CMS terminates Kansas hospital’s Medicare billing privileges: 5 things to know

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CMS revoked Overland Park, Kan.-based Blue Valley Hospital’s Medicare billing privileges April 11, and the hospital is now suing HHS and CMS over the decision.

Here are five things to know.

1. Under rules enacted last September, healthcare facilities must average at least two inpatients per day and an at least two-night average length of stay to be considered an inpatient hospital for Medicare reimbursement. Facilities that fall short of these requirements may instead be considered same-day surgery centers, which have different reimbursement rates, according to The Kansas City Star.

2. CMS said Blue Valley Hospital doesn’t meet the new federal requirements for Medicare participation. A survey by state health officials last November found Blue Valley Hospital did not have any inpatients at that time, and a subsequent report showed the hospital performed about 309 outpatient surgeries, compared with 146 inpatient surgeries over a yearlong period, according to KCUR.

3. Blue Valley Hospital officials acknowledged that the hospital fell short of the two-night average stay requirement, but they say the new federal requirements are arbitrary. “This action taken by CMS was not related to any patient safety or quality of care issue, but results from CMS’ change in the definition of hospital under the Code of Federal Regulations,” Blue Valley Hospital CEO D. Chris Dixon said in a statement to The Kansas City Star.

4. In its recently filed lawsuit against HHS and CMS, Blue Valley Hospital says many of its patients have an expected length of stay of two nights, but they are able to go home earlier than expected due to the high-quality care they receive at the hospital. “CMS’ new criteria suggests that hospitals should keep patients longer than necessary just to meet arbitrary CMS requirements, which is against public policy,” the lawsuit states.

5. Blue Valley Hospital is requesting to keep its Medicare billing privileges while it appeals CMS’ decision to terminate its participation in the Medicare program, according to The Kansas City Star.

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