The U.S. Supreme Court issued a unanimous opinion yesterday that reversed and remanded a circuit court ruling that hospitals could appeal decisions by the Provider Reimbursement Review Board that are up to 25 years old.
A group of 18 hospitals challenged their Medicare disproportionate share adjustments for 1987 through 1994 after the PRRB identified flaws in CMS' methodology in 2006. Those errors resulted in a systematic miscalculation of the DSH adjustment, which resulted in underpayments to the hospitals for low-income patients.
In 2006, shortly after calculation mistakes were exposed, the hospitals sued for proper reimbursements. A district court sided with the government, ruling that the claims were too old, but the U.S. Court of Appeals for the District of Columbia reversed that decision in 2011. The government then appealed to the Supreme Court, which heard oral arguments in December.
Yesterday, the high court ruled the hospitals missed their opportunity to appeal the reimbursement. There is a requirement that appeals be filed within 180 days, or up to three years if the provider shows "good cause" for an appeal. To relax that deadline for the 18 hospitals would "essentially gut" this requirement, according to an opinion written by Justice Ruth Bader Ginsburg.
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A group of 18 hospitals challenged their Medicare disproportionate share adjustments for 1987 through 1994 after the PRRB identified flaws in CMS' methodology in 2006. Those errors resulted in a systematic miscalculation of the DSH adjustment, which resulted in underpayments to the hospitals for low-income patients.
In 2006, shortly after calculation mistakes were exposed, the hospitals sued for proper reimbursements. A district court sided with the government, ruling that the claims were too old, but the U.S. Court of Appeals for the District of Columbia reversed that decision in 2011. The government then appealed to the Supreme Court, which heard oral arguments in December.
Yesterday, the high court ruled the hospitals missed their opportunity to appeal the reimbursement. There is a requirement that appeals be filed within 180 days, or up to three years if the provider shows "good cause" for an appeal. To relax that deadline for the 18 hospitals would "essentially gut" this requirement, according to an opinion written by Justice Ruth Bader Ginsburg.
More Articles on Hospitals and Disproportionate Share Adjustments:
District Court Orders HHS to Recalculate Medicare DSH Payments7 Statistics on Disproportionate Share Hospital Payment Cuts
5 Current Pressures That Scare Independent Hospital CFOs the Most