An acute-care hospital that missed a reporting deadline under the Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU) program lost its final appeal seeking refund of $570,000 it says it was underpaid in 2009. According to an April 8 ruling by the Ninth Circuit in its ruling on the appeal filed by PAMC Ltd. d/b/a Pacific Alliance Medical Center (PAMC), the Centers for Medicare and Medicaid Services (CMS) acted reasonably when it reduced the hospital’s market basket update payments under the RHQDAPU program by 2 percent. PAMC filed for a reconsideration with CMS, which was denied. PAMC then appealed to the Provider Reimbursement Review Board (PRRB), which upheld CMS’s decision in denying the reconsideration decision. PAMC then appealed to the Ninth Circuit, which upheld the PRRB decision. PAMC missed the deadline for submitting quality data for the second quarter for fiscal year 2007. PAMC argued in its reconsideration request that CMS acted arbitrarily and capriciously in its refusal to excuse PAMC’s late filing and that it had a right to equitable relief or the benefit of contract doctrine of substantial performance. The hospital argued that the late filing was not its fault because it had used a third-party vendor, […]
An acute-care hospital that missed a reporting deadline under the Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU) program lost its final appeal seeking refund of $570,000 it says it was underpaid in 2009.
According to an April 8 ruling by the Ninth Circuit in its ruling on the appeal filed by PAMC Ltd. d/b/a Pacific Alliance Medical Center (PAMC), the Centers for Medicare and Medicaid Services (CMS) acted reasonably when it reduced the hospital’s market basket update payments under the RHQDAPU program by 2 percent. PAMC filed for a reconsideration with CMS, which was denied. PAMC then appealed to the Provider Reimbursement Review Board (PRRB), which upheld CMS’s decision in denying the reconsideration decision. PAMC then appealed to the Ninth Circuit, which upheld the PRRB decision.
PAMC missed the deadline for submitting quality data for the second quarter for fiscal year 2007. PAMC argued in its reconsideration request that CMS acted arbitrarily and capriciously in its refusal to excuse PAMC’s late filing and that it had a right to equitable relief or the benefit of contract doctrine of substantial performance. The hospital argued that the late filing was not its fault because it had used a third-party vendor, Thompson Reuters, which was responsible for submitting the data in a timely manner. Thompson Reuters took responsibility for the missed deadline. The hospital also argued that the filing was not very late, approximately 12 hours.
In the ruling, the court pointed out that PAMC did have sufficient time to file the required data in a timely manner like the vast majority of hospitals did successfully. It also pointed out that the vendor PAMC used had reported timely data for about 400 other hospitals. PAMC admitted to missing the deadline and CMS holds hospitals ultimately responsible for ensuing that their vendors submit timely data and comply with all requirements of the RHQDAPU program. Ultimately, the court upheld the PRRB decision.
Takeaway: A hospital, or any other health care provider, is responsible for the actions of it vendors and agents and any errors they may make.
