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Provider Reimbursement Review Board

Proskauer - Health Care Law Brief

Post‑Chevron Spotlight: Disproportionate Share Hospital Payments Restored as Texas Hospitals Prevail in Challenge to HHS Exclusion...

In a victory for Texas health care providers, in Baylor All Saints Medical Center dba Baylor Scott & White All Saints Medical Center‑Fort Worth et al. v. Xavier Becerra, case number 4:24‑cv‑00432, the United States District...more

King & Spalding

CMS Issues IPPS and LTCH Final Rule for FY 2025

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On August 1, 2024, CMS filed a display copy of its final rule for Fiscal Year (FY) 2025 pertaining to the Inpatient Prospective Payment Systems (IPPS) for general acute care hospitals and long-term care hospitals (LTCHs) (the...more

King & Spalding

CMS Issues IPPS and LTCH Proposed Rule for FY 2025

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On April 10, 2024, CMS issued its annual Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) Proposed Rule for Fiscal Year (FY) 2025 (the Proposed Rule). In...more

King & Spalding

D.C. District Court Upholds HHS’s Audits of Hospitals’ Worksheet S-10 and Resulting Adjustments When Determining Medicare DSH...

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On August 30, 2021, the United States District Court for the District of Columbia ruled in favor of HHS and dismissed claims related to improper audits that resulted in adjustments to plaintiff hospitals’ Worksheet S-10 that...more

Baker Donelson

D.C. District Court Issues Two Decisions Addressing CMS's Medicare Bad Debt "Must Bill" Policy – One Rejecting the Policy and the...

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In a significant break from preceding court decisions, the United States District Court for the District of Columbia recently struck down CMS's "must bill" policy, which requires that Medicare providers bill Medicaid and...more

King & Spalding

Provider Reimbursement Review Board Seeks Input on Board Rules

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On March 18, 2019, the Provider Reimbursement Review Board (PRRB) announced that it is inviting comments, suggestions, and other feedback in connection with five topic areas: (1) continued implementation and improvement of...more

Baker Donelson

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

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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

King & Spalding

D.C. District Court Upholds CMS’s Predicate Fact Three-Year Reopening Limitation

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On March 10, 2017, Judge John Bates of the U.S. District Court for the District of Columbia upheld CMS’s three-year cost report reopening limitation, as applied to “predicate fact” determinations. The regulation at issue is...more

Baker Donelson

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

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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

D.C. District Court Bucks the Trend and Rules for Hospital in Provider Tax Case

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Many states assess taxes against hospitals and other providers as a means of funding their Medicaid and other healthcare-related programs. The revenue generated by the taxes is used, with CMS’s approval, to fund Medicaid...more

Baker Donelson

Court Rules in Favor of Hospitals in Bad Debt Collection Effort

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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

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

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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

King & Spalding

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

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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

Baker Donelson

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

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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

King & Spalding

D.C. District Court Holds that CMS’s Rigid Application of the “Similar Collection Efforts” Requirement Violates the Bad Debt...

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In a case of first impression in the U.S. District Court for the District of Columbia, brought by King & Spalding on behalf of Mountain States Health Alliance, the court held that CMS’s disallowance of certain Medicare bad...more

Faegre Drinker Biddle & Reath LLP

Ministry Motivation Costs Hospital $59 Million

Sometimes doing the right thing for the right reason can be costly. Last week it cost nonprofit Via Christi Regional Medical Center $59 million....more

King & Spalding

Provider Reimbursement Review Board Imposes New Requirements for Providers with Pending Medicaid Eligible Days Appeals

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On May 23, 2014, the CMS Office of Hearings released Alert 10, notifying providers with pending appeals before the Provider Reimbursement Review Board (PRRB) of a new sixty-day submission requirement for the Medicaid eligible...more

Baker Donelson

Supreme Court: Providers' Appeal Period Not Extended by Doctrine of Equitable Tolling

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Under the Medicare statute and implementing regulation, providers have 180 days from the issuance of a Notice of Program Reimbursement (NPR) in which to file an appeal to the Provider Reimbursement Review Board (PRRB). This...more

Foley & Lardner LLP

Supreme Court Rules Equitable Tolling Cannot Be Used To Extend Deadline For Filing Medicare Part A Reimbursement Appeals

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On January 21, 2103, the U.S. Supreme Court unanimously held in Sebelius v. Auburn Regional Medical Center that the Medicare statute does not permit the time period for filing an appeal with the Provider Reimbursement Review...more

King & Spalding

Bolstered By Favorable District Court Decision, King & Spalding Now Forming Group Appeals Contesting Inclusion of Part C Days in...

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In a recent decision for which King & Spalding organized the appealing group of hospitals and was co-counsel, the D.C. district court ruled that CMS’s regulation requiring the inclusion of Medicare Part C patient days in the...more

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