The Provider Reimbursement Review Board is an independent panel to which a certified Medicare provider of services may appeal if it is dissatisfied with a final determination of its fiscal intermediary or the Centers for Medicaid & Medicare Services (CMS). A decision of the Board may be affirmed, modified, reversed or vacated and remanded by the CMS Administrator within 60 days of notification to the provider of that decision.
| 2008D36 | 99-3519M | 05-0625 | Whether the Intermediary may refuse to apply a revised graduate medical education base year average per resident amount to the subsequent cost years that fall outside the three-year reopening period set forth in 42 C.F.R. Section 405.1885. |
| 2008D35 | 05-2054 | 36-0112 | 1. Whether the Intermediary's adjustment to include outpatient observation bed days in the bed count for purposes of calculating the Provider's indirect medical education (IME) reimbursment was proper.; 2. Whether the Intermediary's adjustment to include Medicaid outpatient observation days when determining disproportionate share hospital (DSH) eligibility and payment was proper. |
| 2008D34 | 02-1010; 02-0892; 02-1663; 02-2148; 30-0597; 03-1011; 04-0021; 04-0022 | 23-0053 | 1. Whether the Intermediary properly excluded FTEs attributable to rotations by residents in certain unaccredited training programs.; 2. Whether the Intermediary properly excluded IME FTEs attributable to time spent by residents in research that was required by the residents' approved medical residency programs.(On the Record); 3. Whether the Intermediary properly excluded FTEs attributable to resident leave time when it is taken during rotations in which the resident is conducting reserarch.; 4. Whether the Intermediary properly excluded from the FTE cap, FTes attributable to time spent by residents in new programs. |
| 2008D33 | 98-0019; 02-0785 | 22-5682 | 1. Whether the Provider is entitled to a new provider exemption from the skilled nursing facility (SNF) routine service cost limits under 42 C.F.R. section 1413.30(e) for the cost reporting year ended December 31, 1995.; 2. Whether the Intermediary's denial of the Provider's request to be reimbursed the Transitional Period Rate for SNFs under 42 C.F.R. section 413.340(e) for the cost reporting year ended December 31, 1999 was proper. |
| 2008D32 | 03-0778; 04-0914 | 23-0216 | 1. Whether the Provider was required to submit a claim to the Michigan Medicaid program and to obtain a Medicaid remittance advice in order to receive Medicare reimbursement for Part B bad debts relating to services furnished to patients dually eligible for Medicare and Medicaid.; 2. Whether the sampling methodology used by the Intermediary for determining the Provider's entitlement to bad debt payment for the fiscal year ended 6/30/2000 was proper. (CN: 03-0778 only) |
| 2008D31 | 02-0705 | 05-0241 | Whether the Intermediary may recoup an overpayment relative to the Provider's 1987 cost reporting period through a revised Notice of Program Reimbursement (NPR) issued in January 2002. |
| 2008D30 | 02-0050; 02-0615 | 14-4036 | 1. Whether the Intermediary properly adjusted Medicare bad debts.; 2. Whether the Intermediary properly adjusted the Provider's treatment of asset relifing.; 3. Whether the Intermediary properly adjusted public relations and marketing expenses.; 4. Whether the Intermediary properly adjusted officers' life insurance and wind down expenses. (Fiscal year ended (FYE) 10/31/99 only) |
| 2008D29 | 05-0133G; 05-243G | Various | Was the Provider's reimbursement for indirect medical education (IME) and direct graduate medical education (DGME) for Medicare managed care patients properly disallowed for fiscal year 1999 and fiscal year 2000 for failure to file UB92s in accordance with CMS instruction. |
| 2008D28 | 02-0463 | 03-7205 | Whether the Intermediary properly reclassified professional fees from the Administrative and General (A and G) -reimbursable cost center to the A and G-Shared cost center for the cost reporting period ending December 31, 1999. |
| 2008D27 | 05-1219 | 17-1302 | Was the Intermediary's adjustment to the provider's claimed owner's compensation proper? |
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