In light of these trends, this webinar will provide ABI members an overview of the unique issues faced by small rural hospital designated as “critical access hospitals” (“CAHs”) by the Centers for Medicare and Medicaid Services. Established by the Balanced Budget Act of 1997, the CAH designation allows eligible rural hospitals to receive reimbursement from Medicare (and state Medicaid programs) based on 101% of allowable costs rather than the traditional fee-for-service model. In order to receive the CAH designation, a hospital must be at least 35 miles from another hospital and meet at least the following criteria: (1) have 25 or fewer inpatient acute beds; (2) maintain an average length of stay of less than 96 hours for acute beds and (3) provide 24/7 emergency services.
Despite what should be a favorable reimbursement model, the nation’s approximately 1,350 CAHs are plagued with a variety of regulatory and socioeconomic hurdles hampering their profitability. These include shrinking federal and state budgets, physician shortages, the high cost of providing care to under- and uninsured patients, certain physician costs that are not reimbursed on a cost-plus basis, and difficulty repaying overpayments by the Medicare and Medicaid programs.
In a lively forum, this panel will focus on:
Debt restructuring challenges faced by CAHs due to their narrow margins and cost-based reimbursement model;
Alternative solutions to cash flow for CAHs through expansion of medical services, large group physician employment agreements, telemedicine and operational efficiencies;
Legal expansion programs in a CAH environment and illegal schemes perpetrated by bad actors who take expansion too far;
The roadmap to reorganization for CAHs who find themselves amid allegations of violations of the False Claims Act, Stark Law and Anti-Kickback federal and state laws and in the snarls of a healthcare fraud investigation with either CMS, Medicaid, OIG or commercial payers’ SIU departments; and
How to overcome the overpayment liability dilemma.
Wednesday, May 01, 2019
1 pm - 2:15 pm ET
CLE is available in qualifying states.*
Carol L. Fox GlassRatner Advisory & Capital Group LLC
Elizabeth A. Green BakerHostetler
Andrew Helman Murray Plumb & Murray
Frank P. Terzo Nelson Mullins Riley & Scarborough LLP
*1 hour of general CLE credit is available in the following pre-approved 60-minute-hour and 50-minute-hour states: AK, AL, AR, CA, DE, GA, IL, MO, NJ, PA, SC, TN, TX, VT, WI, and WV. These states follow an approved jurisdiction policy: AZ, CO, CT, NH, NY. ABI will submit attendance to DE, IL, NV, PA, TN, and TX. For those jurisdictions not listed,ABI will not seek direct accreditation attorneys will need to self-submit. Some states allow may not allow self-submission. ABI will issue certificates for attorneys to self-submit for approval. ABI charges an administrative fee of $5 for Members and $25 for non-members upon requesting CLE credit for this program. Further details will be provided the day of the event.