Over the years, various instruments have narrowed and darkened providers’ appellate rights relating to Medicare underpayment and recoupments. Recent court decisions, however, may put providers’ Medicare appeal rights back on the yellow brick road. On August 6th, the U.S. District Court for the District of Columbia issued three injunctions, each prohibiting HHS, the PRRB and CMS’s Medicare contractors from further narrowing providers’ rights to appeal Medicare underpayments. These injunctions were issued in three related cases filed on behalf of over 40 hospitals by members of the Squire Patton Boggs Medicare Reimbursement Team in Denver and Washington, DC. The hospitals’ underlying reimbursement claims involve the Medicare outlier supplemental payment program and certain rural floor, budget neutrality adjustments. For further reading, see How to Navigate the Narrow Path to Reimbursement Appeal by Mimi Brouillette and Stephen Nash.
