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The Medicare program's new method for calculating disproportionate share hospital (DSH) payments reduces DSH payments to all qualifying hospitals--possibly to a greater extent than Congress had intended in the Affordable [...]

Section 340B of the Public Health Service Act establishes a program under which certain hospitals may obtain significant discounts on drugs furnished to outpatients. The program was first adopted in [...]

In Medicare, nothing endures like change. On May 23, 2008, the Centers for Medicare and Medicaid Services (CMS) published a final rule adopting several substantial changes to the regulations governing [...]

For years, states and hospitals have relied in substantial part on residents who are training in approved hospital graduate medical education (GME) programs to provide for care of Medicaid recipients [...]

Patient day statistics are a very significant component of several Medicare payment calculations, including, for example, graduate medical education payments and disproportionate share hospital payments. Centers for Medicare and Medicaid [...]

Patient-day statistics are a significant component of several Medicare payment calculations, including graduate medical education payments and disproportionate share hospital payments. The Centers for Medicare and Medicaid Services' rules regarding [...]

Teaching hospitals are by now quite familiar with the basic rules governing Medicare's medical education payments for interns, residents, and fellows who are training in accredited residency programs. However, many [...]

"Curiouser and curiouser!" Alice in Wonderland may have forgotten how to "speak good English," but she aptly describes the Centers for Medicare and Medicaid Services' policies concerning medical education payments [...]

Nearly 30 years ago. Milton Friedman wrote There's No Such Thing as a Free Lunch. To which hospitals might respond, "Have you heard about health care, Milton?" Hospitals traditionally have [...]

AT A GLANCE Discount policies are likely to face increased scrutiny in light of congressional inquiries on Medicare outlier payment and recent media attention regarding pricing for the uninsured. If [...]

Hospitals may receive direct graduate medical education (GME) and indirect medical education (IME) payments under Medicare Part A for residents' training in a physician office, freestanding clinic, or other nonhospital [...]

In June of this year, a federal district court in Minnesota issued the first judicial opinion on yet another hotly contested dispute as to the calculation of the Medicare disproportionate [...]

Hospitals are expecting substantial changes in payment for outliers. CMS has been promising to overhaul the payment methodology for outliers since this past November, when a Wall Street analyst released [...]

In October, two federal appellate courts rendered conflicting decisions as to Medicare new-provider exemptions for skilled nursing facilities (SNFs) that acquire bed rights from other institutions. While these decisions are [...]

Though largely unnoticed, in August 2001, the Centers for Medicare and Medicaid Services (CMS) adopted a significant amendment to the Medicare regulation governing the indirect medical education (IME) payment under [...]

Sometimes it seems that nothing about the Medicare program is ever simple. This certainly seems to be the case with the disproportionate share hospital (DSH) payment. The calculation of the [...]

Two recent publications of the Centers for Medicare and Medicaid Services (CMS) seem to belie the view that providers can expect to see an easing of their regulatory burden under [...]

On April 19, 2001, a Federal district court ruled that HCFA may apply a 5.8 percent payment-reduction factor in determining Medicare Part B payments to hospitals for ancillary services furnished [...]

The Emergency Medical Treatment and Active Labor Act (EMTALA) of 1986 generally requires a hospital to screen and stabilize a patient who "comes to" the hospital emergency department and requests [...]

What is a provider? Thirty-five years after the Medicare statute was enacted, the answer to this seemingly simple question remains subject to interpretation. HCFA usually construes "provider" to mean the [...]

On July 21, 2000, the United States Court of Appeals for the District of Columbia Circuit ruled in District of Columbia Hospital Association v. District of Columbia ("DCHA") that the [...]

On May 1, the Provider Reimbursement Review Board (PRRB) issued new instructions for provider appeals under section 1878 of the Social Security Act regarding Medicare payment determinations by fiscal intermediaries. [...]

On February 29, the U.S. Supreme Court ruled in Shalala v. Illinois Council on Long Term Care that "virtually all" legal challenges under the Medicare statute must be channeled through [...]

The Court of Appeals for the District of Columbia Circuit recently upheld HCFAs refusal to make retroactive payment adjustments when outlier payments made to hospitals under Medicare's prospective payment system [...]

On September 28, 2001, the Centers for Medicare and Medicaid Services (CMS) issued a program memorandum (PM A-01-125) abruptly reversing the agency's policy of applying a payment-reduction factor to the [...]

On July 27, 2001, the D.C. Circuit ruled in Monmouth Medical Center v. Thompson that two disproportionate-share hospitals (DSHs) are entitled to additional DSH payments for Medicaid-eligible days that were [...]

In Eagle Healthcare v. Shalala, long-term care providers obtained a significant Federal court victory supporting their right to be paid for costs incurred to furnish occupational and speech therapy services [...]

The US Supreme Court has ruled that existing Medicare regulations does not permit Medicare providers to appeal to the Provider Reimbursement Review Board (PRRB) a request for reopening that has been denied earlier by a fiscal intermediary. The ruling, based on the fact that administrative reviews are prerequisites to judicial reviews, urges healthcare providers to immediately identify all underpayments made in an intermediary's notice of program reimbursement and appeal them to the PRRB within 180 days., If a healthcare provider finds it necessary to appeal a fiscal intermediary's payment determination to the Provider Reimbursement Review Board (PRRB), the Medicare statute grants the provider 180 days following [...]