Houston partner Greg Etzel authored an article, "Major Changes on the Medicare DSH Landscape," which was published in the July 2, 2010, edition of the Bureau of National Affairs' Medicare Report.
According to Etzel, whose primary area of practice involves the representation of hospitals and other providers relating to healthcare regulatory matters and payment disputes: "Since its inception, the Medicare disproportionate share hospital (DSH) payment has been a frequent source of controversy and litigation, and the first half of 2010 has been a particularly active period. Setting aside the significant changes on the way by virtue of the Patient Protection and Affordable Care Act (Pub. L. No. 111-148), a number of court rulings and actions by the Centers for Medicare & Medicaid Services have furnished plenty of current grist for the mill for hospitals seeking, or considering, additional DSH reimbursement from the Medicare appeals process."
Etzel continues: "The Medicare DSH payment is a statutorily mandated payment, in addition to the base prospective payment system amount, for hospitals serving a disproportionately large percentage (e.g., 15 percent or greater) of low-income patients. Congress established a proxy for determining a hospital's 'disproportionate share patient percentage' (DPP) that ultimately is used to calculate a hospital's DSH payment."
Etzel goes on to discuss the methods for calculating DPP and detailing recent court decisions which provide guidance on the appropriate interpretation of the statutory DSH payment. Etzel also explains CMS Ruling 1498, which implemented three major DSH policy changes.
He concludes: This year has ushered in one of the more active and important eras of the Medicare DSH payment. Hospitals should carefully evaluate the changing DSH landscape and evaluate and preserve any challenges to CMS policy through the Medicare appeals process. Hospitals should consider the impact of the Ruling and the three issues it involves on their DSH payments, and determine the appropriate strategy for their institution. Ultimately, the Ruling will not end the contentious history of the DSH payment. It will simply mark the beginning of a new era."
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