In a September 17, 2019 decision, the United States District Court for the District of Columbia invalidated a CMS rule expanding site-neutral payment reductions to evaluation and management (E&M) services furnished in...more
10/22/2019
/ Administrative Authority ,
Bipartisan Budget Act ,
Budget Neutrality Policy ,
Centers for Medicare & Medicaid Services (CMS) ,
Congressional Intent ,
Hospitals ,
Lack of Authority ,
Off-Campus Departments ,
Outpatient Prospective Payment System (OPPS) ,
Physician Fee Schedule ,
Provider Payments ,
Remand ,
Ultra Vires ,
Vacated
CMS took another step in its campaign to impose "site neutrality" on hospital outpatient payments with its recently published final Medicare hospital Outpatient Prospective Payment System (OPPS) rule for CY 2019. The final...more
12/14/2018
/ Biologics ,
Centers for Medicare & Medicaid Services (CMS) ,
Emergency Rooms ,
HCPCS ,
Health Care Providers ,
Hospitals ,
Medicare ,
MedPAC ,
Off-Campus Departments ,
OPPS ,
Outpatient Services ,
Physician Medicare Reimbursements ,
Prescription Drugs ,
Provider Payments ,
Section 340B ,
Site-Neutral Exception
Is the Department of Health and Human Services (HHS or the government) required to engage in notice and comment rulemaking when it changes a requirement that has an important impact on hospitals' reimbursement? As we reported...more
10/11/2018
/ Administrative Procedure Act ,
Appeals ,
Azar v Allina Health Services ,
Centers for Medicare & Medicaid Services (CMS) ,
Certiorari ,
Department of Health and Human Services (HHS) ,
Disproportionate Share Adjustments ,
Health Care Providers ,
Hospitals ,
Interpretive Rule ,
Medicare ,
Medicare Part C ,
Notice and Comment ,
Petition for Writ of Certiorari ,
Physician Medicare Reimbursements ,
Provider Payments ,
Rulemaking Process ,
SCOTUS
CMS recently published its proposed Medicare outpatient prospective payment system (OPPS) rule for calendar year (CY) 2019. The rule contains a number of "site-neutral" proposals that, if adopted, will result in lower...more
8/8/2018
/ Bipartisan Budget Act ,
Centers for Medicare & Medicaid Services (CMS) ,
Hospitals ,
Medicare ,
Medicare Payment Reform ,
Off-Campus Departments ,
OPPS ,
Outpatient Prospective Payment System (OPPS) ,
Provider Payments ,
Section 340B ,
Trump Administration
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 December 26, 2017, the United States Court of Appeals for the District of Columbia Circuit upheld the procedural validity of 2010 manual instructions setting out the criteria by which Medicare outlier payments might be...more
Hospitals affected by HHS's 2014 decision to include Medicare Part C enrollees as part of the Medicare fraction of the disproportionate share calculation obtained relief late last month when that position was voided by the...more
8/28/2017
/ Administrative Procedure Act ,
Appeals ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
Disproportionate Share Adjustments ,
DSH Adjustments ,
Hospitals ,
Medicare ,
Medicare Part C ,
Notice and Comment ,
Provider Payments ,
Retroactive Application ,
Reversal
CMS recently published its final outpatient prospective payment system (OPPS) rule, which includes its new policies governing payment related to services furnished at off-campus provider-based departments (OPBDs). 81 Fed....more
On July 26, 2016, the United States Court of Appeals for the District of Columbia Circuit decided Fla. Health Sciences Ctr. v. Burwell. In that case, the Court analyzed a statutory bar against judicial review of estimates...more
10/5/2016
/ Administrative Procedure Act ,
Administrative Review ,
Appeals ,
Centers for Medicare & Medicaid Services (CMS) ,
Department of Health and Human Services (HHS) ,
Disproportionate Share Adjustments ,
DSH Adjustments ,
Hospitals ,
Judicial Review ,
Medicaid ,
Medicare ,
Non-Appealable Decisions ,
Provider Payments ,
Reviewability Determinations
As we reported in a Payment Matters article last November 12, 2015, Section 603 of the Bipartisan Budget Act of 2015 changes the payment rules applicable to off-campus, provider-based locations that are new as of November 2,...more
On March 11, 2016, CMS published in the Federal Register its proposed new Medicare Part B Drug Payment Model. Comments are due by May 9, 2016. Below are some highlights of the proposed rule....more
Hospitals have long tried to expand their footprints by developing, or in many instances acquiring, physician practices and other medical operations to provide services beyond the immediate vicinity of the hospital’s campus....more
On April 30, 2014, CMS posted its proposed changes and updates to the Medicare IPPS [PDF] that would apply beginning in fiscal year (FY) 2015. Comments are due by June 30, 2014. Below is a summary of the major changes to the...more