NAVEOS & Hooper Lundy & Bookman, P.C. jointly establishing Medicare Group Appeals to Protect Hospitals’ Medicare DSH in light of recent "Allina Health Services" case

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NAVEOS and Hooper Lundy & Bookman, P.C. are jointly establishing Medicare Group Appeals to Protect Hospitals’ Medicare Disproportionate Share Reimbursement in light of a recent decision in the “Allina Health Services” case (No. 1:10-CV-1463) that involves how Medicare Advantage inpatient hospital days should be counted for Federal DSH purposes. NAVEOS & Hooper Lundy & Bookman, P.C. believe that if upheld on appeal, this decision will likely result in significantly increased Medicare Disproportionate Share (DSH) reimbursement for many of the nation’s acute care hospitals.

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The United States District Court for the District of Columbia rendered a significant decision entitled "Allina Health Services, et al. vs. Kathleen Sebelius" on November 15, 2012 [No. 1:10-CV-1463 (D.D.C. Nov. 15, 2012)], which The Federal Government’s Centers for Medicare and Medicaid Services (CMS) has appealed to the United States Court of Appeals for the D.C. Circuit. If upheld on appeal, this decision will likely result in significantly increased Medicare Disproportionate Share (DSH) reimbursement for many of the nation’s acute care hospitals.

This case involves how Medicare Part C inpatient hospital days should be counted for DSH purposes. This issue has key legal and quantitative reimbursement components that will be jointly addressed through nationwide group appeals to be established and pursued by NAVEOS and Hooper Lundy & Bookman, P.C.

NAVEOS President & CEO, Robert Gricius noted that, “This case has far reaching implications for all Federal Disproportionate Share hospital providers on both fractions of the Medicare DSH calculation from 2005 forward. We are pleased to be working with one of the premier healthcare law firms in the country with a demonstrated record of success in large group appeals on issues involving the full spectrum of Medicare reimbursement, most recently that involving the Rural Floor decision that generated substantial additional Medicare payments for a large subset of hospitals across the country."

Laurence Getzoff of Hooper Lundy & Bookman, P.C. commented that, "The Allina decision presents an excellent opportunity for hospitals across the nation to challenge historical deficiencies in how their DSH adjustments have been calculated since 2005. We are fortunate to be working with NAVEOS, a healthcare data analytics company that has the national government data exchange network and expert systems software to assure that each participating hospital's DSH adjustment is accurately calculated and that all eligible days are accounted for properly."

Questions on this case can be directed to Robert Gricius of NAVEOS at robertgricius(at)naveosdata.com or (703) 444-2422 or to Laurence Getzoff of Hooper Lundy & Bookman, P.C., at lgetzoff(at)health-law.com or (310) 551-8190 or Robert Roth at Hooper, Lundy & Bookman, P.C., at rroth(at)health-law.com or (202) 580-7701.

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Robert Gricius
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