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.
| 2009D21 | 09-0380GC | Various | Whether the Board has jurisdiction over a challenge to an overpayment recoupment action involving the Provider's liability for erroneous payments made to the former owners of the skilled nursing facilities (SNFs) after the change of ownership. |
| 2009D20 | 04-1997G | Various | Whether the Intermediary improperly disallowed direct graduate medical education (DGME) and indirect medical education (IME) payments with respect to discharges of Medicare beneficiaries who were enrolled in Medicare+Choice or other Medicare risk plans in fiscal years ended December 31, 1998, December 31, 1999 and December 31, 2000. |
| 2009D19 | 05-1873; 05-1879; 05-1880; 05-1881 | 24-0036 | Whether the Intermediary should have included all general assistance days in the computation of the Provider's Medicare Disproportionate Share (DSH) adjustment calculation for the Provider's fiscal years ended June 30, 1997, 1998, 1999, and 2000. |
| 2009D18 | 09-0801 thru 09-0810; 09-0815; 09-0816 | 05-0126 | Whether the Board has jurisdiction over the Intermediary's refusal to reopen cost reports to adjust the Supplemental Security Income percentages where the request for reopening were filed more than three years after the issuance of the Notices of Program Reimbursement (NPR). |
| 2009D17 | 09-0764G; 09-1053GC | Various | Should the Provider Reimbursement Review Board (Board) grant expedited judicial review over the question of whether Secretary's elimination of the budget neutrality adjustment factor (BNAF) used in the calculation of hospice payment rates was proper? |
| 2009D16 | 05-1296G; 05-1315G; 05-2197G; 06-1668G | 07-0010; 07-0022; 07-0018 | Whether the Intermediary properly disallowed direct graduate medical education (DGME) and indirect medical education (IME) payments with respect to discharges of Medicare beneficiaries who were enrolled in the Medicare + Choce or other Medicare risk plans in fiscal years ending September 30, 1998, 1999, 2000 and 2001. |
| 2009D15 | 92-1212; 92-1522 | 45-0196 | Whether the denial of the Provider's request for an exception to the Tax Equity and Fiscal Responsibility Act (TEFRA) rate for its rehabilitation unit was proper. |
| 2009D14 | 04-1293 | 08-5029 | 1. Whether the Intermediary's notification of the reopening of the Provider's 1996 cost report was timely pursuant to regulatory standards.; 2. Whether the Intermediary's determination to disallow costs for the Provider's contracted therapy services was proper. |
| 2009D13 | 02-0488; 03-1001 | 05-4144 | Whether the Intermediary's determination of the Provider's direct graduate medical education (DGME) payment was proper. |
| 2009D12 | 08-2907G | Various | Whether the Board has jurisdiction over a challenge to the validity of the Supplemental Security Income percentage under the doctrine of equitable tolling where the appeals were not filed within three years of the issuance of Providers' Notices of Program Reimbursement. |
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