Mandatory Medicare bundled payments and respiratory disease reporting are on the way for hospitals
Hospitals in nearly a quarter of U.S. markets soon will be required to participate in a Medicare bundled payment model covering five surgical procedures, CMS said in newly released regulations. The model is among several policies of note in Medicare’s FY25 final rule for hospital inpatient care and long-term care hospitals. See this previous article…
Appeals court eliminates Medicare supplemental payments for low-wage hospitals (updated-2)
Note: This article was updated most recently Oct. 4 with news that CMS has ended the low-wage-index policy. See that update below. Plaintiff hospitals won litigation last week at the federal appellate level that will adversely affect Medicare payment for some rural hospitals. The U.S. Court of Appeals for the D.C. Circuit backed a district…
Supreme Court ruling on Chevron makes regulations in healthcare (and other industries) more vulnerable to legal challenges
The U.S. Supreme Court issued a decision Friday that has dramatic implications for the regulatory infrastructure in healthcare, among many other industries. Since it was established in a 1984 case, Chevron deference has served as guidance to courts that regulatory authorities such as CMS and dozens of others across the federal government have license to…
New rule on Medicaid DSH payments will impose stricter limits on many hospitals
Numerous hospitals that receive Medicaid disproportionate share hospital (DSH) payments face a tighter cap on their payment amounts after the Feb. 23 publication of a CMS final rule. The regulations were spawned by 2020 year-end legislation that made changes to the DSH hospital-specific limit (HSL), including with respect to how third-party payments factor into the…
Continued 340B eligibility is at risk for hundreds of hospitals thanks to pandemic-related factors
Hospitals that rely on savings from the 340B Drug Pricing Program should examine the possibility that they’ll soon be rendered ineligible. Several factors are having an industrywide impact on the disproportionate share hospital (DSH) adjustment percentage, and if that tally drops below a certain threshold on a hospital’s Medicare cost report, the hospital cannot receive…
HRSA curtails pandemic-era 340B flexibilities for hospitals’ off-campus outpatient facilities
In an expected move that stands to affect the savings reaped by health systems from the 340B Drug Pricing Program, the Health Resources and Services Administration (HRSA) is tightening participation requirements for off-campus outpatient facilities. In a published alert, HRSA announced plans to end pandemic-related flexibilities that have made it easier for off-campus outpatient facilities…
CMS issues RFI to gather best practices for identifying and supporting safety net hospitals
As part of the FY24 proposed rule for hospital inpatient payments, CMS is seeking healthcare stakeholder input on how to best support safety net hospitals in the Medicare program. The agency is considering ways to reimburse safety net hospitals via supplemental payments that may be better targeted than disproportionate share hospital (DSH) and uncompensated care…
Medicare’s proposed FY24 update to inpatient payments falls short, hospitals say
Hospitals are less than pleased with Medicare’s proposed FY24 payment update for inpatient care. In proposed regulations, the net inpatient payment update is 2.8% after factoring in a mandatory productivity adjustment of -0.2 percentage points. As usual, the update would be reduced for any hospital that does not fulfill quality-reporting requirements or qualify as a…
Medicare contractors should more closely examine providers’ bad debt claims, HHS watchdog says
Medicare administrative contractors (MACs) soon could apply more scrutiny to providers’ reported bad debts if CMS implements recommendations from the HHS Office of Inspector General (OIG). OIG in December issued a report in which it examined bad-debt reimbursement claims on Medicare cost reports spanning 2016 through 2018 for 67 randomly selected providers (including 29 hospitals). In those…
IPPS FY23 proposed rule: Medicare proposes changes to methodology for determining graduate medical education payments to teaching hospitals
The biggest change is an effort to comply with a court ruling on weighted FTE slots, while another change affects sharable slots for certain rural hospitals.