News & Analysis as of

Provider Reimbursement Manual

King & Spalding

D.C. District Court Upholds Hospitals’ Bad Debt Indigency Determinations Using Information Provided by Credit Reporting Agency

King & Spalding on

On March 29, 2022, the D.C. District Court granted summary judgment in favor of a group of hospitals operated by Sentara Healthcare seeking reimbursement for bad debt from Fiscal Years (FYs) 2010-2013. The court determined...more

Hinshaw & Culbertson - Health Care

California Appellate Court Rules Federally Qualified Health Center Outreach Expenses Don't Qualify For Cost-Based Reimbursement

Family Health Centers of San Diego (Health Center) operates a federally qualified health center (FQHC) that has 49 locations throughout San Diego County, California, and provides a comprehensive range of primary and...more

Morgan Lewis - Health Law Scan

Flawed Formula Drives Academic Medical Center Underpayments; Impacted Hospitals Should Consider Preserving Right to Payment

In the complex world of Medicare reimbursement, there are a multitude of payment formulae, mathematical adjustments, and reimbursement calculations that translate congressional policy into operational payments for hospital...more

Baker Donelson

The Battle over Medicare's Treatment of Provider Taxes May be Coming to an End

Baker Donelson on

For much of the past decade, hospitals and CMS have battled over whether providers may claim, as Medicare reasonable costs, the full amount of provider tax assessments levied upon them by the states in which they operate. In...more

Baker Donelson

Provider Taxes: The Battle over Medicare's Treatment Continues

Baker Donelson on

For the better part of a decade, hospitals and CMS have fought over the extent to which hospitals may claim as reasonable costs the provider tax assessments levied on them by the individual states in which they operate. In...more

Baker Donelson

It Ain't Over 'Till It's Over – First Circuit Rejects Settlement Agreements Between Providers and Intermediary and Upholds Cost...

Baker Donelson on

On October 27, 2016, a three-judge panel for the United States Court of Appeals for the First Circuit issued an opinion concluding that a Medicare fiscal intermediary (Intermediary) does not have the authority to enter into a...more

Baker Donelson

Court Rules in Favor of Hospitals in Bad Debt Collection Effort

Baker Donelson on

On July 25, 2016, the United States District Court for the District of Columbia issued an opinion favoring provider flexibility in the reasonable collection of Medicare bad debt. Winder HMA, LLC, et al. v. Sylvia Burwell. The...more

Baker Donelson

The Bad Debt Moratorium Requires a Flexible Approach to Evaluating "Reasonable Collection Efforts"

Baker Donelson on

On September 10, 2015, District Judge Randolph D. Moss of the U.S. District Court for the District of Columbia issued an opinion in Mountain States Health Alliance v. Burwell (Mountain States) involving Section 310 of the...more

Baker Donelson

CMS Prevails in Dual Eligible Bad Debt Challenge

Baker Donelson on

In a decision handed down on August 7, 2015, the United States Court of Appeals for the District of Columbia Circuit upheld the denial of the providers' bad debt claims associated with dual eligible beneficiaries. Grossmont...more

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