137 hos­pi­tals sue HHS over HSP rate ad­just­ment

Modern Healthcare - - Late News -

A group of 137 hos­pi­tals, mainly ones in ru­ral ar­eas, sued HHS to re­coup about $86.6 mil­lion in Medi­care pay­ments and change fu­ture small-hos­pi­tal re­im­burse­ment for­mu­las. Medi­care pays many small and ru­ral hos­pi­tals un­der a spe­cial re­im­burse­ment pol­icy called the hos­pi­tal-spe­cific pay­ment rate, which pro­vides higher rates than stan­dard com­mu­nity hos­pi­tals re­ceive. The HSP ap­plies to sole com­mu­nity hos­pi­tals and Medi­care-de­pen­dent small ru­ral hos­pi­tals. In 2010, the HSP was ad­justed down­ward as part of a larger ef­fort to slow ap­par­ent growth in med­i­cal spend­ing caused by changes in billing codes—the CMS’ “doc­u­men­ta­tion and cod­ing ad­just­ment” process. Ankur Goel, an at­tor­ney with the hos­pi­tals’ law firm, Mc­Der­mott Will & Emery in Washington, said the CMS in the past de­cided that it was legally not al­lowed to ap­ply such cod­ing ad­just­ments to the ru­ral hos­pi­tals’ HSP rate. Yet in 2010, the agency changed its mind and ap­plied the change, he said. “We don’t think CMS has the au­thor­ity to ad­just the rates in the way that they did un­der the Medi­care statute,” Goel said. CMS of­fi­cials de­clined to com­ment on the law­suit, which was filed in U.S. District Court in Washington. be re­placed in the in­terim by Doug How­ell, a con­sul­tant to the sys­tem, ac­cord­ing to a state­ment by Jewish Hos­pi­tal & St. Mary’s that was read by a spokes­woman. Jewish Hos­pi­tal & St. Mary’s Health­Care, af­fil­i­ated with Catholic Health Ini­tia­tives, En­gle­wood, Colo., is in the mid­dle of a pro­posed $620 mil­lion three-way merger with the Univer­sity of Louisville (Ky.) Hos­pi­tal and St. Joseph Health Sys­tem Lex­ing­ton, Ky., an­other CHI-af­fil­i­ated or­ga­ni­za­tion. Bon­ick was a

Modern Health­care Up & Comer in 2008, the year he joined Jewish Hos­pi­tal. “We ap­pre­ci­ate his ten­ure with the or­ga­ni­za­tion and the con­tri­bu­tions he has made dur­ing that time,” the sys­tem said in the state­ment.

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