Monitor Mondays

Is Disallowing an Appeals Process for a Decrease in Medicare Payments Unconstitutional?

April 15, 2019
Monitor Mondays
Is Disallowing an Appeals Process for a Decrease in Medicare Payments Unconstitutional?
Chapters
Monitor Mondays
Is Disallowing an Appeals Process for a Decrease in Medicare Payments Unconstitutional?
Apr 15, 2019
Chuck Buck | Ronald Hirsch, MD | Kathy Seward, MD | David Glaser, Esq. | Mary A. Inman, Esq. | Angela Phillips, PT | Knicole Emanuel, Esq.
800 hospitals will be penalized this year for yielding poor results in the Hospital-Acquired Condition (HAC) Reduction Program, including 110 hospitals that are being penalized for the fifth year in a row.
Show Notes

The Centers for Medicare & Medicaid Services (CMS) recently announced that 800 hospitals will be penalized this year for yielding poor results in the Hospital-Acquired Condition (HAC) Reduction Program, including 110 hospitals that are being penalized for the fifth year in a row (the HAC Reduction Program has only been in existence for five years).  

The Code of Federal Regulations does not allow a hospital to appeal the determination of poor results in this program, whereas if you are penalized by a Recovery Audit Contractor (RAC) or a Zone Program Integrity Contractor (ZPIC), you do have the right to appeal. With courts now finding that Medicare reimbursements are a property right, is 42 CFR 412.172 unconstitutional because it disallows an appeals process for a decrease in Medicare payments? 

Reporting this latest development during this edition of Monitor Mondays is healthcare attorney Knicole Emanuel, partner in the Potomac Law Group.

Other segments to appear on the broadcast include:

  • Monday Focus: The American Hospital Association (AHA) and the National Quality Forum have released a guide to help hospitals and health systems deliver tele-behavioral health services to improve patient outcomes and enhance access to behavioral healthcare. An estimated 44 million Americans have a behavioral health disorder. Reporting this developing story is Kathy Seward, MD, chief medical officer for qlēr Solutions Inc., a telemedicine company providing psychiatric care to patients throughout the United States in partnership with hospitals and health systems. 

  • Big Pharma Lawsuits: Three pharmaceutical companies – Jazz Pharmaceuticals plc, Lundbeck LLC, and Alexion Pharmaceuticals, Inc. – have agreed to pay a total of $122.6 million to resolve allegations that they violated the False Claims Act by paying kickbacks to Medicare and Civilian Health and Medical Program (ChampVA) patients through purportedly independent charitable foundations. Famed whistleblower attorney Mary Inman, partner in the London office of Constantine Cannon, has the latest news on this major story. 

  • The IRF Countdown Continues: The Inpatient Rehabilitation Facility (IRF) countdown to Oct. 1, 2019 will end with the change to use quality indicators for case-mix group (CMG) for payment calculation. Reporting this story is one of the nation’s foremost IRF authorities, Angela Phillips, president of Images & Associates and longtime RACmonitor editorial board member and Monitor Mondays panelist. 

  • Risky Business: Healthcare attorney David Glaser returns to Monitor Mondays with his popular segment, in which he reports on problematic issues facing providers. 

  • Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, makes his Monday Rounds with another installment of his popular segment. 


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