Hospitals sue HHS over Medicare billing calculation

Cleveland Clinic is among more than 125 hospitals and health systems suing HHS regarding the calculation of payments owed under Medicare Part A bills and the disproportionate share hospital payment adjustment, Law Street Media reported April 21. 

One of the factors used to calculate the disproportionate share hospital payment adjustment is "days entitled to benefits under part A," according to Law Street Media. The factor is used on both the denominator and numerator side of the calculation of the disproportionate payment percentage. The hospitals allege that HHS uses different definitions for "entitled" depending on which side of the fraction is being reviewed. They argue this results in lower payments to the hospitals. 

"The only thing that unifies the government's inconsistent definitions of this term is its apparent policy of paying out as little money as possible," the hospitals said in the lawsuit.  

The hospitals want the judge to invalidate HHS' current policy, have the department recalculate payments and make prompt payment of any additional amounts due to the hospitals, plus interest, according to the lawsuit. 

The lawsuit was filed April 20 in the U.S. District Court for the Central District of California.

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