RESUMO
Medicare's new disproportionate share hospital (DSH) payment method combines a payment amounting to 25 percent of what a hospital would have traditionally received with an additional amount that is the product of three factors: An estimate of the aggregate amount of DSH payments that the Medicare program would have paid in FFY14 under the traditional payment method. An adjustment to that figure to account for an estimated percentage change in the national uninsured rate between FFY13 and FFY14. Each hospital's estimated percentage of the total uncompensated care costs incurred by all hospitals that are expected to qualify for DSH payments.
Assuntos
Economia Hospitalar/legislação & jurisprudência , Reembolso Diferenciado/economia , Reembolso Diferenciado/legislação & jurisprudência , Medicare , Estados UnidosRESUMO
The 340B program provides an opportunity for hospitals to achieve significant cost savings on outpatient drugs. Disputes surrounding the Medicare DSH payment calculation, and potential misunderstandings of Medicare provider-based rules, pose obstacles to hospitals that wish to continue or gain participation in the program. Eligible hospitals should pay close attention not only to the rules governing the 340B program, but also to Medicare reimbursement rules to ensure access to drug discounts available under the program.
Assuntos
Assistência Ambulatorial , Custos de Medicamentos/legislação & jurisprudência , Indústria Farmacêutica/legislação & jurisprudência , Economia Hospitalar , Preparações Farmacêuticas/economia , Redução de Custos , Estados Unidos , United States Public Health Service/legislação & jurisprudênciaRESUMO
The amended PRRB rules will significantly change the way providers prepare for and prosecute appeals to the board. All providers and chain organizations should take stock of their longstanding as well as upcoming appeal issues to preserve their rights to pursue proper Medicare reimbursement. The rules' emphasis on front-end work by providers could require significant process changes for organizations.
Assuntos
Administração Financeira de Hospitais , Órgãos Governamentais , Reembolso de Seguro de Saúde , Negociação/métodos , Centers for Medicare and Medicaid Services, U.S. , Estados UnidosRESUMO
Although the Centers for Medicare and Medicaid Services says that it lacks statutory authority to provide federal funding for graduate medical education (GME), the authors present three arguments refuting this claim: States have made Medicaid GME payments and received matching funds for those payments since the inception of the Medicaid program. GME costs are costs of patient care services for which states are entitled to federal financial participation (FFP). The Medicaid statute requires FFP for GME costs.
