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CON Not Required for Medical Office Building, Rules N.H. Supreme Court |
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Written by Stephanie Wasek
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Thursday, 13 November 2008 |
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The Supreme Court of New Hampshire has ruled that Elliot Health System is not required to obtain certificate of need review for its Elliot Medical Center at Londonderry medical office building project. However, in a concurring opinion for case No. 2007-800, one of the court's justices calls for an examination of the CON law to potentially close the loophole that Elliot used to avoid CON review.
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CMS Revises Policies for Drugs, Pharmaceuticals and Radiopharmalogicals |
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Written by Stephanie Wasek
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Friday, 31 October 2008 |
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The Outpatient Prospective Payment System (OPPS) final rule updates payment policies and rates for drugs, biologicals, and radiopharmaceuticals furnished in HOPDs. |
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Changes to APCs, Emergency Visits, Partial Hospitalization Under the 2009 OPPS Final Rule |
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Written by Stephanie Wasek
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Friday, 31 October 2008 |
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In addition to a payment update and four new quality measures, CMS is changing how it pays for imaging services when two or more imaging procedures from an imaging family are provided in one session to encourage greater imaging efficiency. The Outpatient Prospective Payment System (OPPS) final rule also makes a change to partial hospitalization services and creates APCs for certain ER visits. |
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HOPDs Get 3.9 Percent Medicare Increase New Quality Measures |
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Written by Stephanie Wasek
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Friday, 31 October 2008 |
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CMS's final Outpatient Prospective Payment System/Ambulatory Surgical Center Payment System (OPPS/ASC) rule also includes a projected 3.9 percent annual inflation update for HOPDs; and adopts changes to payment policies for HOPDs and ASCs beginning Jan. 1. The agency also announced plans to strengthen the tie between the quality of care furnished to people with Medicare in HOPDs and the payments hospitals receive for those services. |
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GAO Examines Nonprofits' "Community Benefit Activities," Calls for More Standardization |
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Written by Stephanie Wasek
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Wednesday, 29 October 2008 |
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The debate over healthcare costs, accountability and what to do about the uninsured continues to center on nonprofits: The GAO has released a report that indicates that the lack of a consistent standard for what constitutes "community benefit" may prevent policymakers from holding them "accountable for providing benefits commensurate with their tax-exempt status." The report, Nonprofit Hospitals: Variation in Standards and Guidance Limits Comparison of How Hospitals Meet Community Benefit Requirements, examines the standards and guidance used by nonprofit hospitals to define charity care, how hospitals in four states measure that care and the effects of charity care on the institutions. |
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3 Biggest Issues Facing Physician-Owned Hospitals |
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Written by Molly Sandvig
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Tuesday, 21 October 2008 |
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These are the three biggest issues currently facing physician hospitals.
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Michael Reese Hospital Files for Bankruptcy Protection |
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Written by Staff
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Monday, 29 September 2008 |
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Michael Reese Hospital in Chicago has filed for bankruptcy protection.
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Reminder: Hospital Physician-Ownership Disclosure Begins Oct. 1 |
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Written by Scott Becker, JD, CPA
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Monday, 29 September 2008 |
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The new rule requiring disclosure of physician-ownership in hospitals becomes effective Oct. 1. |
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CMS Approves Det Norske Veritas Healthcare as National Hospital Accrediting Program |
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Written by Staff
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Monday, 29 September 2008 |
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CMS has issued a notice in the Federal Register approving Det Norske Veritas (DNV) Healthcare as a national accrediting program for hospitals seeking to participate in Medicare and Medicaid, according to Dan Soldato of McGuireWoods.
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Hospital to Pay $89 Million to Settle Medicare, Medicaid Fraud Allegations |
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Written by Stephanie Wasek
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Friday, 19 September 2008 |
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Staten Island University Hospital (SIUH) has agreed to pay the federal government $74 million to settle claims that the hospital defrauded Medicare, Medicaid and the military's health insurance program, TRICARE, the U.S. Justice Department and the Eastern District of New York have announced. The hospital will also pay New York nearly $15 million representing damages sustained by the state's Medicaid program. |
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Provena to Take Challenge Over Loss of Property-Tax Exemption to Supreme Court |
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Written by Rob Kurtz
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Thursday, 11 September 2008 |
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Provena Covenant Medical Center, a Catholic hospital in Urbana, Ill., has announced that it will seek the Illinois Supreme Court’s review of a ruling by the Illinois 4th District Appellate Court, which stripped the organization of its property-tax exemption when it reversed an earlier Circuit Court order to restore the religious and charitable property tax exemption of the hospital. |
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Hospital Loses Property-Tax Exemption; Court Has Strong Words About "Charity" |
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Written by Stephanie Wasek
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Wednesday, 03 September 2008 |
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Provena Covenant Medical Center, a Catholic hospital in Urbana, Ill., has lost its property tax exemption after the Illinois 4th District Appellate Court agreed with the state Department of Revenue that Covenant's commitment to charitable care was insufficient. More worryingly, the court decried what it believes is hospitals' misuse of the term charity to "sanctify any socially beneficial use of property that a court deems worthy of subsidy." |
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HHS Proposes Replacing ICD-9 Code Sets for Diagnoses and Procedures |
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Written by Stephanie Wasek
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Monday, 18 August 2008 |
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The Department of Health and Human Services (HHS) has announced a long-awaited proposed regulation that would replace the ICD-9-CM code sets now used to report health care diagnoses and procedures with greatly expanded ICD-10 code sets, effective Oct. 1, 2011. In a separate proposed regulation, HHS has also proposed updating electronic transfer standards, essential to the use of the proposed ICD-10 codes. |
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Peer Review Alone Not Enough for Hospital to Dismiss Physician, Court Rules |
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Written by Stephanie Wasek
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Wednesday, 06 August 2008 |
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The results of peer review proceedings at the another hospital may not be enough to base a dismissal decision upon, according to an opinion issued by the Court of Appeals of California, Fifth District. |
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Increased Interest in EHR Donations Under the Stark Act: 9 Issues to Consider |
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Written by Scott Becker, JD, CPA, and Ron Lundeen, JDHR
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Tuesday, 29 July 2008 |
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CMS created a Stark Act exception in 2006 to let hospitals and other entities provide physicians with software and other assistance relating to implementation of electronic health records systems. Over the past few years, the utilization of this exception has increased significantly. Further, parties have examined which types of donations would not qualify as remuneration or compensation under the Stark Act and thus need not fit within this exception. This article briefly discusses nine key points relating to this EHR exception. |
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$700 Million in Improper Medicare Payments Saved by CMS Recovery Audit Contractor Program |
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Written by Stephanie Wasek
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Wednesday, 16 July 2008 |
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CMS has released a report offering fresh evidence that the recovery audit contractors (RACs) pilot program is successfully identifying improper payments ? $693.6 million has been returned to the Medicare Trust funds between 2005 and March 2008, officials say. |
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Top 5 Hospital and Top 4 Physician Services With Overpayments |
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Written by Stephanie Wasek
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Wednesday, 16 July 2008 |
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According to CMS's recovery audit contractor (RAC) evaluation report, here are the top five hospital services with overpayments from 2005 through March 27.
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Service-Specific Example of an Overpayment Identified by Recovery Audit Contractors |
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Written by Stephanie Wasek
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Wednesday, 16 July 2008 |
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This is a review of claim facts and corrective actions taken for excisional debridements (complex review, incorrect coding), one of the top five overpaid services in inpatient hospitals, as explained in CMS's recovery audit contractor evaluation report. |
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CMS Proposes Stark Exception for Gain-Sharing and Other Payments to Physicians |
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Written by Stephanie Wasek
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Wednesday, 16 July 2008 |
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Citing "concerns about physicians responding to incentive payment and shared savings programs by stinting, cherry picking, steering and making quicker-sicker discharges," CMS has proposed a self-referral exception for such incentive and gain-sharing programs aimed at preventing these potential issues while encouraging rewards for high-quality and cost-effective delivery of healthcare services.
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Joint Commission Suspends Medical Staff Standard Implementation Date |
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Written by Stephanie Wasek
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Monday, 16 June 2008 |
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The Joint Commission's board of commissioners approved the continued engagement of its implementation task force on the revision of medical staff standard MS.1.20. The Board also suspended the planned July 2009 implementation date for the current revised standard. |
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News & Analysis 
