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Notes From CMS Ruling No. 1498-R

 

 

  • Under the Alternative Implementation Procedure, the hospital in a single provider appeal my submit a single written request to the pertinent administrative tribunal, requesting a remand of each and every specific claim on any of the three DSH issues for qualifying patient discharge dates and cost reporting periods that were raised in such appeal to the appropriate Medicare contractor for implementation of the ruling without the administrative tribunal first determining whether each of the provider's claims is for one of the three DSH issues. The Medicare contractor would assume the responsibility for determining whether each of the provider's claims is subject to this ruling.
     

  • In order for a hospital to invoke the Alternative Implementation Procedure, the provider must submit an appropriate written request to the pertinent administrative appeals tribunal. The provider also must serve promptly a full copy of its written remand request on the opposing party for any pending appeal.
     

  • Per CMS, in matching Medicare and SSI eligibility data for each properly pending claim that is subject to this ruling, will include in the hospital's SSI fraction the non-covered inpatient hospital days (for example, MSP days) and the exhausted benefit inpatient hospital days of persons entitled to Medicare Part A, along with any LDR inpatient days for patients who were entitled to Part A benefits.
     

  • If a hospital were to appeal only the SSI fraction data matching process issue, the uniform inclusion of non-covered and exhausted benefit inpatient days and qualifying LDR days CMS' suitably revised data matching process will produce a more accurate revised SSI fraction than would result from the alternative approach, if not uniformly including non-covered and exhausted benefit inpatient days and qualifying LDR days in the agency's revised data matching process.
     

  • The CMS and Medicare contractors, will resolve, in accordance with the instructions set forth in section 5 of this ruling, each properly pending claim in a DSH appeal, for cost reports with patient discharges before October 1, 2004, in which a provider challenges the exclusion from the DPP on non-covered inpatients hospital days (e.g. MSP days) or exhausted Medicare days.
     

  • CMS and the Medicare contractors will resolve appeals for cost reporting periods beginning before October 1, 2009, in which a provider challenges the exclusion from the DPP of LDR inpatient days.
     

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