Hospitals fight for millions in Medicaid underpayments

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More hospitals are claiming reimbursement miscalculations. This time, two Houston hospitals are asking Texas to change the Medicaid reimbursement rates 14 hospitals received for fiscal years 2008 and 2009, the Houston Business Journal reported.

The 14 hospitals, including HCA-owned Conroe Regional Medical Center and East Houston Medical, claim the Texas Health and Human Services Commission (HHSC) failed to comply with a state Supreme Court injunction issued in 2008 to update the reimbursement rates, the article noted.

While the HHSC did recalculate reimbursements in 2010, it continued to base the hospitals' Medicaid payments on the old formula for 2008 and 2009, leading to millions in underpayments, according to attorney Marie Yeate's oral argument in front of the Supreme Court of Texas on Wednesday.

Meanwhile, more than 100 hospitals will see their Medicaid disproportionate share hospitals (DSH) payments recalculated by the U.S Department of Health & Human Services, FierceHealthcare previously reported. The HHS's decision to exclude Medicare Advantage patient days from the Medicaid fraction of DSH calculations prior to Oct. 1, 2004, violated the rule against retroactive rulemaking, according to a January order from the U.S. District Court for the District of Columbia.

However, 18 hospitals recently faced a legal blow when the Supreme Court sided with HHS and refused to allow extensions for Medicare reimbursement appeals beyond the usual 180 days or three years for good cause. With the ruling, the hospitals will miss out on Medicare underpayments worth millions of dollars.

To learn more:
- read the Houston Business Journal article
- listen to the oral argument (.pdf)

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