Protest Improper Wage Index Rural Floor on FY 2017 Cost Report

January 24, 2018 Alerts and Newsletters

Download a print-friendly PDF of this Client Alert here.

January 24, 2018

Clients and friends:

As you work to prepare and finalize your hospital's FY 2017 Medicare cost report that is due at the end of February, we want to alert you to an action to take now that may protect your rights in the future. As was widely reported by MHA and in the trade press, the FY 2017 Medicare wage index rural floor for Massachusetts hospitals was understated due to CMS' refusal to correct identified errors in data submitted by Nantucket Cottage Hospital, the state's only rural hospital. The wage index rural floor was set at 1.1822 instead of the correct 1.2659. At least two group appeals were filed at the Provider Reimbursement Review Board (PRRB) contesting the setting of the improperly reduced rural floor. Since the PPRB cannot offer those hospitals relief by voiding a regulation, the issue has proceeded to federal district court in DC, where briefing has begun in the case.

We obviously do not have a crystal ball to predict whether the court litigation will have a favorable result for the hospitals, but, in case the matter does have a positive outcome through a decision or settlement, we recommend that any Massachusetts hospital that was adversely affected by the decreased rural floor preserve any existing rights to relief it may have by filing the wage index amount as a protested item on its FY 2017 cost report. To properly protest an item on the cost report a provider should follow the requirements of 42 CFR 413.24 (j) by: (1) including an estimate of the reimbursement amount for each self-disallowed item, and (2) attaching a separate work sheet that explains why the item was self-disallowed and describes how the estimated reimbursement amount in issue was calculated. Without preserving your rights your institution may be barred from seeking relief on this issue once its NPR for FY 2017 has issued.

We would be happy to discuss this recommendation with you in more detail and answer any questions you may have concerning how to preserve your hospital's rights. We look forward to hearing from you.

___________________________________________________________________
This communication is intended for general information purposes and as a service to clients and friends of Verrill Dana, LLP. This publication, which may be considered advertising under the ethical rules of certain jurisdictions, should not be construed as legal advice or a legal opinion on any specific facts or circumstances, nor does it create attorney-client privilege.

Firm Highlights

Publication/Podcast

Fraud and Abuse Investigations Handbook for the Health Care Industry, Second Edition.

Health care attorney Paul Shaw co-authored Fraud and Abuse Investigations Handbook for the Health Care Industry, Second Edition with Robert Griffith, published by the American Health Law Association (AHLA). Paul and Robert provide legal...

News

High-Profile Former U.S. Department of Justice Prosecutor, David Lazarus, Joins Verrill’s Health Care and Life Sciences Practice

(November 29, 2021) – Verrill is pleased to welcome David Lazarus to the firm’s Boston office as a Partner in its nationally recognized Health Care & Life Sciences Group. Lazarus is a former Department...

Publication/Podcast

James Roosevelt, Jr. Published in ScienceDirect

Verrill attorney James Roosevelt Jr. was published in the February 2022 volume of ScienceDirect , a scientific, technical, and medical research publication. His article “A Federal Indian Health Insurance Plan: Fulfilling a Solemn Obligation...

News

Verrill Adds Lead Prosecutor On Insys Case To Boston Office- Law360

On November 18, 2021 Law360 published the article "Verrill Adds Lead Prosecutor On Insys Case To Boston Office," featuring David Lazarus , a recent addition to the Health Care and Life Sciences group at...

News

Pair of Recent Victories Hearten Counsel for MassHealth Providers

Verrill attorney David G. Lazarus was recently mentioned in the Massachusetts Lawyers Weekly article "Pair of Recent Victories Hearten Counsel for MassHealth Providers." The article covers two appellate court decisions regarding the boundaries to...

Publication/Podcast

How Growing Cyber Scrutiny Affects Corporate Compliance

Verrill attorneys David Lazarus , Michael Fee , and Jeffery Smagula authored an article published in Law360 on December 3, 2021 entitled "How Growing Cyber Scrutiny Affects Corporate Compliance." In the article Lazarus, Fee...

News

65 Verrill Attorneys Recognized by Best Lawyers® 2022, Including Eight Named Lawyers of the Year

(August 31, 2021) – 65 Verrill attorneys were recognized as "Best Lawyers" by Best Lawyers® 2022 , including 8 attorneys named “Lawyer of the Year,” a distinguished recognition for only a single lawyer in...

News

The Boston Globe on Federal Prosecutor Joining Verrill

News

Verrill's Strategic Growth in Key Areas Shared in Mainebiz

On Monday, November 15th Verrill was listed as a Maine law firm who is innovating ways to hire talent in the Mainebiz article "Remote Work Changes Hiring Strategies for Some Maine Law Firms." The...

Contact Verrill at (855) 307 0700