Recent decisions impacting the Medicare DSH Calculation

The Decision in the “Allina” case (Medicare Part C Days Issue) The Allina case challenged the validity of the Secretary’s 2004 final rule in which it was stated Part C days should be included in the Medicare fraction.  The validity of that rule was challenged because the Secretary did not follow proper protocol.  In 2012, […]

Outpatient Evaluation & Management Services Billed at the New Patient Rate

The US Department of Health and Human Services (HHS) Office of Inspector General (OIG) issued the fiscal year (FY) 2014 Work Plan on January 31, 2014. The OIG organization has a number of offices that review topics in the Work Plan. The Office of Audit Services (OAS) has listed a new topic in 2014 Work […]

PRRB Posts Jurisdictional Decisions on Website

The process of submitting an appeal to the Provider Reimbursement Review Board (“Board” or “PRRB”) begins with filing the Medicare Cost Report.  Effective with cost report periods ending on or after December 31, 2008, in order for the PRRB to have jurisdiction over a disputed issue, Medicare regulations require that a provider either include a […]

Review Your Medicare Part A Rejection Reason Code Trends to Improve Recoveries and Reduce Rework

In February, Novitas Solutions Medicare published the top ten Medicare rejection reasons for Jurisdiction L (District of Columbia, Delaware, Maryland, New Jersey, Pennsylvania) and Jurisdiction H (Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma, Texas). Most of the rejection reasons are “billing” related, and with some internal process improvement within the Patient Financial Services area, can […]

The More Things Change, the More They Stay the Same: SGR and ICD-10

With only hours to spare, Congress approved yet another “Doc Fix” bill: Protecting Access to Medicare Act of 2014, which was signed into law by President Obama on April 1.  This law postpones permanent changes to the standard growth rate (“SGR”) for one more year.  In a controversial twist, the law also delays the implementation […]