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.
| 2007D75 | 00-3353 | 42-6548 | 1. Did the Intermediary improperly reopen the cost report?; 2. Was the Intermediary's adjustment to salaries - physical therapy proper?; 3. Was the Intermediary's adjustment to salaries - speech therapy proper?; 4. Was the Intermediary's adjustment to salaries - occupational therapy proper?; 5. Was the Intermediary's adjustment to salaries - administrative proper?; 6. Was the Intermediary's adjustment to travel expenses proper?; 7. Was the Intermediary's adjustment to accounting expense proper?; 8. Was the Intermediary's adjustment to recruiting cost - Rehab Resources proper?; 9. Was the Intermediary's adjustment to occupational therapy expense proper?; 10. Was the Intermediary's adjustment to consultant expense proper?; 11. Was the Intermediary's adjustment to maintenance expense proper?; 12. Was the Intermediary's adjustment to contract services - administrative and general (A&G) proper?; 13. Was the Intermediary's adjustment to contract services - occupational therapy proper?; 14. Was the Intermediary's adjustment to contract services - physical therapy proper?; 15. Was the Intermediary's adjustment to rent expense proper?; 16. Was the Intermediary's adjustment to telephone expense proper?; 17. Was the Intermediary's adjustment to total charges - physical therapy proper?; 18. Was the Intermediary's adjustment to other charges - physical therapy proper?; 19. Were the Provider's requests for the inclusion of additional costs for depreciation and reimbursable bad debts for which no adjustments were made proper? (Provider's Issues 19 and 20); 21. Was the Intermediary's adjustment to total expenses proper? |
| 1998D034 | 97-1914 | 11-6670 | 1. Did the Intermediary properly adjust Medicare charges?; 2. Did the Intermediary properly adjust Medicare deductables, co-insurance and payments?; 3. Did the Intermediary properly adjust physical therapy salary equivalency limits?; 4. Was the Intermediary's adjustment to legal and accounting costs and other offset items proper?; 5. Was the Intermediary's adjustment to other self-disallowed costs proper? |
| 2000D57 | 96-0939 | 05-0267 | 1. Did the Intermediary properly include the Provider's inpatient Part B charges with outpatient Part B charges, thereby subjecting the inpatient Part B charges to the 5.8% outpatient cost reduction?; 2. Was the Intermediary's calculation of the Provider's disproportionate share ("";DSH"";) adjustment proper? |
| 1999D41 | 96-2199 | 16-0088 | 1. Did the Intermediary, in the course of considering the Provider's request for a Medicare Dependent Hospital (MDH) volume adjustment, have jurisdiction to waive compliance with the applicable time requirement and to grant the Provider a one-day extension of time?; 2. If so, did the circumstances in this case merit such a waiver and extension? |
| 1998D090 | 92-0948 | 50-0064 | 1. Did the Provider maintain adequate documentation to properly determine the paramedical education costs claimed for the physical therapy clinical training program and did those costs qualify as paramedical education costs reimbursable on a pass-through basis?; 2. Was the Provider's inclusion of foreign medical graduates in its resident count proper?; 3. Was the Provider's documentation adequate to support additional claimed costs related to the County Treasurer's costs of services performed for the Provider? |
| 2005D26 | 97-2174 | 38-0018 | 1. Does the Board have jurisdiction over a new provider exemption appeal filed within 180 days of exemption determination?; 2. Does the Board have jurisdiction over multiple fiscal years in a new provider exemption or must the Provider file an exemption request for each cost reporting period?; 3. Was the Health Care Financing Administration's (HCFA's)denial of the Provider's request for exemption as a new provider proper? |
| 2004D27 | 95-2033R; 96-1979R; 97-1498R; 98-2049R | 04-0036 | 1. Does the Provider meet the criteria set forth at Section 4004(b) of Omnibus Budget Reconciliation Act (OBRA) 1990?; 2. Do the costs at issue meet the definition of clinical training costs? |
| 1998D061 | 91-2894M; 92-1709; 94-1277; 94-1278; 94-1702; 94-2063 | 36-0152 | 1. Should the costs incurred by the Provider's General Practice Center ("";GPC"";) for the Family Practice Residency Program be costs of a separate outpatient cost center or costs of the interns and residents medical education cost center and included in the graduate medical education ("";GME"";) base year cost and "";rate""; year per resident amounts?; 2. Should the salaryand incentive compensation of GPC's director and assistant director be costs of a separate outpatient ancillary cost center or costs of the interns and residents medical education cost center and included in the graduate medical education ("";GME"";) base year cost and "";rate""; year per resident amounts? |
| 1998D050 | 94-2093G; 94-2094G; 94-2095G; 96-1323G; 96-1325G | Various | 1. Should the Intermediary have appled the exception to the related organizations principal in computing the Provider's reimbursement for the serices of Data-Med, Inc. the organization which supplies the data processing and other computer services to the Providers?; 2. Was the Intermediary's adjustment to directly allocate salaries proper?; 3. Was the Intermediary's disallowance of owners' compensation costs proper? |
| 2007D13 | 97-2986 | 14-0119 | 1. Should the Provider's transplant surgery residents be included in the full-time equivalent (FTE) count for the purposes of both direct graduate medical education (DGME) and indirect medical education (IME) reimbursement?; 2. To the extent transplant surgery residents are not included in the FTE counts for purposes of DGME and IME, is the Provider entitled to reimbursement for costs it incurred with such individuals pursuant to 42 C.F.R. Section 4105.523?; 3. In calculating the Provider's Disproportionate Share Hospital (DSH) payment, should all of the Medicaid Health Maintenance Organization (HMO) days, as reported by the Illinois Department of Public Aid, be included?; 4.Was the intermediary's disallowance of a portion of the depreciation expense claimed for the Atrium Pavilion proper? |
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