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Payment Matters
May 3, 2012
CMS Releases Proposed FFY 2013 IPPS Rule
By: Mark A. Stanley
CMS has released its proposed federal fiscal year (FFY) 2013 prospective payment system (PPS) rule for inpatient stays in acute care and long-term care hospitals (LTCHs). The rule projects an increase in operating payments to acute care hospitals in the amount of $175 million dollars for FFY 2013 in comparison with FFY 2012 payments. The proposed rule can be viewed here [PDF].
Click to continue...Protect Wage Index Budget Neutrality Issue by Protesting Amount on FYE 12/31/11 Cost Report
The Department of Health and Human Services (HHS) recently agreed to settle a dispute with many hospitals involving the calculation of the Medicare wage index. The settlement involves the calculation of the rural floor budget neutrality component associated with the wage index. The settlement amounts for this issue have the potential to be quite large. Providers that have not yet filed their fiscal year ending (FYE) December 31, 2011 cost report have an opportunity to protect this issue for appeal. There may also be avenues available for other hospitals that have not previously appealed this issue.
Providers should ensure they have protected this issue, and thus their ability to seek settlement with HHS. There are two ways to protect the issue in appeals filed with the Provider Reimbursement Review Board. The first is to note the issue in an appeal filed within 180 days of the publication of the wage index in the Federal Register. In this case, for the fiscal year ending (FYE) December 31, 2011 cost report, the federal fiscal year (FFY) 2011 wage index that is applicable, was published in the August 16, 2010 Federal Register. Hospitals may have protected their rights to appeal this aspect of the wage index by appealing the issue within 180 days from the August 16, 2010 publication date.
Click to continue...CMS's Non-Hospital Training Rules Again Upheld
By: Thomas W. Coons
In the recently decided case University Med. Ctr., Inc. v. Sebelius, https://ecf.dcd.uscourts.gov/cgi-bin/show_public_doc?2011cv0260-22, the U.S. District Court for the District of Columbia upheld CMS policies regarding non-hospital training agreements as those policies were applied in 1999. As all teaching programs are aware, hospitals have been permitted since 1997 to include, in both their indirect medical education (IME) and direct medical education (DGME) payment calculations, time spent by residents training in non-hospital sites. As a condition to hospitals' receiving those payments, however, CMS regulations have required that there be a written agreement between the hospital and non-hospital site and that the agreement specify that the hospital was incurring all or substantially all of the costs of the non-hospital site training. CMS then interpreted this policy as requiring that the written agreement be in place prior to the training actually taking place. Plaintiff University Medical Center challenged these requirements as applied to training that took place in 1999. The court, however, rejected the challenge.
Click to continue...Contracting Opportunities Begin for Dual Eligible Integrated Care
By: Sarah E. Swank
Nine million Americans are eligible for both Medicare and Medicaid. Called "dual eligibles," these individuals account for a disproportionate amount of the spending across both programs. Fifteen states will soon launch programs with funding from the State Demonstrations to Integrate Care for Medicare-Medicaid Enrollees. Under this program, the Medicare/Medicaid Coordination Office and the CMS Innovation Center selected states based on their proposals to improve care delivered to dual eligibles, and a medium or high level of readiness to roll out these programs quickly. These states will receive federal funding to design and implement patient-centered models coordinating care among primary, acute, behavioral and long term care settings and services. States are beginning to reach out to providers to participate in state-specific programs.
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