Last week, CMS published a proposed rule on the treatment of Medicare Advantage (MA) Part C days for discharges prior to October 1, 2013, related to the Medicare DSH calculation.
Category: Mcare Court
Last week, providers won a major victory at the Ninth Circuit Court of Appeals relating to the government’s inclusion of non-covered Medicare Part A days (such as exhausted benefit days and Medicare Secondary Payer days) in the SSI Ratio of the Medicare DSH payment calculation. The Court held in favor of providers that the 2005 Rule promulgated by the Secretary of Health and Human Services be vacated on the grounds that the rule is “substantively invalid.” (Empire Health Foundation v. Azar, Case 18-35845).
Please contact Karen S. Kim at (888) 514-9312 or firstname.lastname@example.org if you have any questions or concerns.
We have been asked by several of our clients whether the 2-Midnight rule is dead now that CMS has made adjustments to the current PPS base rate increases to reverse the effects of the past implementation of the 2-Midnight rule. After review of the issue and follow-up with our legal counsel, we are continuing to pursue the issue as we believe that there are additional reimbursements to be recovered not reflected in CMS’ changes in the FY2017 final rules.
Our plan for clients in our groups is to continue pursuing this issue. We will keep you appraised as this issue progresses.
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