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Category: CMS Admin

Medicare DSH – Norwalk Hospital

From: CMS Administrator Decision – Not Yet Posted (6/8/12)

Glenn Bunting, Vice President of our Appeals, team learned earlier today from a PRRB representative that the Norwalk Hospital (PRRB Decision 2012-D14) has been overruled by the CMS Administrator. The CMS Administrator’s decision has not yet been published.

In this case the FI challenged the PRRB’s jurisdiction over Medicaid eligible days where there was no adjustment made by the FI in the finalization of the Medicare cost report.  The Board concluded in this case that they (i.e. The PRRB) have jurisdiction over the DSH – Medicaid Eligible Days issue.

We will post the decision for viewing in a later News You Need to Know reporting.

Medicare DSH – Norwalk Hospital

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Medicare Bad Debt Decisions – 1987 Moratorium

George Washington University Hospital – FYE 12/31/99

CMS Admin Decision PRRB 2011-D31

Universal Health Svcs, Inc. – FY 2004 & 2005

CMS Admin Decision: PRRB 2011-D30

Both of the above PRRB decisions were overturned by the CMS Administrator. The common issue involved Medicare bad Debt claims that were denied by the FI because the accounts continued to reside at collection agencies. The issue involved the Bad Debt Moratorium that prevents CMS and te FIs from changing bad debt policy in effect prior to 1987.

The PRRB ruled in favor of the Providers stating:

“The Intermediary improperly disallowed the Provider’s claimed bad debts solely on the ground that accounts related to such bad debts still remained at an outside collection agency.”

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Medicare DSH – Sampling; Medicare + Choice Days – Exempla Lutheran Med Ctr – FYE 12/31/04

Medicare DSH – Sampling; Medicare + Choice Days – Exempla Lutheran Med Ctr – FYE 12/31/04

CMS Admin Decision: PRRB 2011-D32

The CMS Administrator overturned the 6/3/2011 PRRB (2011-D32) decision allowing

Medicare + Choice days in the Medicaid fraction prior to October 1, 2004 discharges. The case also involved a dispute with the sampling methodology used by the Intermediary that was overturned by the PRRB. The CMS Administrator overturned both PRRB decisions.

As discussed above, we are very hopeful of a resolution for this issue based on the recent Appellate Court decision reported to you in the week of September 12th, 2011.

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