Payment Matters

November 14, 2012

AHA and Hospitals Sue HHS Over Claims Denials Involving Patient Status

By: Leslie Demaree Goldsmith

In a suit recently filed [PDF] in the United States District Court for the District of Columbia, the American Hospital Association (AHA) and several hospitals, assert that the Medicare Program improperly denied payment to hospitals for reasonable and necessary services provided to hospital patients who Medicare contractors found were improperly admitted as hospital inpatients.The plaintiffs claim that these Medicare denials issued by Recovery Audit Contractors (RACs) are both procedurally and substantively flawed.

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Calendar Year 2013 Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Final Rule Released by CMS

By: Aaron Rabinowitz

On November 1, 2012, CMS issued the Calendar Year (CY) 2013 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) final rule, updating Medicare payment policies and rates for hospital outpatient and ASC services. In addition, the final rule changes how relative payment weights are calculated and makes several changes to the quality reporting program for outpatient departments. The final rule may be viewed here.

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CMS Releases Home Health Prospective Payment System Final Rule for CY 2013

By: Mark A. Stanley *

CMS has released its calendar year 2013 final rule [PDF] for payments to Home Health Agencies. The rule anticipates that payments to home health agencies will remain virtually unchanged next year, with a total reduction of about $10 million (0.01 percent) in payments. This reflects a 1.3 percent home health payment reduction, an update to the wage index, an updated fixed-dollar loss ratio, and an adjustment to case-mix coding. Among other changes, the rule:

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