Click on a headline below for the full story.

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.

For more details, contact your sales rep.

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.

• The “good cause” requirement for claims reopenings: Recent decisions. As CMS prepares to unleash recovery audit contractors (RACs) nationally, there is increased focus on the circumstances under which claims may be reopened. In this article, the author examines Medicare regulations on when claims reopenings may occur, as well as recent decisions issued by administrative law judges and the Medicare Appeals Council (MAC).

Read this month's Advisor. Subscribers only

Not a subscriber? Subscribe today.

Fourth Quarter 2007, Volume 22, Number 1

• Gross Days Revenue Outstanding. US hospitals closed 2007 with a slight increase in the gross days revenue outstanding (GDRO) average. The fourth quarter GDRO average was 50.78, up 0.16 days from the third quarter. Nevertheless, the average GDRO continues to fall well within benchmark range, which is to hold the GDRO average to fewer than 60 days. The pages of the HARA Report on Fourth Quarter 2007 hold more details regarding this key indicator.

Subscribers only

Not a subscriber? Subscribe today.

The Senate has voted against moving forward on legislation by Senate Finance Committee Chairman Max Baucus (D-Mont.) that would delay a 10.6 percent physician payment cut for 18 months and increase physician payments by 1.1 percent for 2009. The pay cut is currently scheduled to take place on July 1.

The mostly party-line vote on S. 3101 on June 12, 2008, was 54 to 39, six votes shy of the number needed to allow the Senate to begin debate. President Bush’s advisors had suggested that Bush would veto the legislation. Senate Finance Committee ranking member Charles Grassley (R-Iowa) has offered alternative legislation (S. 3108) that he said would not be vetoed. Senators are likely to begin discussing a new plan. “I hope that this failed vote will get us to the negotiating table,” said Grassley. CCH Washington Bureau, June 12, 2008.

A Final rule imposing new requirements for hospice participation in Medicare and Medicaid becomes effective December 2, 2008. The rule clarifies and increases requirements for patient assessments and plans of care, sets new standards for the qualifications of the medical director, social workers, hospice aides, and adds requirements for infection control. Final rule, 73 FR 32087, June 5, 2008, ¶180,743.

A federal court in Tacoma, Washington has dismissed a class action by Medicaid recipients because the challenged rule has been repealed. The state's “ shared living rule” required a 15 percent reduction of the home care services available to recipients whose caregivers lived with them. The recipients claimed that the rule violated Soc. Sec. Act §1902(a)(10)(B)requiring comparability of services available to all eligible individuals, and Act §1902(a)(23), requiring a free choice of willing providers. Pfaff v. State of Washington, W.D. Wash., May 29, 2008, ¶302,434.

A federal magistrate in Brooklyn has recommended that a complaint filed by Medicaid patients with mental illness challenging their confinement to nursing facilities (NF) should not be dismissed. The recipients contend that their NF placements violate their rights under the Americans with Disabilities Act (ADA), the Rehabilitation Act (RA) and the federal Nursing Home Reform Act (NHRA) because they do not require the care provided in NFs.

Joseph S. v. Hogan, E.D. N.Y., April 21, 2008, ¶302,436.

The False Claims Act public disclosure bar to jurisdiction was not applicable to a qui tamcomplaint against an imaging company and several physicians and professional corporations (defendants) accused of perpetrating a scheme to defraud Medicaid and Medicare by submitting bills for unnecessary medical tests and procedures. U.S. ex rel. Landsberg v. Levinson, W.D. Penn., May 29, 2008, ¶302,435.

Medicare Claims Processing Manual , Pub. 100-04, Transmittal No. 1529, June 6, 2008, ¶157,381. Premium content

Medicare Claims Processing Manual, Pub. 100-04, Transmittal No. 1530, June 6, 2008, ¶157,382. Premium content

Medicare Claims Processing Manual, Pub. 100-04, Transmittal No. 1531, June 6, 2008, ¶157,383. Premium content

One Time Notification Manual, Pub. 100-20, Transmittal No. 347, June 6, 2008, ¶157,384. Premium content

One Time Notification Manual, Pub. 100-20, Transmittal No. 349, June 6, 2008, ¶157,385. Premium content

One Time Notification Manual, Pub. 100-20, Transmittal No. 384, June 6, 2008, ¶157,386. Premium content