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AHA to CMS: Rebilling limitation unlawful and unfair

April 18, 2013

The AHA yesterday pressed the Centers for Medicare & Medicaid Services to revise a March 13 Ruling that would permit hospitals to rebill Part A claims denied by Medicare Recovery Audit Contractors only if they are currently being appealed or the time for appeal has not lapsed. The ruling would prohibit hospitals from rebilling tens of thousands of denied claims for which the time to appeal has expired. The letter urges CMS to take immediate action to ensure that hospitals can seek and receive payments for all previously denied claims, noting that hospitals long refrained from rebilling based on CMS representations that it would be futile to do so. “CMS now admits that its representations did not comport with the law,” AHA President Rich Umbdenstock wrote to Health and Human Services Secretary Kathleen Sebelius. “And yet in the same breath, [the agency] states that hospitals that relied on those representations have forfeited their right to be paid for reasonable and necessary services they provided. The Administrative Procedure Act and fundamental principles of equity and fair play do not permit that result.”