Hospital groups may formally ask HCFA to rewrite the regulations that describe which facilities are eligible for reimbursement under the new Medicare outpatient prospective payment system.
If HCFA agrees to craft a new proposal, it could delay the implementation of that provision, which is slated to take effect Oct. 10, said Thomas Nickels, the American Hospital Association's senior vice president for federal relations.
The hospitals contend that the criteria for "provider-based entities" as listed in the April 7 final PPS regulations are unclear. Since the PPS is intended for hospital outpatient departments, HCFA must designate facilities outside the walls of the hospital as "provider-based entities" before they can receive payment under the PPS.
"As drafted, the regulation could have a negative impact on hospitals that provide services to the poor and to poor (Medicare) beneficiaries" through satellite facilities, Nickels said late last week.
The AHA's comments came days after HCFA announced that the new billing systems are correctly processing the majority of Medicare claims to be paid under the 3-week-old PPS.
In a notice available on HCFA's World Wide Web site, www.hcfa.gov, the agency said it has told fiscal intermediaries that it no longer needs its first contingency plan, which was designed to pay claims in the event that claims couldn't be processed properly by the new systems.
HCFA also told the intermediaries that they may use the second contingency plan, which permits providers whose systems are not functioning properly to ask for accelerated Medicare payments for outpatient services.
Hospital groups, which unsuccessfully lobbied HCFA to delay the PPS a second time, were quick to paint a darker picture of the agency's PPS implementation progress.
"Some of our hospitals were told by their fiscal intermediaries that they won't be able to pay the claims on time," said Edward Goodman, vice president of public policy for VHA, an alliance of not-for-profit hospitals.