DSH adjustment controversies continue.
Some Medicare intermediaries are reducing the disproportionate share hospital (DSH) payment by excluding labor/delivery room days and dual-eligible days from the DSH calculation. Some intermediaries are excluding maternity patients who are in a labor/delivery room at the census-taking hour unless the patient previously occupied a routine bed. Intermediaries also are excluding Medicaid-eligible days attributable to patients who are not entitled to payment under Medicare Part A. These adjustments are of questionable legal validity and hospitals should protect their rights to appeal these issues.
Keough
Christopher L
CL
Powers Pyle Sutter & Verville PC, Washington, D.C., USA. ckeough@ppsv.com
D014487:Centers for Medicare and Medicaid Services, U.S.; D003696:Delivery Rooms / Q000191:economics / Q000331:legislation & jurisprudence; D005260:Female; D005377:Financial Management, Hospital / Q000379:methods*; D006297:Health Services Accessibility / Q000191:economics; D006801:Humans; D008484:Medicaid / Q000331:legislation & jurisprudence; D016344:Medicare Part A / Q000331:legislation & jurisprudence*; D016134:Organizational Policy; D011247:Pregnancy; D020444:Reimbursement, Disproportionate Share / Q000331:legislation & jurisprudence*; D017664:Uncompensated Care / Q000191:economics; D014481:United States