Trouble with images? View as a Web page.

Facebook Twitter More...

Download PDF

Polsinelli Shughart Health Reform and Related Health Policy News
More Information

For questions regarding
any of these issues,
please contact:

Matthew J. Murer
Practice Area Chair
Download vCard

Colleen M. Faddick
Practice Area Vice-Chair
Download vCard

Bruce A. Johnson
Practice Area Vice-Chair
Download vCard

Alan K. Parver
Practice Area Vice-Chair
Download vCard

Darryl Drevna
Download vCard


Additional Health Care Professionals

Cynthia E. Berry
Teresa A. Brooks
Julius W. Hobson, Jr.
Steven K. Stranne
Harry Sporidis


To learn more about our
Health Care practice,
click here.


Upcoming Health Care Events

Polsinelli Shughart Health Care Webinar Series:

Next Event:
Stark Update - What Providers Need to Know
- October 16, 2012




An executive summary of political, legal and regulatory issues that may impact your business, prepared by Polsinelli Shughart Health Care legal and Public Policy professionals.


Health Reform + Related Health Policy News

Update for October 3, 2012


Top News


Additional Hospital Groups Deny Fraudulent 'Upcoding,' Congress Eyes Funds for Doc-Fix Offset

The Federation of American Hospitals (FAH) and the Association of Academic Health Centers (AAHC) have joined the American Hospital Association in challenging CMS' assertion that hospitals are using upcoding to "game the system" and overcharge Medicare. The Obama Administration on September 24 sent a "strongly worded" letter to the American Hospital Association and other hospital groups warning that CMS will consider using its authority to address inappropriate coding through its payment rules. The Administration's letter from HHS Secretary Kathleen Sebelius and Attorney General Eric Holder said that there are "troubling indications" that some providers are using EHR systems to "game the system." The AHA responded that HHS should offer more clarity, not more "duplicative audits" that divert resources from patient care. The FAH and AAHC have denied any wrongdoing and said that HHS' lack of guidance is largely responsible for coding confusion. FAH wrote that EHRs allow hospitals to more accurately code patient encounters and are not used for potentially fraudulent spending. FAH wrote that better patient data results in more efficient and effective care. The AAHC responded that is concerned by the absence of "clear and useful guidance" on coding for evaluation and management services. AAHC also requested a meeting with CMS to discuss the issue.

The dispute over "upcoding" may prompt Congress to act. CMS earlier estimated that upcoding resulted in a 5.8 percent increase in hospital payments in 2008 and 2009. In response, CMS applied payment reductions in FY 2011 and FY 2012 to recoup the funds. For FY 2013, CMS proposed to impose an additional 1.9 percent reduction and an additional 0.8 percent reduction for case-mix issues, which together would have recovered $850 million from hospitals. While CMS did not finalize its proposal, congressional staff reportedly is investigating if the $850 million could be applied to an offset to cover the cost of preventing the scheduled 27 percent cut in Medicare physician payments.


State News


Regulatory News


Additional Reading

Click here for a list of additional articles.


Federal Register

Click here to preview a summary of notices which appeared in the September 28 - October 5, 2012 Federal Register.




Connect with us on Facebook. Connect with us on Twitter. Connect with us on LinkedIn.

With more than 600 attorneys, Polsinelli Shughart is a national law firm and a recognized leader in the areas of health care, financial services, real estate, life sciences, energy and business litigation. Serving corporate, institutional and individual clients, the firm builds enduring relationships by creating value through our legal services – with passion, ingenuity and a sense of urgency. The firm can be found online at Polsinelli Shughart PC. In California, Polsinelli Shughart LLP.

Chicago, Dallas, Denver, Edwardsville, Jefferson City, Kansas City, Los Angeles, New York Overland Park, Phoenix, St. Joseph, St. Louis, Springfield, Topeka, Washington, D.C., Wilmington DE

To update your email preferences, please contact To opt out of these communications, click the unsubscribe link below.

Polsinelli Shughart provides this material for informational purposes only. The material provided herein is general and is not intended to be legal advice. The choice of a lawyer is an important decision and should not be based solely upon advertisements. Polsinelli Shughart PC. In California, Polsinelli Shughart LLP. Polsinelli Shughart® is a registered trademark of Polsinelli Shughart PC.

Copyright © 2012 Polsinelli Shughart PC ®.