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Medicare Administrative Contractors

Court Takes Broad View of Medicare DSH Eligibility for § 1115 Waiver Program Days


Posted on August 9, 2019 in Health Law News

Published by: Hall Render

Recently, the D.C. District Court ruled that HHS must include certain waiver programs in its Medicare disproportionate share calculations. This is a significant ruling because many states have experimented with different ways to provide health care to low-income populations. As a result, hospitals serving these populations may be entitled to increased payments.[1] Background Under... READ MORE

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CMS Proposes Payment Policy Changes Impacting Hospital Outpatient Department Services – What You Need to Know


Posted on August 2, 2019 in Health Law News

Published by: Hall Render

On July 29, 2019, the Centers for Medicare & Medicaid Services (“CMS”) released its proposed rule for Calendar Year (“CY”) 2020 Hospital Outpatient Prospective Payment System (“Proposed Rule”). Among many other changes, CMS proposed three key payment policy updates impacting hospital outpatient departments, including: (1) lowering the supervision standard for hospital outpatient therapeutic services... READ MORE

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Location Matters: Get It Right or Don’t Get Paid


Posted on March 6, 2019 in Health Law News

Published by: Hall Render

Location, location, location – this will be the focus of a Medicare hospital claims processing requirement. Starting in April 2019, CMS will activate billing edits that will Return to Provider (“RTP”) any hospital UB-04 claims that identify a service location that is not an exact match to a Medicare enrolled location identified in Provider... READ MORE

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