HHS ordered back to the drawing board – and told to work quickly.
A federal judge has upheld a lower court’s ruling that the U.S. Department of Health and Human Services (HHS) exceeded its statutory authority when it reduced the 2018 Medicare reimbursement rate for drugs covered by the federal 340B Program.
U.S. District Court Judge Rudolph Contreras, sitting in the District of Columbia, issued the ruling Monday in the matter of American Hospital Association v. Alex M. Azar, HHS Secretary, ordering HHS back to the drawing board and warning it to act with haste to make a correction.
“On or before Aug. 5, 2019, the parties shall submit a status report regarding the agency’s progress on remand to remedy the issues raised in this litigation concerning the 2018 and 2019 OPPS (Outpatient Prospective Payment System) Rules,” Contreras concluded in his 22-page decision. “The Court expects that the agency will act expeditiously to resolve these issues.”
The ruling stopped short of vacating HHS’s 2018 and 2019 OPPS rules, “given the havoc … (it) may wreak on Medicare’s administration,” as Contreras put it. And it did not order that hospitals be compensated for 340B payments lost in the past two years.
Maureen Testoni, President and Chief Executive Officer of 340B Health and a repeat guest on Monitor Mondays, the weekly Internet radio broadcast hosted by RACmonitor, nonetheless hailed the decision as a clear win for providers nationwide.
“On behalf of the nearly 1,400 hospitals we represent that participate in 340B, we are pleased that the court has, once again, found that HHS exceeded its statutory authority by cutting what Medicare pays for outpatient drugs delivered to their patients,” Testoni said in a statement. “The cuts made in 2018 and again in 2019 have reduced hospitals’ ability to care for those in need. The sooner this policy is reversed, the better hospitals will be able to serve the needs of patients with low incomes and those in rural communities. HHS must act quickly, as any further delay will only harm patients and the hospitals they rely on for care.”
Healthcare Dive published a report online this week noting that the 340B Program has come under scrutiny from several angles in recent months, “largely prompted by concerted opposition from the pharmaceutical industry’s trade group, PhRMA,” as legislators have called for enhanced transparency and oversight from the Program.
The report also noted that the number of hospitals in the Program has jumped in the past few years, going from 1,465 in 2011 to 2,399 in 2016, according to the Government Accountability Office.
Program Note:
Listen to RACmonitor national correspondent Timothy Powell report this story live during Monitor Monday, May 20, 10-10:30 a.m. ET.
Aetna’s recent policy update, which became effective July 1, marks a significant change in how the insurer will manage hospital readmissions. Previously, Aetna’s Diagnosis-Related Group
Our readers know that Hierarchical Condition Categories (HCCs) are groups of diagnoses. Each diagnosis is classified to a payable or non-payable HCC based on whether
Please log in to your account to comment on this article.
Uncover critical guidance. HIM coding expert, Kay Piper, RHIA, CDIP, CCS, provides an interactive review on important information in each of the AHA’s 2025 ICD-10-CM/PCS Quarterly Coding Clinics in easy-to-access on-demand webcasts, available shortly after each official publication.
Uncover critical guidance. Kay Piper provides an interactive review on coding guidelines and more in the AHA’s fourth quarter 2025 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Uncover critical guidance. Kay Piper provides an interactive review on coding guidelines and more in the AHA’s third quarter 2025 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Uncover critical guidance. Kay Piper provides an interactive review on coding guidelines and more in the AHA’s second quarter 2025 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Providers face increasing Medicare audits when using skin substitute grafts, leaving many unprepared for claim denials and financial liabilities. Join veteran healthcare attorney Andrew B. Wachler, Esq., in this essential webcast and master the Medicare audit process, learn best practices for compliant billing and documentation, and mitigate fraud and abuse risks. With actionable insights and a live Q&A session, you’ll gain the tools to defend your practice and ensure compliance in this rapidly evolving landscape.
Dr. Ronald Hirsch dives into the basics of Medicare for clinicians to be successful as utilization review professionals. He’ll break down what Medicare does and doesn’t pay for, what services it provides and how hospitals get paid for providing those services – including both inpatient and outpatient. Learn how claims are prepared and how much patients must pay for their care. By attending our webcast, you will gain a new understanding of these issues and be better equipped to talk to patients, to their medical staff, and to their administrative team.
Hospitals face growing challenges in measuring observation metrics due to inconsistencies in classification, payer policies, and benchmarking practices. Join Tiffany Ferguson, LMSW, CMAC, ACM, and Anuja Mohla, DO, FACP, MBA, ACPA-C, CHCQM-PHYADV as they provide critical insights into refining observation metrics. This webcast will address key issues affecting observation data integrity and offer strategies for improving consistency in reporting. You will learn how to define meaningful metrics, clarify commonly misinterpreted terms, and apply best practices for benchmarking, and gain actionable strategies to enhance observation data reliability, mitigate financial risk, and drive better decision-making.
The 2025 Medicare Physician Fee Schedule brings significant changes to payment rates, coverage, and coding for physician services, impacting practices nationwide. Join Stanley Nachimson, MS., as he provides a comprehensive guide to understanding these updates, offering actionable insights on new Medicare-covered services, revised coding rules, and payment policies effective January 1. Learn how to adapt your practices to maintain compliance, maximize reimbursement, and plan for revenue in 2025. Whether you’re a physician, coder, or financial staff member, this session equips you with the tools to navigate Medicare’s evolving requirements confidently and efficiently.
Copyright © 2025 ICD10monitor. Powered by MedLearn Media.
Happy National Doctor’s Day! Learn how to get a complimentary webcast on ‘Inpatient Admission Order: Master the Who, When, and How Webcast‘ as a token of our heartfelt appreciation! Click here to learn more →
Happy National Doctor’s Day! Learn how to get a complimentary webcast on ‘Decoding Social Admissions’ as a token of our heartfelt appreciation! Click here to learn more →
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
