In a decision with implications that could go back 35 years, the United States Court of Appeals for the District of Columbia Circuit rejected a CMS interpretation of its reopening rules as that interpretation affects current...more
In Northeast Hosp. Corp. v Sebelius, 657 F.3d 1 (D.C. Cir. 2011), the United States Court of Appeals for the District of Columbia Circuit upheld hospitals' challenge to CMS's disproportionate share hospital (DSH) calculation...more
7/16/2018
/ Administrative Appeals ,
Appeals ,
Centers for Medicare & Medicaid Services (CMS) ,
Disproportionate Share Adjustments ,
DSH Adjustments ,
Hospitals ,
Inpatient Prospective Payment System (IPPS) ,
Judicial Review ,
Medicaid ,
Medicare ,
Provider Payments ,
Reviewability Determinations ,
Statutory Construction Test
On March 27, 2018, the United States Court of Appeals for the Fifth Circuit published an opinion that provides Family Rehabilitation, Inc. (Family Rehab) a second chance to postpone recoupment of about $7.6 million in...more
4/12/2018
/ Administrative Appeals ,
Administrative Backlogs ,
Administrative Law Judge (ALJ) ,
Appeals ,
Dismissals ,
Due Process ,
Exhaustion Doctrine ,
Health Care Providers ,
Judicial Review ,
Medicare ,
Overpayment ,
Preliminary Injunctions ,
Recoupment ,
Reversal ,
Social Security Act ,
Subject Matter Jurisdiction ,
TRO ,
Ultra Vires
For the last several years, hospitals, on the one hand, and the Centers for Medicare and Medicaid Services and its contractors (collectively, CMS), on the other, have been engaged in a spirited dispute over claims denials for...more
For many years, CMS policy has been that, if an inpatient admission was denied for medical necessity reasons, the hospital could bill under Part B for only a limited set of services that, significantly, did not include...more