HHS to appeal ruling in AHA lawsuit on outpatient payment cut

The Department of Health and Human Services Dec. 12 announced that it intends to ask the U.S. Court of Appeals to reverse a district court ruling in favor of the AHA and hospital organizations that found the Centers for Medicare & Medicaid Services exceeded its statutory authority when it reduced payments for hospital outpatient services provided in off-campus provider-based departments grandfathered under the Bipartisan Budget Act of 2015.

“We are confident an appeals court will affirm the district court’s decision confirming congressional intent to protect these hospitals from punitive reductions in payment,” said AHA General Counsel Melinda Hatton. 

A federal judge in September ruled in favor of the AHA and hospital organizations, and in October, the judge reaffirmed her previous order to CMS to vacate the payment cut.

Earlier this week, CMS announced that it will automatically reprocess calendar year 2019 claims affected by these cuts in order to repay hospitals pursuant to the judge’s order.