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.
| 2008D26 | 02-0326; 03-0730; 04-1130 | 05-0327 | Whether the payment for indirect medical education (IME) and direct graduate medical education (DGME) was understand because not all managed care days and discharges for inpatient services for Medicare beneficiaries were included in the calculation. |
| 2008D25 | 05-1788 | 05-0599 | Whether the Intermediary can make an adjustment to the Provider's Medicare cost report more than three years after the original Notice of Program Reimbursement date. |
| 2008D24 | 01-0679; 02-0244 | 05-0043 | Whether the TEFRA base year used by the fiscal intermediary to compute a target amount for the Provider's excluded psychiatric unit for the February 28, 1998 and February 28, 1999 cost years was proper. |
| 2008D23 | 04-1953; 05-1582 | 45-0076 | 1. Whether the Intermediary properly disallowed the Provider's request for an adjustment to the TEFRA rate-of-increase ceiling to account for the cost of new drugs that were not approved in the 1983 base year.; 2. Whether the Intermediary properly calculated the Provider's 1996 reasonable cost that were included in the denominator of the fraction used to determine the payment-to-cost ratio for purposes of the Outpatient Prospective Payment System (OPPS) hold harmless payment. |
| 2008D22 | 04-0183 | 31-0014 | Whether the Medicare fiscal intermediary erred by not including in the calculation of the disproportionate share hospital (DSH) payment for fiscal year 2000 all of the Provider's inpatient days relating to patients who were not entitled to Medicare, but who qualified for medical assistance under the New Jersey Charity Care Program. |
| 2008D21 | 01-1910 | 05-6833 | Whether the Intermediary properly disallowed bad debts claimed for uncollectible deductibles and coinsurance amounts related to outpatient therapy services furnished to Medicare beneficiaries dually eligible for Medicare and Medicaid, and paid under the Part B fee schedule. |
| 2008D20 | 06-0763; 06-2010 | 24-0213 | Whether the Intermediary's refusal to reimburse the Provider for capital-related costs under the hold harmless methodology was proper. |
| 2008D19 | 04-1995G | 35-0002; 35-0015 | Whether the Intermediary properly disallowed reimbursement for direct graduate medical education (DGME) and indirect medical education (IME) costs in the non-hospital setting by reducing the Provider's full-time equivalent (FTE) resident counts. |
| 2008D18 | 01-0801 | 14-0174 | Whether the Intermediary's adjustment disallowing the loss on disposal of depreciable assets through consolidation was proper. |
| 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. |
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