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.
| 2008D17 | 04-0088G | Various | Whether the Providers are entitled to receive additional indirect medical education (IME) and direct graduate medical education (DGME) payments for Medicare managed care enrollees for fiscal years ended December 31, 1998 and 1999. |
| 2008D13 | 00-1904G | Various | Whether the Intermediary's calculation of the disproportionate share hospital (DSH) payment was proper. |
| 2007D67 | 03-0522G | Various | Whether the Intermediary failed to properly adjust the wage data for Rochester General Hospital used in the calculation of the Federal Fiscal Year (FFY) 2003 Wage Index for The Rochester, New York Metropolitan Statistical Area (MSA). |
| 2008D02 | 01-1674G | Various | 1. Whether the Providers entitled to have general relief (GR) days included in the calculation of their disproportionate share percentage to the hold harmless provisions of Program Memorandum A-99-62.; 2. Whether the failure to allow the Providers to include GR days in the calculation of their disproportionate share percentage was arbitrary and capricious and in violation of law. |
| 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. |
| 2007D52 | 02-0530G | Various | Whether St. Luke's Hospital's letter of March 8, 2001 requesting corrections to its hospital wage data for its fiscal year ended 6/30/1999 (including documentation contained in Exhibit 1-7) satisfied the requirements established by CMS (then HCFA) set forth in 66 Fed. Reg. 39828 -39871 (Aug 1, 2001) for a timely request to the hospital's intermediary to correct any incorrectly reported wage data on its cost report for purposes of the wage data correction process. |
| 2007D42 | 00-1882G | Various | Whether the Intermediary's adjustments disallowing the loss claimed by Medicare Providers on the disposition of assets resulting from the statutory merger of California Medicorp into Presbyterian Health Services Corporation were proper. |
| 2000D88 | 99-3515G | Various | Were the Intermediary's adjustments reclassifying workers' compensation and unemployment insurance expenses from the administrative and general cost center to the varying cost centers where employees were assigned proper? |
| 2000D83 | Various | Various | Was the Intermediary's inclusion of maintenance treatments in the Provider's cost aportionment statistics for Medicare reimbursement proper? |
| 2000D81 | 96-2281G | Various | Whether HCFA's methodology of determining the amount of the exception from the routine cost limits for freestanding skilled nursing facilities (SNF) as set forth in HCFA Pub. 15-1, Section 2534.5, Transmittal No. 378, is correct? |
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