Casa Colina Sues Feds Over Payments
The Casa Colina rehabilitation hospital has sued the U.S. Department of Health and Human Services (HHS) in federal court, claiming the agency’s scrutiny of Medicare claims is overkill and preventing the Pomona-based facility from realizing important Medicare revenue.
The suit, which was filed in U.S. District Court in Los Angeles, is demanding that the HHS resolve disputes over Medicare claims within the statutorily-mandated 90 days.
The Centers for Medicare & Medicaid Services (CMS) has retained contractors that audit claims submitted by hospitals, and may reject payments if they deem the services are not medically necessary or delivered in the correct care setting.
Hospitals may appeal those denials in a five-step process that includes a hearing in front of an administrative law judge. They prevail about three-quarters of the time, according to data compiled by the American Hospital Association. But so many claims have been appealed in recent years that the court backlog is two years or more, according to Casa Colina officials and other industry observers.
“The lengthy delay in addressing our appeals could threaten our ability to serve the rehabilitation needs of Medicare beneficiaries in California,” said Casa Colina Chief Executive Officer Felice Loverso in a statement.
In order to address the backlog, CMS offered to settle claims over short inpatient stays last year for 68 cents on the dollar. However, a Casa Colina spokesperson said the settlement only included acute care hospitals and not rehabiliation facilities.
Jennifer Bayer, spokesperson for the Hospital Association of Southern California, said the backlog of disputed claims has become troublesome for providers in the region.
“The flood of audit contractors has resulted in a surge of redundant audits, unmanageable medical records requests and erroneous payment denials for hospitals,” she said in an email response. “Further oversight is needed to ensure auditing efforts are accurate, timely, transparent and administratively reasonable.”
