Kelly Cleary Quoted in Modern Healthcare on CMS’s Rejection of Site-Neutral Pay Cut Exemptions

Akin Gump health care and life sciences partner Kelly Cleary has been quoted in the Modern Healthcare story “Hospitals get ‘raw deal’ as CMS rejects site-neutral pay cut exemptions.”

The article reports that the Centers for Medicare & Medicaid Services (CMS) may claw back millions of dollars in payments after denying reimbursement rate cut exemptions for hospitals’ off-campus outpatient facilities. As a result, the article says, these facilities’ reimbursement rates would drop to 40 percent of the full Outpatient Prospective Payments System rate and they might also be liable for overpayments going back to 2018.

Cleary noted that, while the law precludes administrative and judicial review of audit determinations, it would not necessarily preclude a challenge to CMS’ decision to retroactively apply the determination. It also would not preclude a provider from challenging the audits themselves, she said.

“The fact that it took CMS over two years to make these determinations public is perhaps the most remarkable aspect of this,” said Cleary. “While CMS sat on the audit results, some providers were unknowingly accruing what CMS believes are overpayments. This is patently unfair, and could further compound the financial losses many providers incurred as a result of the pandemic.”