Under Section 1878 of the Social Security Act and the regulations at 42 CFR 405.1875, the Administrator of the Centers for Medicare & Medicaid Services has the authority to review decisions rendered by the Provider Reimbursement Review Board and to issue final Agency decisions for the Secretary of the Department of Health and Human Services.
If you need a copy of a decision that is not listed on this site, please contact the Office of the Attorney Advisor. Please note that, because of 508 compliance needs, these decisions are not copies of the actual signed Administrator decisions. Copies of the actual signed decisions may be obtained from the Office of the Attorney Advisor.
| 2006-D07 | Chicago 98-00 MSA Wage Index Group vs. Mutual of Omaha Insurance Company | N/A |
| 2006-D1 | Saint Mars Hospital vs. BlueCross BlueShield Association/Noridian Administrative Services | Whether the Intermediarys denial of the Providers request for an adjustment to its TEFRA target amount due to untimely filing of the request was proper. |
| 2006-D10 | Highland Medical Center vs. Mutual of Omaha Insurance Company | Whether the Intermediarys determination that the Provider had less than 100 beds for purposes of disproportionate share hospital (DSH) eligibility purposes under the inpatient prospective payment system (IPPS) was proper. |
| 2006-D11 | St. Joseph Hospital vs. Mutual of Omaha Insurance Company | Whether the denial of the Providers request for an exception to the renal dialysis composite rate by the Centers for Medicare and Medicaid Services (CMS) was proper. |
| 2006-D12 | Immanuel - St. Josephs Hospital vs. Blue Cross Blue Shield Association/Noridian Administrative Services | Whether the Intermediarys adjustment to reduce the unweighted FTE resident count and related adjustment cap for time spent by residents providing services at the Mankato Clinic was proper. |
| 2006-D13 | Community Hospital of the Monterey Peninsula vs. BlueCross BlueShield Association/United Government Services, LLC-CA | Whether for purposes of the Providers disproportionate share (DSH) adjustment calculation, the Provider is entitled to an increased number of days of care rendered to eligible Medicaid beneficiaries. |
| 2006-D14 | Harborside Healthcare-Reservoir vs. BlueCross BlueShield Association/Empire Medicare Services | Whether the Intermediary properly denied the Providers new provider exemption request. |
| 2006-D15 | Acadian HomeCare, Inc. vs. Blue Cross Blue Shield Association/Palmetto Government Benefits Administrators | Whether the Intermediarys disallowance of medical director fees was proper. |
| 2006-D16 | Dameron Hospital vs. Blue Cross Blue Shield Association/United Government Services, LLC | Whether the Intermediarys disallowance of the Providers inpatient and outpatient Medicare bad debts was proper. |
| 2006-D17 | Alden Court Nursing Home vs. Mutual of Omaha Insurance Company | Whether CMS denial of the Providers request for an exception to the routine cost limits for skilled nursing facilities as a provider of atypical services was proper. |
