The AAMC, the American Hospital Association, America’s Essential Hospitals, and the Federation of American Hospitals filed an amicus brief (PDF) in the U.S. Court of Appeals for the District of Columbia in the case of Battle Creek Health System v. Becerra. In the brief, the groups urged the court to preserve the ability of a hospital to promptly appeal reimbursement rules and interpretations made by the Centers for Medicare & Medicaid Services (CMS) that it believes are erroneous to the Provider Reimbursement Review Board (PRRB). Specifically, the court considered the issue of whether the CMS’ publication of Supplemental Security Income (SSI) ratios — without the actual settling of a hospital’s cost reports by the Medicare Administrative Contractor — was a “final determination” for purposes of filing an appeal with the PRRB.
The brief pointed out that “like CMS’ other determinations administering the prospective-payment system, its decisions interpreting the [disproportionate share hospital] formula can materially affect hospitals’ Medicare payments. When an error by CMS causes a hospital not to receive the full DSH payment it is owed, the hospital may face financial distress and be unable to serve patients adequately.” Therefore, it argued, under the governing statute, providers must be able to seek review of CMS determinations immediately rather than having to wait months or years for the CMS to correct a mistake.