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.
| 2002D34 | 89-1181R | 05-0230 | 1. Did CMS invalidly apply pre-composite rate ESRD Screens to limit the Provider's reimbursement for the reasonable costs it incurred for the treatment of ESRD patients?; 2. Whether and to what extent the Provider is entitled to an exception from the $138 per treatment ESRD screens for fiscal years 2/28/81, 2/28/82, and 2/28/83. |
| 2000D37 | 95-2401; 95-2402; 95-2403 | 39-0029 | 1. Did HCFA properly deny the PRovider's requests for a permanent adjustment to its TEFRA base year in fiscal years ("";FY"";) 1989 and 1990, and the "";assignment of a new base period""; in FY 1991?; 2. Did HCFA properly grant only limited cost year specific adjustments? |
| 2006D07 | 99-3690G | Various | 1. Did Michael Reese Hospital (Reese) fail to exhaust its administrative remedies for a correction to its wage data during the February-March 1998 window for correcting wage data?; 2. Did Reese Hospital nevertheless meet the criteria for a correction in the mid-year correction process as a data entry or tabulation error?; 3. Can other hospitals in the same Metropolitan Statistical Area (MSA) seek a correction to the wage data for Reese Hospital? |
| 2000D13 | 94-0718 | 31-0001 | 1. Did the Intermediary err by including the Provider's fourteen neonatal intensive care unit ("NICU") beds when calculating the Medicare reimbursement for costs relating to indirect medical education ("IME")?; 2. Did the Intermediary err by including NICU days when calculating the Provider's Medicare reimbursement for graduate medical education ("GME") costs? |
| 2007D20 | 03-0573 | 36-0141 | 1. Did the Intermediary err in refusing to include Provider's cost for contracted perfusionist services in its wage index calculations?; 2. Did the Intermediary err in refusing to include Provider's cost for contracted pharmacy services in its wage index calculations? |
| 1998D089 | 91-2907M | 39-0196 | 1. Did the Intermediary improperly exclude physician compensation costs, attributable to teaching and supervision of interns and residents in the departments of surgery, from the graduate medical education ("";GME"";) costs used to compute the Provider's average per resident amount?: 2. Did the Intermediary improperly exclude physician compensation costs, attributable to teaching and supervision of interns and residents in the departments of radiation therapy, from the GME costs used to compute the Provider's average per resident amount?: |
| 2007D70 | 00-3349 | 34-6538 | 1. Did the Intermediary improperly reopen the cost report? (Provider Issue 1); 2. Was the Intermediary's adjustment to bad debts proper? (Provider Issue 2); 3. Was the Intermediary's adjustment to salaries proper? (Provider Issue 3); 4. Was the Intermediary's adjustment to travel expense - speech therapy proper? (Provider Issue 4); 5. Was the Intermediary's adjustment to travel expense - physical therapy proper? (Provider Issue 5); 6. Was the Intermediary's adjustment to travel expense - occupational therapy proper? (Provider Issue 6); 7. Were the Intermediary's adjustments to travel expense - administrative and general proper? (Provider Issue 7); 8. Was the Intermediary's adjustment to auto expense proper? (Provider Issue 8); 9. Was the Intermediary's adjustment to contracted services - occupational therapy services proper? (Provider Issue 9); 10. Was the Intermediary's adjustment to contracted services - speech therapy proper? (Provider Issue 10); 11. Was the Intermediary's adjustment to contracted services - administrative and general proper? (Provider Issue 11); 12. Was the Intermediary's adjustment to consulting expenses proper? (Provider Issue 12); 13. Was the Intermediary's adjustment to accounting expense proper? (Provider Issue 13); 14. Was the Intermediary's adjustment to legal fees proper? (Provider Issue 14); 15. Was the Intermediary's adjustment to supply expense proper? (Provider Issue 15); 16. Was the Intermediary's adjustment to seminar expense proper? (Provider Issue 16); 17. Was the Intermediary's adjustment to telephone expense proper? (Provider Issue 17); 18. Was the Intermediary's adjustment to administrative dues and subscription expense proper? (Provider Issue 18); 19. Was the Intermediary's adjustment to office supply expense proper? (Provider Issue 19); 20. Was the Intermediary's adjustment to rent expense - building and equipment proper? (Provider Issue 20); 21. Was the Intermediary's adjustment to maintenance agreement expense proper? (Provider Issue 21); 22. Was the Intermediary's adjustment to depreciation expense proper? (Provider Issue 22); 23. Was the Intermediary's adjustment to recruiting costs - Rehab Resources proper? (Provider Issue 23); 24. Was the Intermediary's adjustment to total charges - physical therapy proper? (Provider Issue 24); 25. Was the Intermediary's adjustment to total charges - occupational therapy proper? (Provider Issue 24); 26. Was the Intermediary' adjustment to total charges -speech therapy proper? (Provider Issue 24); 27. Was the Intermediary's adjustment to other charges - physical therapy proper? (Provider Issue 24); 28. Was the Intermediary's adjustment to other charges - occupational therapy proper? (Provider Issue 24); 29. Was the Intermediary's adjustment to other charges - speech therapy proper? (Provider Issue 24); 30. Were the Provider's requests for additional costs for depreciation and contracted services - physical therapy proper? (Provider Issues 25 and 26) |
| 2007D69 | 00-3348 | 34-6538 | 1. Did the Intermediary improperly reopen the cost report? (Provider Issue 1); 2. Was the Intermediary's adjustment to physical therapy salaries proper? (Provider Issue 2); 3. Was the Intermediary's adjustment to contracted occupational therapy services proper? (Provider Issue 3); 4. Was the Intermediary's adjustment to contracted speech therapy services proper? (Provider Issue 4); 5. Was the Intermediary's adjustment to contracted administrative services proper? (Provider Issue 5); 6. Was the Intermediary's adjustment to recruiting costs - physical therapy proper? (Provider Issue 6); 7. Was the Intermediary's adjustment to recruiting costs - occupational therapy proper? (Provider Issue 7); 8. Was the Intermediary's adjustment to recruiting costs - speech therapy proper? (Provider Issue 8); 9. Was the Intermediary's adjustment to recruiting costs - other proper? (Provider Issue 9); 10. Was the Intermediary's adjustment to recruiting costs - Rehab Resources proper? (Provider Issue 10); 11-14. Were the Intermediary's adjustments to seminars - physical therapy, occupational therapy, speech therapy and administrative proper? (Provider Issues 11, 12, 13 and 14); 15. Was the Intermediary's adjustment to administrative dues proper? (Provider Issue 15); 16-19. Were the Intermediary's adjustments to supplies - physical therapy, occupational therapy, speech therapy and administrative proper? (Provider Issues 16, 17, 18 and 19); 20. Was the Intermediary's adjustment to accounting expense proper? (Provider Issue 20); 21. Was the Intermediary's adjustment to telephone expense proper? (Provider Issue 21); 22. Was the Intermediary's adjustment to auto lease expense proper? (Provider Issue 23); 23. Was the Intermediary's adjustment to nursing home lease expense proper? (Provider Issue 24); 24. Was the Intermediary's adjustment to related party rent expense proper? (Provider Issue 25); 25. Was the Intermediary's adjustment to office equipment lease expense proper? (Provider Issue 26); 26. Was the Intermediary's adjustment to insurance expense proper? (Provider Issue 27); 27. Was the Intermediary's adjustment to home office costs proper? (Provider Issue 30); 28. Was the Provider's request for additional costs for depreciation proper? (Provider Issue 28) |
| 2007D77 | 00-3356 | 44-6530 | 1. Did the Intermediary improperly reopen the cost report?; 2. Was the Intermediary adjustment to contract services - administrative proper?; 3-4. Were the Intermediary's adjustment to contract services - speech and occupational therapy proper?; 5. Was the Intermediary's adjustment to travel - speech therapy proper?; 6-8. Were the Intermediary's adjustments to travel - physical therapy, occupational therapy and administrative proper?; 9. Was the Intermediary's adjustment to accounting expense proper?; 10. Was the Intermediary's adjustment to telephone expense proper?; 11. Was the Intermediary's adjustment to office supplies proper?; 12. Was the Intermediary's adjustment to recruiting costs proper?; 13. Was the Intermediary's adjustment to rent expense proper?; 14. Was the Intermediary's adjustment to total expense proper?; 15. Was the Intermediary's adjustment to interim payments proper? (Provider Issue 16); 16. Was the Intermediary's adjustment to home office costs proper? (Provider Issue 17); 17. Was the Provider's request for costs incurred in the settling of cost reports after termination from the Medicare program proper? (Provider Issue 15) |
| 2007D73 | 00-3352 | 42-6548 | 1. Did the Intermediary improperly reopen the cost report?; 2. Was the Intermediary's adjustment to Medicare bad debts proper?; 3. Was the Intermediary's adjustment to physical therapy salaries proper?; 4. Was the Intermediary's adjustment to recruiting costs - other proper?; 5. Was the Intermediary's adjustment to recruiting costs - Rehab Resources proper?; 6. Was the Intermediary's adjustment to supplies - physical therapy proper?; 7. Was the Intermediary's adjustment to supplies - administrative proper?; 8. Was the Intermediary's adjustment to office supplies proper?; 9. Was the Intermediary's adjustment to accounting expense proper?; 10. Was the Intermediary's adjustment to contract services - physical therapy proper?; 11. Was the Intermediary's adjustment to contract services - occupational therapy proper?; 12. Was the Intermediary's adjustment to contract services - administrative proper?; 13. Was the Intermediary's adjustment to rent expense proper?: 14. Was the Intermediary's adjustment to telephone expense proper?; 15. Was the Intermediary's adjustment to home office costs proper? (Provider's Issue 16); 16. Was the Provider's request for the inclusion of additional costs for depreciation for which there were no adjustments made proper? (Provider's Issue 15) |
Email
Print
