Federal Court of Appeals rules against CMS in overpayments case: 5 insights for anesthesiologists

Earlier this year, Caring Hearts, a home health agency, appealed a CMS order requiring it to refund an $800,000 overpayment. However, the Federal Court of Appeals ruled against CMS and an Anesthesia Business Consultants blog discusses what anesthesiologists can learn from the case.

Here are five insights:

1. The Federal Court of Appeals ordered the to refund the overpayment on the grounds that some of the physical therapy or skilled nursing services the agency performed in 2008 were not provided for "homebound" patients and were not "reasonable and necessary."

2. The Court of Appeals for the Tenth Circuit, however, reversed the CMS order, saying "CMS had applied regulations that did not exist in 2008," according to the blog.

3. For example, in 2008, CMS only required the home health agency's services meet the "accepted standards of medical practice," which it did meet.

4. Today, providers must provide stringent documentation to prove medical necessity in the case of physical therapy services.

5. Thus, anesthesiologists looking to overturn CMS orders can look into whether the regulations they allegedly violated were in effect at the time the activity took place, which CMS is challenging.

More articles on anesthesia:
11 top-paying states for anesthesiologists — Iowa tops list
CRH Medical acquires 65% ownership of Community Anesthesia — 4 takeaways
2 anesthesiologists sound off on MACRA, the opioid epidemic

Copyright © 2024 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.

 

Featured Webinars

Featured Whitepapers

Featured Podcast