The American Hospital Association (AHA) announced on December 13 that the AHA and hospital co-plaintiffs have filed a motion in federal court urging the court to expedite proceedings in their challenge of a CMS payment policy. Specifically, the plaintiffs are contesting payment denials that are based on Recovery Audit Contractor (RAC) determinations that the same medical benefit would have been obtained if the patient had been treated on an outpatient basis rather than as inpatients. AHA filed suit in the U.S. District Court for the District of Columbia challenging CMS’ refusal to reimburse hospitals for reasonable and necessary care that recovery audit contractors later decided could have been provided in an outpatient setting. RACs issue such determinations months and sometimes years after an inpatient treatment was provided and CMS can deny the inpatient claim based on the RAC’s determination. “CMS has refused, and is still refusing, to pay the nation’s hospitals for hundreds of millions of dollars’ worth of medically necessary care,” AHA said in its motion.
The lawsuit seeks to overrule CMS’ nonpayment policy, which AHA and the hospitals say “has shunted providers into an endless loop” of payment denials that later will be overturned on appeal. Plaintiffs state in their request that they stand ready to file a motion for summary judgment and have asked the court to accelerate the schedule for future proceedings in the case. The motion is available here.