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Payment Matters
September 1, 2011
Hospitals Suffer Setback in IME Research Case
By: Thomas W. Coons
The issue of whether hospitals are entitled to Medicare Indirect Medical Education (IME) payment for time spent by residents in “pure research” has a turbulent history. Initially, federal district courts in Ohio, Arizona, Rhode Island, Illinois, and Michigan all ruled that such reimbursement is appropriate. In 2008, however, the U.S. Court of Appeals for the First Circuit in Rhode Island Hospital v. Leavitt, 548 F.3d 29 (2008) issued a contrary decision and upheld the Secretary’s disallowance of IME for such activities. A year and a half later, the U.S. Court of Appeals for the Seventh Circuit reached a contrary conclusion, deciding that reimbursement for such expenses is allowable. University of Chicago Med. Ctr. v. Sebelius, 618 F.3d 739 7th Cir. (2010). Now, the U.S. Court of Appeals for the Sixth Circuit has added its voice to the tumult, upholding the Secretary’s position and her denial of reimbursement for such expenses. Henry Ford Health Sys. v. Department of HHS, No. 10-1209 (6th Cir. Aug. 18, 2011) [PDF]
Click to continue...CMS Proposes Medicaid Face-to-Face Requirements for Home Health and Medical Supplies and Equipment
By: Carel T. Hedlund
Home health agencies, still struggling to meet the Medicare face-to-face requirements that went into effect last spring, will also have to deal with similar requirements for their Medicaid patients. CMS issued a proposed rule [PDF] on July 12, 2011 that would provide that, in order for a physician to order home health services or medical supplies, equipment or appliances (called for convenience "medical equipment"), the physician or a permitted non-physician practitioner (NPP) must have a face-to-face encounter with the patient. The proposed rule also clarifies where and to whom Medicaid home health services can be provided and elaborates on the definition of medical equipment. The comment period ends on September 12, 2011.
Click to continue...CMS Proposes Rules Impacting Expansion of Qualifying Physician-Owned Hospitals and Patient Notice Requirements
The Centers for Medicare and Medicaid Services (CMS) recently published proposed regulations in the Medicare hospital outpatient prospective payment system (OPPS) that would provide certain rural providers and physician-owned hospitals with a process to apply for, and possibly obtain, an exception to the general prohibition against the expansion of physician-owned hospitals. These proposed rules would also update the patient notice requirement stated in 42 C.F.R. § 489.20.
Section 6001 of the Patient Protection and Affordable Care Act (PPACA) generally prohibits the expansion of a rural provider’s and physician-owned hospital’s number of operating rooms, procedure rooms and beds beyond what that hospital was licensed for as of March 23, 2010 or the date of its initial provider agreement (provided such agreement was in effect by December 31, 2010). However, § 6001(a)(3) of PPACA requires CMS to create a process by which such providers could apply for an exception to the expansion prohibition. The proposed rules issued by CMS, if finalized, would implement that section of PPACA.
Click to continue...CMS Delays Submission Deadline for Two Structural Measures Under Hospital Outpatient Quality Reporting Program to November 1, 2011
Recognizing that several hundred hospitals would not meet the August 15, 2011 deadline for reporting two structural measures under the Hospital Outpatient Quality Reporting (OQR) Program, CMS delayed the deadline for reporting on the following measures to November 1, 2011:
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