The regulatory-legal merry-go-round relating to Medicare reimbursement of certain services provided at grandfathered off-campus hospital provider-based departments continues.
As MHA has reported, a U.S. District Court ruled in September 2018 that CMS reimbursement cuts contained in the 2019 outpatient prospective payment system (OPPS) rule overrode congressional intent and had to be refunded to hospitals. Then, when the 2020 OPPS rule contained the same cuts, the judge refused to hospitals relief, saying they had not exhausted their administrative remedies; that is, they hadn’t first filed 2020 claims and had them rejected by CMS.
Last week, the American Hospital Association, other hospital groups, and some individual facilities that did, indeed, file 2020 claims and were underpaid, filed suit in the U. S. District Court for the District of Columbia.
“CMS may not contravene clear congressional mandates merely because the agency wishes to make cuts to Medicare spending,” the hospitals wrote, adding the move is especially egregious since the courts had already ruled the reimbursement cuts impermissible in the previous year’s OPPS rule.