Holland & Hart Healthcare Law Blog

TWENTY-FIVE STEPS IN DEFENSE OF RAC AUDITS.

Recovery Audit Contractors (RACs) are in the process of saddling up for the nationwide roll out of their Medicare payment recoupment mission. Here are twenty-five recommended proactive steps to circle the wagons and defend the RAC threat.

1. Develop and implement a written audit defense plan- the government bounty hunters are coming your way and they will be looking for the  low lying fruit.

2. Select an audit team or responsible persons depending upon the size of your organization. Including if appropriate internal audit, billing and coding, medical records, risk management and the CFO.

3. Assign specific team member responsibilities in dealing with anticipated audit issues.

4. Consider running an internal pre-audit to identify vulnerabilities such as “medical necessity” and “duplication of services.”

Call 911-Surgical Hospitals Under Attack For Complications At Abilene Hospital.

On February 8, 2007, Sen. Bax Baucus, Chairman of the Senate Finance Committee, Sen. Charles Grassley Ranking Member of the Senate Finance Committee and Pete Stark Chairman of the Health Subcommittee of the House Ways and Means Committee sent a joint letter to Leslie V. Norwalk, the Acting Administrator of Centers of Medicare and Medicaid Services asking for an investigation concerning the Medicare status of the West Texas Hospital in Abilene, Texas, which had to call 911 to transport a patient with respiratory arrest related to spinal surgery at the hospital. The patient later died.  The case is reminiscent of a similar case in Oregon about two years ago which was the subject of much debate and outcry by politicians opposed to the development of specialty hospitals.  One of the concerns raised by the three politicians was how the hospital could obtain Medicare provider status during the specialty hospital moratorium. The new hospital apparently came on line during 2005.  The answer just might be that the West Texas Hospital is not in fact a specialty hospital. (It does look like a specialty hospital though and apparently has no emergency room.)

Missing The Point In The Specialty Hospital Wars.

The current political maneuvering by the American Hospital Association and its member hospitals to extend the moratorium which the Congress imposed upon the proliferation of physician owned specialty hospitals seems to be missing the point as to whether the current general hospital model is viable in the long run. Can a general hospital be all things to all patients and still maintain quality of performance?

Dead Ambulatory Surgical Center Retains Life In Antitrust Suit Against Hospital

Large hospitals in relatively small health care markets risk antitrust exposure if they use their market power to compete against upstart ambulatory surgical centers and their investor physicians. A classic case in point is the recent decision by U.S. District Court Judge David N. Hurd in Rome Ambulatory Surgical Center, LLC vs. Rome Memorial Hospital, Inc. and Greater Rome Affiliates, Inc., 5:01-cv-23, (N.D. N.Y, 2004) issued in lated December, 2004 granting in part and denying in part the hospital's motion for summary judgment.

Feds Impose 18 Month Moratorium On Physician Owned Hospitals.

Newton, Kansas added a pair of suspenders to its municipal belt to buttress its opposition to the development of physician owned specialty facilities when the federal government announced an 18 month moratorium on the building and development of physician owned specialty hospitals November 25, 2003. The argument again is quality, efficiency and cost savings on the specialty hospital side verses cross subsidize from lucrative specialty services to support loosing services mandated by state and federal law for full service hospitals. The government needs the moratorium to study the issue. Hopefully there will be some homework in the assignments.

Newton Kansas Passes Ordinance Restricting ASCs and Specialty Hospitals Despite Lack Of Interest In Newton.

This is a story that appeared in Modern Healthcare in late October. Who knows, it may start a plethera of local ordinances springing up over the winter to the sound of one hand clapping. As federal and state policymakers weigh restrictions on physician-owned specialty hospitals, at least one municipality already has taken action. Newton, Kan., with a population of just over 17,000, passed an ordinance to block the entry of ambulatory surgery centers and specialty hospitals. Passed last July at the request of the town's only hospital, Newton Medical Center, the measure requires licensing ambulatory surgery centers and specialty hospitals, imposes a one-year moratorium on such licenses, and directs the creation of a task force to conduct a yearlong study on niche facilities.

Specialty Hospital Turf War Continues.

This in from the hospital compliance wire.

The growing popularity of specialty hospitals has general hospitals in a panic - and lawmakers and regulators may make the lives of physicians who invest in specialty facilities trickier than ever.

Santa Fe St. Vincent's war on Specialty Hospital

St. Vincent Hospital in Santa Fe is engaged in an all out fight to retain its cancer treatment domanence in North Central New Mexico against the rise of a new cancer specialty hospital.

Proposed Rule to eliminate Stark exception for Specialty Hospitals and to redefine imaging services as DHS.

The May 27, 2003 issue of the FR contains a listing of proposed new rules set for July by CMS. Included is a rule removing the "whole hospital" exception for physician owned specialty hospitals. This proposed action by CMS echoes the Hospital Investment Act introduced by Rep. Stark to proscribe what he apprently sees as a major "loophole" in his previous bills. CMS also proposes amending the defination of designated health services to cover a broader range of imaging services. The Specialty Hospital industry is lobbying heavily against both initiatives. The passage or adoption of such a prohibition could alter the course of development of this rapidly evolving restructuring of the hospital industry.