Payment Matters

June 11, 2008

CMS Adopts Final Rule Addressing Part A Appeals Before Intermediaries and the PRRB

By: Leslie Demaree Goldsmith and Mark A. Stanley

The Centers for Medicare and Medicaid Services (CMS) published its final rule revising procedures for Medicare Part A appeals before intermediaries and the Provider Reimbursement Review Board (PRRB) in the Federal Register on May 23, 2008. 73 Fed. Reg. 30,190 (http://edocket.access.gpo.gov/2008/pdf/E8-11227.pdf). With limited exceptions, the new regulations will apply to all appeals pending as of, or filed on or after, August 21, 2008. The proposed rule was first published on June 25, 2004. 69 Fed. Reg. 35,716.

CMS Adds IDTFs to Payment Manual

By: Robert E. Mazer

Over the past few years, independent diagnostic testing facilities (IDTFs) have received increased attention from CMS. The likely root causes of this attention are their tremendous growth in number, and the agency's perception that standards are necessary to ensure quality care and to avoid payments for services that are not properly documented or are not medically necessary.

D.C. District Court Rules Moratorium Laws Prohibit CMS from Changing its Bad Debt Policy to Disallow Bad Debts Claimed While Still at a Collection Agency

By: Leslie Demaree Goldsmith

...that the Intermediary had improperly disallowed the Provider's fiscal year 1995 Medicare bad debts that were still at a collection agency when claimed. Foothill Hospital - Morris L. Johnston Memorial v. Leavitt, D.D.C., No.1:07-cv-00701-ESH, 5/30/08, No. 07-701, 2008 U.S. Dist. LEXIS 41816 (May 30, 2008).

Beware of Overpayments in a CHOW Situation

By: Thomas W. Coons

By now, most providers are aware of the government's position regarding successor liability: when one assumes a Medicare provider agreement, one takes on whatever liability is associated with that agreement. That has been the government's position since at least the early 1990s and is reflected in the well-known decision United States v. Vernon Home Health, Inc., 21 F.3d 693 (5th Cir.), cert. denied, 513 U.S. 1015 (1994). Thus, purchasers of facilities need to research extensively the facility's potential Medicare liabilities before assuming its provider agreement and should consider placing sums in escrow to provide protection against future, but as yet unasserted, overpayment demands. A recent federal district court decision underscores the importance of these actions.

CMS Note to Providers on FY 2006 DSH/SSI Ratios

By: Leslie Demaree Goldsmith

The Centers for Medicare and Medicaid Services (CMS) recently posted the following note on its website related to use of the supplementary security income (SSI) ratios used for disproportionate share hospital (DSH) calculation purposes: