatment of Part C Days as Days “Entitled to Part A” for Purposes of...

On August 17, 2016 the United States District Court for the District of Columbia granted summary judgment in favor of HHS in a dispute over whether Part C days can be treated as “days entitled to benefits under Part A” for...more

D.C. District Court Invalidates CMS’s “Protest” Requirement

On August 19, 2016, the United States District Court for the District of Columbia granted a group of hospitals’ motion for summary judgment against HHS in a challenge of the Provider Reimbursement Review Board’s (PRRB) denial...more

NOTICE Act Scheduled to Take Effect This Fall

The Final Rule of the Notice of Observation Treatment and Implications for Care Eligibility Act of 2015 (Pub. L. 114-42) is scheduled to become effective October 1, 2016. Thereafter, hospitals and Critical Access...more

OIG Cautions that States May Be Claiming Matching Funds for Privately-Operated Hospitals

The OIG has issued a memo to CMS suggesting that some states may be claiming matching funds for government-owned but privately-operated hospitals, where no state or local government funds are used to operate the hospital....more

OIG Examines Adverse Events in Rehab Hospitals

According to a recent HHS Office of Inspector General (OIG) report, about 29% of Medicare beneficiaries experienced adverse or temporary harm events during their rehabilitation hospital stay, based on sample of 417...more

Managing the Transition to Transformation: Provider/Payor Integration: 2016 Is Not the 1990s

McDermott’s Managing the Transition to Transformation series is designed to help health systems and other health care industry leaders address the many challenges presented by the transformation in payment and care delivery...more

Sharing FTE Caps: Threshold requirements for entering into Medicare GME affiliation agreements

Teaching hospitals’ full-time equivalent (FTE) resident caps dictate the maximum number or residents for which the hospital is eligible to receive graduate medical education (GME) reimbursement from the Medicare program. As...more

Brief Reprieve Before Hospitals Must Provide Medicare Patients with “Observation” Notices

Hospitals now have additional time before they must meet federal requirements to provide written notice to Medicare patients who are receiving observation services. Congress passed the Notice of Observation Treatment and...more

Also In The News - Health Headlines - August 2016 #2

GAO Alleges that Medicare Is Overpaying Hospitals For Uncompensated Care – A recent report from the Government Accountability Office (GAO) found that Medicare’s uncompensated care payments to hospitals are not well aligned...more

CMS Finalizes FY 2017 Update to Medicare IPPS, LTCH PPS Rates and Policies

The Centers for Medicare & Medicaid Services (CMS) has released its final rule to update Medicare acute hospital inpatient prospective payment system (IPPS) and long-term care hospital (LTCH) prospective payment system (PPS)...more

CMS Releases FY 2017 Hospital Inpatient Prospective Payment System and Long-Term Care Hospital Prospective Payment System Final...

On August 2, 2016, CMS released a final rule (Final Rule) with updates to the Hospital Inpatient Prospective Payment System (Hospital IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) affecting...more

Proposed Cardiac, Hip, and Femur Episode Payment Models Are Next Generation from BPCI and CJR

The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule on July 25, 2016, entitled, Advancing Care Coordination Through Episode Payment Models (EPMs); Cardiac Rehabilitation Incentive Payment Model; and...more

CMS Issues Final Update to Medicare Hospice Payment Rules for FY 2017

CMS has released a final rule that updates the Medicare hospice wage index, payment rates, and cap amount for fiscal year (FY) 2017. CMS estimates that the final rule will increase overall Medicare payments to hospices by...more

CMS Proposes New Bundled Payment Models for Cardiac and Orthopedic Care

On July 25, 2016, CMS posted a proposed rule that would create three new Medicare Parts A and B episode payment models for patients admitted for care for a heart attack, bypass surgery or surgical hip/femur fracture treatment...more

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