Instructions for the Provider Reimbursement Review Board - (Prior to August 21, 2008)

The Provider Reimbursement Review Board's Instructions for providers and intermediaries are effective on March 1, 2002. These Instructions supercede those previously issued on May 5, 2000.  [Issued March 1, 2002] [Note: A clerical correction was made to Part I-B.I.a.2. on March 25, 2002]

Supplemental Instructions for ESRD Appeals

A set of supplemental instructions which set forth hearing procedures for ESRD appeals. [Issued March 15, 2001]

Supplemental Instructions for Appeals of Childrens Hospital Graduate Medical Education (CHGME)

A set of supplemental instructions which set forth hearing procedures for Appeals of Children's Hospital Graduate Medical Education (CHGME). [Issued May 03, 2004]

NEW RULES - (Effective August 21, 2008)

The Provider Reimbursement Review Board's (Board) Rules, which are effective August 21, 2008, are provided below.  To coincide with the CMS Final Rule at 73 Fed. Reg. 30190 which updated, clarified and revised regulatory provisions governing Board appeals, these Board Rules apply to all appeals pending as of, or filed on or after, August 21, 2008.

These Rules supersede the Board's previous Instructions.  The Board may revise these Rules to reflect changes in the law, regulations or the Board's policy and procedures.

SUGGESTIONS:

We welcome written suggestions regarding these Rules.  Please send your suggestions to SuggestionsonPRRBRules@cms.hhs.gov.  We will consider every suggestion but may not respond to each one.

CORRESPONDENCE NOTICE:

The PRRB often sends official correspondence via e-mail (including the Acknowledgement and Critical Due Dates letter).  Please modify your spam filter to accept e-mail from the PRRB.  This will help ensure that you receive the Board's correspondence and it is not sent to your spam or junk e-mail box.  In addition, please watch this website for Alerts, Answers to Frequently Asked Questions and other notices.

ALERT 1: Automatic Extension of Position Paper Due Dates - (August 13, 2008)

If you received an acknowledgement letter prior to August 21, 2008 which set preliminary or final position paper due dates that fall due on or after September 1, 2008, the Provider's preliminary position paper deadlines (or proposed JSO) is extended by four months from the original due date.  If a jointly executed proposed JSO is not filed by this 4 month extension, the Intermediary's preliminary position paper due date will be extended by six months from the original due date as noted in the acknowledgement letter.

The parties may disregard any final position paper due dates set in acknowledgment letters issued before August 21, 2008.  Final position paper due dates will be reset in the Board's Notice of Hearing.

Example:  An acknowledgement letter issued August 5 would set the Provider's and Intermediary's preliminary due dates as December 1 and February 1 respectively.  Both parties' final position papers would have been due on April 1.   Under this scenario, the parties would have to submit either a jointly signed proposed JSO or a provider preliminary position paper by April 1 and if a proposed JSO was not submitted, the intermediary preliminary position paper would be due 6 months from the original due date or on August 1.  In either case, the original final position paper due dates would be suspended and new dates will be set in the Board's Notice of Hearing.

ALERT 2: Clarification of PRRB Deadlines - (October 1, 2008) 

Contents:

A.  Automatic Extension of Position Paper Due Dates - Individual Appeals

B.  Due Dates for Position Papers When a Revised NPR Appeal is Combined with an Existing Appeal - Individual Appeals

C.  Optional (Non-CIRP) Groups Filed Prior to August 21, 2008

D.  Optional (Non-CIRP) Groups that Received Group Acknowledgment & Critical Due Dates Letters Between August 21, 2008 and September 25, 2008

E.  Optional (Non-CIRP) Groups Filed On or After August 21, 2008

F.  Mandatory (CIRP) Groups Filed Prior to August 21, 2008

G.  Mandatory (CIRP) Groups Filed On or After August 21, 2008

              NOTE:  PLEASE SEE LINK BELOW TO DOWNLOAD THIS ALERT

ALERT 3:  ADDED ISSUE DEADLINES - (October 3, 2008)

The following are deadlines applicable only to CASES PENDING BEFORE AUGUST 21, 2008, AND HAVE AN ISSUE ADDED ON OR AFTER AUGUST 21, 2008.  

In cases filed prior to August 21, 2008, if issues are added after that date pursuant to 73 FR 30240 (60 days after implementation of the Regulations or, as applicable, 60 days after expiration of the 180 day appeal deadline) but after position paper deadlines have already expired, a supplemental position paper that complies with the requirements of Rule 25 for the added issue is due as follows: 

     *   Provider's supplemental position paper - 120 days prior to hearing 

     *   Intermediary's response - 60 days prior to hearing 

     *   Provider's rebuttal (optional) - 30 days prior to hearing. 

EXCEPTION:  If you have a hearing date scheduled on or before March 1, 2009, contact the Intermediary to work out a position paper schedule for the added issue. If no agreement can be reached, contact your Board Advisor. The position paper must meet Rule 25 requirements.

ALERT 4: ADDED ISSUE (PRIOR TO AUGUST 21, 2008) POSITION PAPER DEADLINES) - (November 12, 2008)

If an issue was added to an appeal prior to August 21, 2008, after your final position paper was filed and the issue has not yet been briefed, a supplemental position paper that complies with the requirements of Rule 25 for the added issue is due as follows: 

*  Provider's supplemental position paper on the added issue - 120 days prior to hearing. 

*  Intermediary's responsive position paper on the added issue - 60 days prior to hearing. 

*  Provider's rebuttal (optional) - 30 days prior to hearing. 

Exception: If you have a hearing date scheduled on or before March 1, 2009, contact the Intermediary to work out a position paper schedule for the added issue. If no agreement can be reached, contact your Board Advisor. The position paper must meet Rule 27 requirements.

FREQUENTLY ASKED QUESTIONS (FAQs) - October 24, 2008

Please see link below to download FAQs.

NEW REGULATIONS - 2008

The Centers for Medicare & Medicaid Services issued new appeal regulations for Medicare Part A provider appeals on May 23, 2008.  These regulations will affect Provider Reimbursement Review Board (PRRB) appeals pending as of or filed on or after August 21, 2008.  The regulations are available for download.  (See Related Links Outside CMS at the bottom of the page.)

Downloads
PRRB Instructions [PDF, 665 KB] (Prior to August 21, 2008) Supplemental Instructions for ESRD Appeals [PDF, 7 KB] Supplemental Instructions for CHGME [PDF, 63 KB] PRRB Rules 2008 [PDF, 2,136 KB] (Effective August 21, 2008) ALERT 2: CLARIFICATION OF PRRB DEADLINES [PDF, 38 KB] (October 1, 2008) FREQUENTLY ASKED QUESTIONS (FAQs) [PDF, 20 KB] (October 24, 2008)
Related Links Inside CMS
There are no Related Links Inside CMS
Related Links Outside CMS
CMS New Medicare Appeal Regulations for Medicare Part A Providers (May 23, 2008)

Page Last Modified: 11/12/2008 10:18:51 AM
Help with File Formats and Plug-Ins