Vermont hospitals will soon be receiving a communication from the Department of Vermont Health Access (DVHA) saying hospitals will receive reimbursement for underpayments relating to high level emergency department claims (99284 and 99285) from July 14, 2009 through September 30, 2010.  The decision to reimburse these claims is a result of ongoing negotiations with DVHA jointly initiated by Central Vermont Medical Center and Rutland Regional Medical Center who worked our firm to pursue their claims.  My colleague Maggie Platzer and I represented the hospitals.  After exchange of significant legal and reimbursement analysis, we were able to convince Commissioner Larson that the claims had not been properly paid, and then we worked cooperatively with him to correct the error for the hospitals.  These efforts were so successful that they resulted in a decision to reimburse all hospitals for the identified underpayments.

We are told by DVHA that they are currently calculating the amounts owed to each hospital for these claims and will be issuing reimbursements soon.  We expect the reimbursement will come with a condition that each hospital sign a release in favor of DVHA for underpayments related to emergency department services during a larger time frame than what is being reimbursed.

The underpayments result from a fairly complicated application of OPPS packaging rules by DVHA and involve significant monies for most hospitals - the impact on the two clients is more than $800,000.  If you'd like further details about the underpayment issue, please contact me.

Linda Cohen, Chair, Healthcare Practice Group