Alek Pivec

Alek Pivec

King & Spalding

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CMS Publishes Final Rule for CY 2020 Hospital Outpatient Prospective Payment System

n November 1, 2019, CMS posted the final rule establishing the payment rates for the Hospital Outpatient Prospective Payment System (OPPS) and the Ambulatory Surgery Center (ASC) Payment System for calendar year (CY) 2020...more

11/15/2019  /  Ambulatory Surgery Centers , Appeals , Centers for Medicare & Medicaid Services (CMS) , Final Rules , Food and Drug Administration (FDA) , Health Care Providers , Hospitals , Inpatient Prospective Payment System (IPPS) , Lack of Authority , Medical Devices , Medicare , Off-Campus Departments , Outpatient Prospective Payment System (OPPS) , Payment Rates , Prescription Drugs , Price Transparency , Prior Authorization , Provider Payments , Rural Health Care Providers , Section 340B

CMS Issues FY 2020 Inpatient PPS and Long-Term Care Hospital PPS Final Rule

On August 2, 2019, CMS issued its annual Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System Final Rule for FY 2020 (the Final Rule). Highlights include...more

8/9/2019  /  Affordable Care Act , CEHRT , Centers for Medicare & Medicaid Services (CMS) , Final Rules , Inpatient Prospective Payment System (IPPS) , Inpatient Quality Reporting , Long Term Care Facilities , Medicare , Payment Systems , Psychiatric Hospitals , Wage Index

Florida Hospitals Prevail in Litigation Challenging the Exclusion of Low Income Pool Days from the Medicare Disproportionate Share...

On July 23, 2019, Judge Rosemary Collyer of the United States District Court for the District of Columbia issued an opinion ruling in favor of ten Florida hospitals in their case challenging the calculation of their Medicare...more

7/31/2019  /  Centers for Medicare & Medicaid Services (CMS) , Disproportionate Share Adjustments , Hospitals , Inpatient Billing , Medicaid , Medicare

Fifth Circuit Orders CMS to Count Mississippi Hospitals’ UCCP Days in the Medicaid Fraction of the Medicare DSH Payment Formula

In a ruling dated June 10, 2019, the United States Court of Appeals for the Fifth Circuit sided with Mississippi hospitals in a dispute over the calculation of the Medicare DSH payment. Forrest General Hospital v. Azar, No....more

7/8/2019  /  Appeals , Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Hospitals , Medicaid , Medicare , Social Security Act

CMS Releases FY 2020 Medicare IPPS and LTCH PPS Proposed Rule and Proposes Key Changes to Several Regulatory Requirements

On April 23, 2019, CMS issued its annual Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System Proposed Rule for FY 2020 (the Proposed Rule), which will affect...more

4/30/2019  /  Centers for Medicare & Medicaid Services (CMS) , Comment Period , Graduate Medical Education , Health Care Providers , Healthcare , Hospitals , Inpatient Prospective Payment System (IPPS) , Long Term Care Facilities , Medicare , Proposed Rules , Quality Payment Program (QPP) , Regulatory Requirements

CMS to Begin Enforcing “Longstanding” Accounting Classification Rule for Crossover Bad Debts

Last week, CMS announced on its website that for cost reporting periods beginning on or after October 1, 2019, providers must comply with a so-called “longstanding” rule to claim reimbursement for crossover bad debts from the...more

4/10/2019  /  Accounting , Bad Debt , Centers for Medicare & Medicaid Services (CMS) , GAAP , Health Care Providers , MACs , Medicare , Reimbursements

Eighth Circuit Upholds CMS’s Methodology for Calculating the Volume Decrease Adjustment for Cost Reporting Periods Preceding...

Last week, the United States Court of Appeals for the Eighth Circuit issued a consolidated opinion for three cases in which it upheld the methodology that CMS used to calculate the volume decrease adjustment (VDA) for...more

3/21/2019  /  Appeals , Centers for Medicare & Medicaid Services (CMS) , Hospitals , Inpatient Prospective Payment System (IPPS) , Medicare , Reimbursements

CMS Begins Audits of Worksheet S-10 for FY 2015 Cost Reports

In the Inpatient Prospective Payment System (IPPS) rulemaking for fiscal year (FY) 2019, the Centers for Medicare and Medicare Services (CMS) announced that it would begin auditing the charity care and bad debt costs...more

10/10/2018  /  Audits , Centers for Medicare & Medicaid Services (CMS) , Inpatient Prospective Payment System (IPPS) , MACs , Medicaid , Medicare

D.C. Circuit Clears the Way for Hospitals to Challenge Base-Year Factual Determinations

The United States Court of Appeals for the District of Columbia Circuit recently held in Saint Francis Medical Center v. Azar that Medicare’s reopening regulation, which prohibits providers from seeking to revise payment...more

7/30/2018  /  Appeals , Centers for Medicare & Medicaid Services (CMS) , Hospitals , Medicare

CMS Issues New Instructions for Completing Worksheet S-10 and Extends Deadline for Providers to Submit Updated Data for FYs 2014...

For the second time in less than one year, CMS has updated its instructions for completing Worksheet S-10 of the Medicare cost report for hospitals. The new instructions expand the definition of charity care, as reported in...more

10/3/2017  /  Affordable Care Act , Centers for Medicare & Medicaid Services (CMS) , Charitable Deductions , Deadlines , Hospitals , Medicare
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