​Inpatient Denials

A recent CMS ruling establishes billing policy regarding inpatient denials due to medical necessity. This interim rule was effective as of March 13, 2013. The CMS ruling was announced as an interim policy until the “Medicare Program: Part B Inpatient Billing in Hospitals” proposed rule (also issued on March 13) is finalized. Read the March 2013 RAC Newsletter »

HA Memo: Allina Health – Implications for DSH Payments; 340B Eligibility

On November 15 2012, the D.C. District Court issued a decision favorably impacting Disproportionate Share Hospital (DSH) patient percentage calculations. If this decision is upheld on appeal, Medicare Advantage days may be removed from the SSI/Medicare Fraction, thereby typically increasing hospitals' DSH payments. In addition to the direct benefit of increased DSH payments for acute care hospitals, improved DSH patient percentages increase the likelihood that a hospital will qualify for participation in the 340B drug discount program or be able to maintain their 340B program eligibility. However, the Allina decision is subject to further review due to an appeal filed by CMS to the D.C. Court of Appeals. Read the entire memo »​