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CCH® Reimbursement Integrated Library
The Reimbursement Integrated Library delivers the key performance indicators for maximizing reimbursement. The Library includes three invaluable titles:

• Dennis Barry's Reimbursement Advisor - This monthly newsletter provides all the facts about reimbursement strategies to minimize the adverse effects of DRGs, RBRVs, APCs and capitation to optimize hospital reimbursement.
• Receivables Report - This monthly newsletter includes actual profit-improvement examples from facilities nationwide, secrets for successfully challenging denials, tips for using automation to increase cash flow, and strategies your colleagues are using now to prepare for health care reform.
• Hospital Accounts Receivable Analysis - This quarterly journal is a synopsis of statistical data related to hospital receivables.

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June 2008, Volume 23, No. 10

Among the articles featured in the June 2008 issue is one that examines a federal district court’s ruling in favor of a hospital that challenged the Centers for Medicare and Medicaid Services’ (CMS) calculation of the supplement security income (SSI) fraction used to determine Medicare disproportionate share hospital payments. This issue also features articles on recent decisions regarding the “good cause” requirement for claims reopenings, successor liability when purchasing a provider, and the potential financial risk related to the “foundation model” for graduate medical education (GME) programs.

• Court rules in hospital’s favor in DSH SSI case: Ruling requires CMS to correct its own payment errors. Earlier this year, the U.S. District Court for the District of Columbia ruled in favor of a hospital that challenged CMS’ calculation f the SSI fraction used to determine Medicare DSH payments for fiscal years 1993 through 1996. This decision is significant, as the decision in the Baystate Medical Center v. Leavitt case requires that CMS to correct its own payment errors. In this article, the author takes a closer look at the Baystate decision and its implications for hospitals.

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Fourth Quarter 2007, Volume 22, Number 1

• Uncollectibles. In the fourth quarter 2007, write-offs fell to 4.59 percent, a 0.20 percentage point improvement from the prior quarter. With improved uncollectibles performance in the fourth quarter, hospitals responding to the HARA Report secured better than benchmark level performance for this major financial indicator in three of the four quarterly financial reporting periods of 2007. The uncollectibles benchmark is to hold the percent of gross revenue written off as charity or bad debt to 5 percent or less of total gross revenue. For more on bad debt and charity, please see the HARA Report on Fourth Quarter 2007.

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A Medicare provider's bad debts that were sent to an outside collection agency were “uncollectible,” and should have been reimbursed by Medicare. The Medicare provider sought reimbursement for unpaid Medicare deductibles and coinsurance in its fiscal year ending Sept. 30, 2005. The bills had been outstanding for more than 300 days and written off as uncollectible but at the same time sent to a collection agency. The Medicare accounts had been treated the same as non-Medicare accounts. Because the Administrator erred when it ruled that bad debts held by a collection agency were per se ineligible for reimbursement, its decision was vacated and remanded for further action consistent with the correct legal standards. Foothill Hospital v. Leavitt, D. D.C., May 30, 2008, ¶302,432.

Walgreen Co., a national chain of retail pharmacies, has agreed to pay $35 million to settle claims of Medicaid fraud. From 2001 to 2005, Walgreen allegedly dispensed more expensive versions of Ranitidine, Fluoxetine and Eldepryl than were prescribed. All three are generic drugs that were available in more than one form. Walgreen replaced 10 and 20 milligram doses of Fluoxetine, prescribed in capsule form, with more expensive tablets. Ranitidine and Eldepryl tablets were replaced with capsules paid at a higher rate. The federal government will receive $18.6 million of the settlement; 46 states and Puerto Rico will share about $16.4 million; and the whistle-blower will receive $5 million. Walgreen did not admit any wrongdoing. Walgreen also entered into a five-year corporate integrity agreement. CCH Chicago Bureau, June 4, 2008.

Most Medicare beneficiaries who signed up for the Part D prescription drug benefit during the program's first two years found the process of selecting from among the numerous private drug plan offerings too complicated; a complexity that may have kept some from finding the plan that best filled their needs--and possibly from even enrolling in Part D, according to a recent report by the Commonwealth Fund, “Medicare Part D: Simplifying the Program and Improving the Value of Information for Beneficiaries.” The report discusses: standardizing benefit descriptions and procedures used by plans and the Medicare program; standardizing plans' cost-sharing requirements, including those for deductibles, coinsurance, and copayments; and simplifying the rules governing plan formularies. CCH Washington Bureau, June 2, 2008.

A proposed arrangement under which a hospital system would license a custom software physician practice interface would not create a “compensation arrangement” as defined under §1877(h)(1)(A)of the Social Security Act. The hospital system (the requestor) contracted with a software vendor to install a proprietary health care information system (software) with a physician practice interface for use by the hospital's affiliated physician practices. The requestor would limit the functionality of the physician practice interface to the ordering or communicating of the results of laboratory tests or procedures furnished by the requestor. The software would only be used to order or communicate the results of tests or procedures provided by the requestor, the software cannot be altered or modified to provide a different service, and the software may not be resold, transferred, or assigned. CMS Advisory Opinion, No. CMS-AO-2008-01, May 28, 2008, ¶52,242.

Medicare Advantage (MA) plans enrolled a record 9.8 million beneficiaries as of April 2008, representing an increase of more than 800,000 beneficiaries in four months, according to a June issue brief prepared for the Washington D.C.-based Kaiser Family Foundation by Marsha Gold of Mathematica Policy Research, Inc., Princeton, N.J. The brief determined: (1) Medicare HMOs account for the largest share of MA enrollment, but private fee-for-service plans account for 20 percent of total MA enrollment as of December 2007; (2) most Medicare beneficiaries can choose among at least three types of MA plans: private fee for service, medical savings accounts, and regional preferred provider organizations; (3) nearly half of beneficiaries living in urban areas have at least six HMO or local PPO options available to them; and (4) more than one in five beneficiaries living in urban areas is enrolled in a MA plan – more than double the enrollment rate among beneficiaries living in rural areas. CCH Washington Bureau, June 5, 2008.

Medicare Claims Processing Manual, Pub. 100-04, Transmittal No. 1522, May 30, 2008, ¶157,372. Premium content

Medicare Claims Processing Manual, Pub. 100-04, Transmittal No. 1523, May 30, 2008, ¶157,373. Premium content

Medicare Claims Processing Manual, Pub. 100-04, Transmittal No. 1519, May 30, 2008, ¶157,374. Premium content

Medicare Claims Processing Manual , Pub. 100-04, Transmittal No. 1520, May 30, 2008, ¶157,375. Premium content

Medicare Claims Processing Manual, Pub. 100-04, Transmittal No. 1521, May 30, 2008, ¶157,376. Premium content

Medicare Claims Processing Manual, Pub. 100-04, Transmittal No. 1524, May 30, 2008 ¶157,377. Premium content

Medicare Claims Processing Manual, Pub. 100-04, Transmittal No. 1526, May 30, 2008, ¶157,378. Premium content

Medicare Claims Processing Manual, Pub. 100-04, Transmittal No. 1527, May 30, 2008, ¶157,379. Premium content

Medicare Claims Processing Manual, Pub. 100-04, Transmittal No. 1528, May 30, 2008, ¶157,380. Premium content