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List of PRRB Decisions

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 (FI)/Medicare Administrative Contractor (MAC) 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.

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Decision # Case # Provider # Issue
2004D11 99-3324 42-7025 1. Was the intermediary's adjustment to Board of Directors fees proper?; 2. Was the intermediary's adjustment to routine and non-routine supply costs proper?
2004D14 98-1861 34-0115 Was the Intermediary's determination disallowing the loss incurred on change of ownership proper?
2004D15 97-2025 05-0373 Whether the Provider's budgeted beds are the most appropriate measure of available beds for proposes of computing the indirect medical education (IME) payment?
2004D17 00-2285 32-7125 Was the Intermediary's adjustment to the Provider's cost limits proper?
2005D20 02-1342 15-0021 1. Whether for purposes of evaluating the Routine Cost Limit (RCL) exception request, the base year per diem amounts should be adjusted to reflect reclassifications made by the Provider.; 2. Whether the Intermediary properly offset the costs for the "private room differential" from the direct cost centers only.
2005D21 02-0028 18-5175 Whether the Intermediary's adjustment removing the Skilled Nursing Facility (SNF) for purposes of evaluating the Routine Cost Limit (RCL) exception amount was appropriate?
2005D23 01-3385 53-7025 1. Whether the Intermediary's disallowance of a portion of the fiscal year 1998 accrued compensation for the Provider's Administrator and Assistant Administrator was proper?; 2. Whether the Intermediary's disallowance of a portion of the fiscal year 1998 payroll taxes and other withholdings required by the government was proper?; 3. Whether the Intermediary's adjustment removing a portion of claimed consulting, accounting and legal fees was proper?
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?
2005D30 03-0901 19-4056 Whether the Intermediary erred when it adjusted the method of reimbursing the Provider's skilled nursing facility (SNF) from cost-based reimbursement to the prospective payment system (PPS.)
2004D31 99-3760 39-7628 Was the Intermediary's adjustment applying Medicare's Physical Therapy Compensation Guidelines to the Provider's employee physical therapists proper?
2004D32 98-2100 24-0063 1. Was the Intermediary's adjustment to the provider's disproportionate share (DSH) payment proper? ; 2. Was the Intermediary's adjustment to the provider's capital DSH payment proper?
2004D33 99-3663G; 00-2170G Various Should the provider's Federal Insurance Contributions Act (FICA) payroll costs be classified to the administrative and general cost center?
2004D35 96-0059; 96-0060 15-5383 Was the Provider entitled to an exemption from the routine cost limit as a "new" provider?
2004D36 00-0386 39-0088 Was the Intermediary's denial of the Provider's loss on disposal of assets proper?
2004D37 96-0720 18-0092 Whether non-acute care swing-bed days should be included in the Medicare proxy for the disproportionate share calculation ("DSH")?
2004D38 02-1971 31-0067 Was the intermediary's determination of loss on consolidation proper?
2004D39 96-0591; 97-2042 05-7252 Should denied Medicare visits be included in the "total visits" count for purposes of apportioning costs to the Medicare program?
2004D40 02-0431; 02-0364 23-0075; 23-0004 1. Was the Intermediary's adjustment to the Provider's TEFRA rate Proper?; 2. Did the Intermediary properly conclude that the Provider failed to make reasonable collection efforts and document such efforts with respect to certain bad debts claimed by the Provider?
2004D41 98-3477G Various Was the Intermediary's determination of the disproportionate share hospital (DSH) computation relating to state-only General Assistance Days Proper?
2004D42 01-2416 05-4012 Did the Intermediary properly eliminate the Provider's Medicare bad debts due to the Provider allowing discounts to only non-Medicare patients?
2004D43 00-3936; 00-3937 19-2531; 19-2509 Whether the Intermediary correctly disallowed Medicare bad debts related to amounts not included in the End-Stage Renal Dialysis (ESRD) Composite rate?
2004D44 94-2187 23-0098 Whether the cost of terminating Provider's retirement benefits and retirees' health and life insurance benefits, which were allowed and approved by the Intermediary, should be allocated to prior cost reporting periods and reimbursed to the Provider as a below-the-line adjustment in its final cost report?
2004D46 01-1540; 01-2860; 02-1247 23-7251 Was the Intermediary's adjustment to start-up costs proper?
2003D01 99-0299; 99-3610 26-0094 Were the Intermediary's adjustments reclassifying home health agency (HHA) building rent to the HHA cost center and the elimination of corresponding square footage allocation statistics proper?
2003D02 99-3300 45-0272 Whether the Intermediary's disallowance of disproportionate share (DSH) payments to the Provider on the grounds that it did not have 100 or more available beds was proper?
2003D03 01-0710G Various 1. Were the Intermediary's adjustments to the Providers' cost reports for FYE 12/31/97 to eliminate the Providers' claimed losses on disposition of assets proper?; 2. Did the Intermediary err in determining that the Providers disposed of their assets on or after December 1, 1997?; 3. Alternatively, is the regulation that eliminates recognition of gain or loss on asset sales on or after December 1, 1997 invalid, so that the Providers are entitled to losses on disposition of their assets regardless of the date on which that disposition occurred?
2003D04 01-0320 28-5149 Whether the provider's appeal of bad debts was derived from an intermediary determination or adverse finding?
2004D19 99-0729; 01-0036 39-5432 Was it proper for the Intermediary to make an adjustment to remove the hours in the ancillary areas used to allocate nursing administration on Worksheet B-1 of the Medicare cost report?
2004D18 01-1017 10-5930 Whether the Intermediary's adjustment reducing the adjusted hourly salary equivalency amount allowed for services of Physical Therapy Aides was proper?
2004D22 03-0063; 03-0064 39-0026 Were the Intermediary's adjustments disallowing direct graduate medical education (GME) and indirect medical education (IME) costs of the interns and residents full-time equivalent counts proper?
2004D24 98-0815 15-7046 Was the Intermediary's decision to deny the Provider's request for an exception to Medicare's salary equivalency guidelines for physical therapy services furnished under arrangement proper?
2004D25 96-1496; 98-0237 14-7135 Was the Intermediary's adjustment disallowing Medicare reimbursement for a portion of the Provider's physical therapy costs due to its application of physical therapy compensation guidelines 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?
2004D29 96-2359; 01-0124 22-5681 Was the Intermediary's denial of the Provider's request for an exemption from Medicare's service cost limits proper?
2003D19 99-0646 03-5145 Whether the Intermediary properly calculated the Provider's Medicare bad debts?
2003D21 01-0153 06-7201 Was the Intermediary's adjustment to owner's compensation proper?
2003D22 96-1531, 97-1417; 98-1063 20-0024 Is the Provider entitled to a TEFRA exception?
2003D23 99-0160 45-0119 Was the Intermediary's determination of available beds for purposes of the disproportionate share payment calculation proper?
2003D06 97-0061 & 97-0062 22-0156; 22-0111 Was there a recognizable loss upon the transfer of assets to Good Samaritan Medical Center ("Good Samaritan") from Goddard Memorial Hospital ("Goddard") and Cardinal Cushing Hospital ("Cushing") that occurred in connection with the consolidation of the two hospitals and the resulting creation of Good Samaritan Medical Center?
2003D08 00-3980 49-5281 Was the Intermediary's adjustment disallowing the allocation of general service costs to the ancillary cost centers proper?
2003D09 00-3979 17-5185 Was the Intermediary's adjustment disallowing the allocation of general service costs to the ancillary cost centers proper?
2003D10 00-3413 39-5460 1. Was the Intermediary's reclassification of Staff Development Coordinator salaries proper?; 2. Was the Intermediary's reclassification of Social Services salaries proper?
2003D12 97-1686 39-7006 Was the Intermediary's adjustment to rent paid by the Provider to a related party proper?
2003D18 99-0321 06-3027 Did the Intermediary incorrectly determine that the Provider was not entitled to a new provider exemption from the application of the skilled nursing facility for its provider-based skilled nursing facility?
2003D17 00-0544 05-0248 Was the Intermediary's adjustment to the residents count and Graduate Medical Education payments proper?
2003D16 02-0721G 50-0023, 44-0131; 45-0059 Were the Intermediaries adjustments to exclude observation bed days from the providers' bed count in determining disproportionate share hospital ("DSH") eligibility and payments proper?
2003D15 96-1651 33-5758 Is it proper for the Intermediary to apply the lower of cost or charges (LCC) principle in calculating the Provider's reimbursement on the Medicare cost report Worksheet E, Part I?
2003D14 96-1951 23-0167 Whether the Board has jurisdiction over the calculation of the disproportionate share adjustment where the issue is added to the appeal of an original Notice of Program Reimbursement?
2003D13 96-0618G, 96-0619G; 96-0620G Various Whether the intermediary's refusal to accept the Provider's amended cost reports constituted a final determination appealable to the Board? [This Decision was Vacated.]
2003D11 00-2451 39-7279 Were the Intermediary's adjustments to physical therapy costs proper?
2003D25 99-3866; 01-0764 39-5742 1. Was the Intermediary's reclassification of Staff Development/ Quality Assurance Coordinator salaries proper?; 2. Was the Intermediary's adjustment allocating social service costs proper?
2003D26 94-3266 05-0373 Did the Intermediary correctly reduce the number of full-time equivalent interns and residents in approved training programs for the purpose of calculating the Provider's graduate medical education adjustment? (Whether the Intermediary may change the bases for excluding residents from the count more than three years after the issuance of the revised Notice of Program Reimbursement.)
2003D27 00-2949 49-7259 1. Whether the Intermediary's adjustment to disallow advertising cost was proper.; 2. Whether the Intermediary's adjustment to include Heaven Sent Nursing Services as a non-reimbursable cost center was proper.; 3. Whether the Intermediary's adjustment to reclassify the Community Education Coordinator's salary to a non-reimbursable cost center was proper.; 4. Whether the Intermediary's adjustment to remove the Administrator's excess compensation was proper.
2003D41 00-0346; 01-0210 39-5789 Was the Intermediary's adjustment to remove nursing administration statistics from the ancillary cost centers on worksheet B-1 proper?
2003D24 98-0362G, 99-2356; 01-0053 Various Was the Intermediary's adjustment to deny the allocation of social service costs based on departmental gross charges proper?
2003D42 02-1198 41-7001 Was the Intermediary's disallowance of the Provider's Spanish and Portuguese interpreter expenses proper?
2003D43 97-3008 10-0055 Was the Intermediary's determination of obligated capital proper?
2003D44 02-0901G Various Was the Intermediary's disallowance of liabilities not liquidated timely on the Medicare cost report proper?
2003D45 99-0722 05-7252 Whether the Intermediary's adjustment of Medicare visits to agree with Medicare's Provider Statistical and Reimbursement (PS&R)report were proper?
2003D28 00-3416 14-7614 Was the Intermediary's adjustment to disallow accrued bonuses for employees proper?
2003D29 01-1866 23-0205 Was the Intermediary's adjustment to DRG (Diagnostic Related Group) payments proper?
2003D30 01-1525 31-7060 Was the Intermediary's adjustment to the Per Beneficiary Limit (PBL) calculation proper?
2003D31 98-0507, 99-2398; 00-0946 36-0003 1. Was the Intermediary's reclassification of certain administrative costs from ambulatory serices area to the Administrative and General Cost Center proper? (Fiscal years 1994, 1995 and 1996); 2. Was the Intermediary's reclassification of clinic dieticians' salary costs to the Dietary Cost Center proper? (Fiscal years 1994 and 1995)
2003D32 98-1282 67-7181 Was the Intermediary's Audit Adjustment #2 which disallowed $108,875 of Administrative and General Costs proper?
2003D33 01-1779; 02-0270 18-3026 Was the all inclusive rate allocation Methodology proper?
2003D34 99-2427G Various Were the Intermediary's adjustment disallowing the Providers' claimed losses on disposal of assets due to a change of ownership proper?
2003D35 99-2241G Various Were the Intermediary's adjustment disallowing the Providers' claimed losses on disposal of assets due to a change of ownership proper?
2003D36 98-1973 12-0006 Were the Intermediary's adjustment disproportionate share hospital payments proper?
2003D37 94-2728 34-0141; 34-S141 Whether the Intermediary and HCFA properly determined that the Provider's request for an adjustment to the TEFRA limits was untimely?
2003D38 01-1637 15-0102 Was the Intermediary's adjustment to limit reimbursement to the lower of cost or charges for the Provider's distinct part psychiatric unit proper?
2003D40 01-2787 10-5858 Did the Centers for Medicare and Medicaid Services ("CMS") properly deny the Provider's request for an exemption from the Medicare skilled nursing facility routine service cost limits ("SNF RCLs") as a new provider under 42 C.F.R. Section 413.30(e) based on CMS' determination that the exemption request was not timely filed for cost reporting periods ended May 31, 1996, 1997 and 1998?
2003D39 97-2608 55-5405 Was the Intermediary's denial of the Provider's SNF routine service cost limit exception request proper?
2003D46 00-1172 55-7008 Whether the Provider is entitled to an exception to the visit cost limits in accordance with Medicare regulations?
2003D47 98-2105, 98-2106;98-2107 33-0261 Was the Intermediary's treatment of the Provider's increase in bed size of its exempt rehabilitation unit proper?
2003D48 99-2780, 99-2781, 01-1334, 01-1335; 02-0450 39-7015 Was the Intermediary's adjustment to home office costs proper?
2003D49 02-1970 14-0167 Is the Provider entitled to status as a Medicare Dependent hospital ("MDH") for the period of October 1, 2001 through January 14, 2002?
2003D50 00-0961G Various Was the Intermediary's adjustment to restorative nurses aides proper?
2003D51 01-3608G Various Was the Intermediary's adjustment to restorative nurses aides proper?
2003D52 01-2455 N/A Were the Intermediary's adjustments reclassifying the Medical Director cost proper?
2003D54 01-2453 05-6323 Was the Intermediary's adjustment reclassifying Medical Director cost proper?
2003D55 01-2262 55-5336 1. Was the Intermediary's adjustment to advertising costs proper?; 2. Was the Intermediary's adjustments reclassifying Medical Director cost proper?
2003D56 99-3820 40-0098 1. Was the Intermediary's adjustment to interest expense proper?; 2. Was the Intermediary's adjustment to deferred organizational cost proper?
2003D57 99-3821 40-0098 Was the Intermediary's adjustment to bad debts proper?
2003D58 95-0590 40-0016 Was the Center for Medicare & Medicaid Services' denial of the Provider's exception request proper?
2003D59 00-1344 40-0079 Was the Intermediary's adjustment to the disproportionate share, (DSH) computation proper?
2003D60 00-0064 46-7051 1. Was the Intermediary's adjustment to home office costs proper?; 2. Was the Intermediary's adjustment disallowing a portion of the auto allowance proper?; 3. Was the Intermediary's adjustment to travel and lodging costs proper?
2003D61 01-0627 23-3519 Was HCFA's (the Center for Medicare & Medicaid Services') determination concerning the exception request under the prospective payment system proper?
2003D62 99-0584 39-0080 Was the Intermediary's determination of loss on sale of assets proper?
2003D63 99-2054, 99-2307G; 01-0337 Various Case No. 99-2054- 1. Was the Intermediary's adjustment disallowing capital related expenditures proper?; 2. Was the Intermediary's adjustment disallowing interest expense proper?; Case No. 99-2307G- 1. Was the Intermediary's adjustment disallowing rental expense proper?; Case No. 01-0337- 1.Was the Intermediary's adjustment disallowing rent expense proper?; 2. Was the Intermediary's adjustment disallowing capital related expenditures proper?; 3. Was the Intermediary's adjustment disallowing interest expense proper?
2003D64 98-2851 17-0087 Was the Intermediary's determination of loss on consolidation proper?
2003D65 95-2104G, 95-1244G; 96-2516G Various Whether the Intermediary correctly applied the Medicare lower of cost or charges limit in determining payments to the Providers?
2003D66 99-4073 49-5280 Was the Intermediary's adjustment disallowing Medicare Part A and Part B bad debts proper?
2005D18 98-2318 15-5400 1. Was the Intermediary's adjustment to National Premier Financial Services, Inc., and NPF VI, Inc. Costs/Program Fees was proper?; 2. Was the Intermediary's failure to allow $18,215 of related party depreciation was proper?; 3. Was the Intermediary's adjustment to decrease total respiratory therapy hours worked, unduplicated days, the cost of respiratory therapy services from outside providers, and $5,661 of related respiratory therapy expense was proper?
2004D02 99-3609; 00-3050; 01-2972 22-4022 Were the Intermediary's adjustments to physician stand-by costs in the routine area correct?
2004D03 99-3323 42-7010 1. Was the Intermediary's adjustment to Board of Directors fees proper?; 2. Was the Intermediary's adjustment to legal and professional fees proper?; 3. Was the Intermediary's adjustment to key employee compensation proper?; 4. Was the Intermediary's adjustment to routine and non-routine supply costs proper?
2004D04 00-2255; 01-2782 17-8012 Whether the Intermediary's adjustment to include private duty nursing costs on the Medicare cost report was correct?
2002D18 96-1254; 96-1443 06-7032 1. Was the Intermediary's disallowance of administrative salaries proper? (For Cost Reporting Period Ended September 30, 1993 - Case No. 96-1254); 2. Was the Intermediary's disallowance of legal fees proper? (For Cost Reporting Period Ended May 9, 1994 - Case No. 96-1443)
2002D19 99-0233 13-0024 Was the Intermediary's adjustment to emergency room ("ER") physicians' availability costs proper?
2002D30 95-1515, 95-2428, 99-3520, 99-3125 05-0366 Was the Intermediary's reopening in accordance with Medicare regulations, and did the Intermediary use the proper hospital-specific rate in determining the Provider's reimbursement?
2002D31 97-0135 01-5426 Was the Centers for Medicare & Medicaid Services' (Formerly the Health Care Financing Administration) denial of a new provider exemption proper?
2002D32 00-3418G Various Was the Intermediary's adjustment to the non-qualified deferred compensation plan proper?
2002D33 91-0550G Various Was the Intermediary's adjustment to Indirect Medical Education costs proper?
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.
2002D35 00-3147; 00-3150 23-6554 Did the Intermediary properly adjust the provider's bad debt expense?
2002D36 97-1761 14-7525 1. Were the Intermediary's adjustments to disallow patient advocate/community relations costs proper?; 2. Was the Intermediary's elimination of accrued expenses proper?; 3. Was the Intermediary's disallowance of pension costs proper?; 4. Was the Intermediary's treatment of executive compensation reasonable?
2002D38 98-1171 06-7239 Was the Intermediary's determination of legal fees proper?
2002D39 97-0403 39-5066 Was the Intermediary's adjustment to Medicare patient days proper?
2002D40 96-2090R 39-5863 Whether the Provider is entitled to reimbursement as ancillary services, certain nursing service costs for monitoring the functional operation of air-fluidized beds (AFBs) for the care of Medicare patients with stage IV pressure ulcers/decubitus ulcers?
2002D41 99-0286R 31-7062 Was the interest paid on working capital loans from the Friend Center Fund and commercial banks necessary and allowable?
2002D42 99-0417 37-5262 Was the Intermediary's methodology used in settling a low utilization cost report proper?
2002D43 98-2295; 99-2144 15-2009 1. Was the Intermediary's determination of the provider's Medicare TEFRA base year proper?; 2. Was the Intermediary's determination of the Provider's TEFRA target rate limitation proper?
2002D44 97-3201 20-0009 Was it proper for the Intermediary to deny the Provider's TEFRA exception request for untimely filing?
2002D45 97-2659 21-5302 Did the Provider meet the regulatory requirements for approval of the new provider exemption?
2002D46 98-0460 05-0211 1.(A) - Did the Intermediary properly apply the low occupancy adjustment in Centers for Medicare and Medicaid Services ("CMS" formerly called the Health Care Financing Administration ("HCFA")) Transmittal No. 378, Section 2534.5.A?; 1.(B) - Was CMS' refusal to grant an exception for that portion of the Provider's per diem costs which do not exceed 112 percent of the total peer group mean cost proper? - on the record; 2. - Was the Intermediary's adjustment eliminating the community education director's salary proper? - on the record.
2002D47 00-3139; 01-2861 23-0115 Was the Intermediary's denial of the Provider's request for additional payment for decreased discharges proper?
2002D48 96-2035, 96-2036, 96-2037; 96-2038 22-5673 Did the Centers for Medicare and Medicaid Services ("CMS") properly deny Milton Hospital Transitional Care Unit's request for an exemption from the Medicare skilled nursing facility routine service cost limits ("SNF RCLs") as a new provider under 42 C.F.R. Section 413.30(e)?
2002D49 98-0489 22-0036 Was the Intermediary's adjustment (denial) of the transitional care unit new provider exemption proper?
2002D50 96-1033 50-5025 Was the decision of the Health Care Financing Administration ("HCFA"), pursuant to its Provider Reimbursement Manual ("PRM") Section 2534.5, to refuse to grant an exception for that portion of the Provider's per diem costs which exceed the Routine Cost Limit, but which do not exceed 112% of the total peer group mean cost, arbitrary, capricious, an abuse of discretion or not in accordance with law?
2001D12 97-0744; 99-0318 10-7281 FY 1994 - 1. Was the Intermediary's adjustment to administrative and general for the intake coordinator's salaries proper?; 2. Was the Intermediary's adjustment to administrative and general staff expenses proper?; 3. Administratively resolved and withdrawn at hearing.; FY 1995 - 1. Same as No. 1 for FY 1994.; 2. Issue administratively resolved and withdrawn at hearing.; 3. Was the Intermediary's adjustment removing expenses from the cost report that were not actually incurred proper? (Parties relied upon materials in the record.)
2001D55 91-2902M & 95-1677 39-0156 1. Was the Intermediary's failure to recognize and reclassify certain operating costs as graduate medical education ("GME") proper?; 2. Was the Intermediary's failure to add misclassified operating costs to the Provider's Prospective Payment System ("PPS") hospital specific rate ("HSR") and TEFRA target amount ("TA") proper?
2000D02 96-1218 44-0008 Was the Intermediary's reclassification of home health agency costs proper?
2000D15 94-1517 10-0129 Does the recapture of depreciation due to the gain on the sale of depreciable assets have any effect on the Provider's equity capital for prior years?
2000D16 97-0080 05-7299 1. Was the Intermediary's adjustment to reclassify supplies' salaries to the administrative and general cost center proper?; 2. Was the Intermediary's adjustment to disallow costs paid to a related organization proper?; 3. Was the Intermediary's adjustment to allocate cost shared with the related company using the pooled cost method proper?
2000D17 92-1549 26-0104 Was the computation and allocation of the cashiering, accounts receivable, and collections cost center done correctly and done in accordance with the regulations?
2000D18 94-1750 45-0698 Did the Intermediary properly disallow the Provider's claim of an allowable loss on the sale of assets through a transaction that transferred ownership of all hospital assets and liabilities from Lamb County Hospital Authority to Lamb County, Texas?
2000D19 95-0072 38-0007 Was the Intermediary's or HCFA's determination regarding the Provider's TEFRA exception request proper?
2000D20 94-2879 33-3028 Was HCFA's partial denial of the Provider's request for a TEFRA target rate adjustment proper?
2000D21 95-0897 31-0002 Was the Intermediary's failure to apply updated reasonable compensation equivalent limits proper?
2005D02 96-2577G Various Were the Intermediary's adjustments disallowing bad debts claimed by the Provider on uncollectable deductable and coinsurance amounts pertaining to items and services reimbursed outside of Medicare's composite rate for End Stage Renal Disease facilities proper?
2005D03 96-0211, 97-1061R, 98-2080R 26-0015 Was the Provider entitled to an exemption from the skilled nursing facility routine cost limits for the years ended December 31, 1992, December 31, 1993, and December 31, 1994?
2005D04 01-1458 20-0033 Was CMS' denial of the Provider's end stage renal disease (ESRD) composite rate exception request correct?
2005D05 94-3085 05-0295 Was the Center For Medicare and Medicaid Services (CMS)' parial denial of the Provider's End Stage Renal Disease (ESRD) atypical service exception request proper?
2005D06 97-0592, 98-1495 23-0077 For purposes of allocation of Administrative & General ("A&G") costs, should Part B physicians' compensation and related fringe benefits be included in total expenses of private physician practices?
2005D07 00-0374 52-5478 Was the Intermediary correct in determining that Provider's request for an exception to the Skilled Nursing Facility (SNF) Routine Cost Limit was untimely filed?
2005D08 00-1542, 01-1278, 03-0040 10-0070 Were the Intermediary's adjustments to interest expense relating to the acquisition of medical records and an assembled work force proper?
2005D09 99-1467 05-0420 Is a loss required to be recognized by Medicare as a result of the May 30, 1996 merger of the former corporate owner of the Provider into a new corporate owner?
2005D10 02-0355 19-7210 1. Whether the Intermediary's disallowance of owner's accrued salary expense for untimely liquidation was proper?; 2. Whether the Intermediary's adjustment to the related party portion of the office supplies and revision of the related party medical supply expense was proper?
2005D11 00-3166, 00-3167, 00-3119 03-0023, 03-7047 Whether the Intermediary's denial of a request for exception to the Home Health Agency (HHA) per visit cost limits was proper?
2005D12 99-0452G Various Whether the Intermediary properly processed the Providers' TEFRA exception request?
2005D13 02-0078 19-7585 Whether the Intermediary denial of the Provider's request for exception to its per-visit cost limits was proper?
2005D14 00-0945 15-5258 1. Whether the Intermediary adjustment to disallow a portion of the owners' compensation was proper?; 2. Whether the Intermediary adjustment to disallow bad debts was proper?
2005D15 02-0020 05-6092 Whether the Intermediary's denial of the Provider's Routine Cost Limit (RCL) exception request was proper?
2005D16 Various Various What relief is available through appeal to thre Provider Reimbursement Review Board (Board) for failure of the Intermediaries to timely settle the Provider's cost reports, especially where prejudice will result from the failure to settle such cost report?
2005D17 02-0013, 02-0319 04-3816 Was the Intermediary's adjustment to physician/owners compensation proper?
2004D05 01-0741 23-2557 Did the Centers for Medicare and Medicaid Services ("CMS") correctly deny Chippewa Dialysis Services' request for an exception to the end stage renal disease ("ESRD") composite rate?
2004D06 01-0742 23-2553 Did the Centers for Medicare and Medicaid Services ("CMS") correctly deny Alpena Dialysis Services' request for an exception to the end stage renal disease ("ESRD") composite rate?
2004D08 03-0666 37-5109 Does the Board have jurisdiction over the recoupment of overpayments appealed from a letter from the Centers for Medicare and Medicaid Services?
2004D07 01-0743 23-2315 Did the Centers for Medicare and Medicaid Services ("CMS") correctly deny Northern Michigan Hospital's request for an exception to the end stage renal disease ("ESRD") composite rate?
2004D09 03-0665 37-5109 Does the Board have jurisdiction over the recoupment of overpayments appealed from a letter from the Centers for Medicare and Medicaid Services, and the reimbursement effect is less than $10,000?
2005D29 95-0468 05-0076 Was the Intermediary's partial denial of the Provider's End Stage Renal Disease (ESRD) exception request proper?
2004D01 01-1470; 01-1534G; 01-1539G Various Whether the Board has jurisdiction to determine which entity is the proper payee under the terms of a settlement agreement between the Providers and the Intermediary?
2003D07 00-3976 17-5218 Was the Intermediary's adjustment disallowing the allocation of general service costs to the ancillary cost centers proper?
2005D31 01-1679 48-0001 Whether CMS' determination to deny a request for an exception to the end stage renal disease(ESRD) composite rate based on a lack of documentation supporting the criteria of the isolated essential facility (IEF) was proper.
2005D32 94-3299, 96-0845, 98-2163 31-0111 Whether the Intermediary failed to properly classify certain projects as old capital.
2005D01 02-0212, 02-0213,02-0214 et al 40-7019;40-7013;40-7017;et al Whether the Providers' receivable financing was a loan or a sale of assets?
2004D13 01-0881GE Various This case arises from Hunterdon Medical Center's and Somerset Medical Center's (Providers') dissatisfaction with having a closed hospital's wage data included in the Providers' Metropolitan Statistical Area (MSA) wage index and the exclusion from the wage index data of providers that have been reclassified by the Medicare Geographic Classification Review Board (MGCRB). The question addressed by the decision is whether expedited judicial review (EJR) is appropriate because the Board cannot grant the remedy sought by the Providers: a change to the Secretary's policies used to calculate wage indices.
2003D05 00-3145 05-8017 Was the Intermediary's adjustment of start-up costs proper?
2003D20 99-4064 52-0089 Was the Intermediary's determination of the TEFRA exception request proper?
2004D16 00-0411; 00-2594 45-0061 Was the Intermediary's adjustment excluding observation bed days from the determination of the Provider's disproportionate share hospital adjustment proper?
2004D30 01-0937 23-7252 Was the Intermediary's adjustment to the single business tax proper?
2004D26 01-0883 20-0018 Was CMS' denial of end stage renal disease composite rate exception request correct based on applicable Medicare law?
2004D21 99-1424 04-0048 Was the Intermediary's determination of the loss on disposal of assets proper?
2004D10 00-2699; 00-2700 15-7193; 15-7318 The case involves the propriety of reimbrusing home health agencies (HHA) under the Medicare program for expenses that the HHA incurs to provide pastoral care to its patients?
2004D28 04-1640; 04-1641 50-3300 Were the Intermediary's adjustments to the provider's intern and resident full-time equivalents ("FTEs") counts used for calculating chidren's hospital graduate medical education ("CHGME") payments proper?
2005D22 01-0700 15-5228 Whether the Intermediary's adjustment to disallow a portion of the owner's compensation was proper?
2004D23 97-2439 19-0160 Was the Provider's routine cost limit determined in accordance with Medicare law, regulations, and program instructions?
2005D27 02-1008 25-0019 Was the Intermediary's disallowance of Medicare bad debts proper?
2005D19 01-0261 19-7558 Was the Intermediary's adjustment to disallow accrued salaries proper?
2004D20 98-1344; 99-1718; 00-2691 51-0001 Was the Intermediary's adjustment to bond interest proper?
2005D25 99-1213 67-7455 1. Whether the Intermediary's adjustment to remove accrued salaries for owners due to payment not being properly liquidated within 75 days after the close of the cost reporting period was correct?; 2. Whether it was proper for the Intermediary to disallow the portion of the accrued owner's compensation expenses attributable to the employees' share of Federal and State withholding taxes?
2005D24 02-0183 19-7545 1. Whether the Intermediary's adjustment to remove accrued salaries for owners due to payment not being properly liquidated within 75 days after the close of the cost reporting period was proper?; 2. Whether it was proper for the Intermediary to disallow the portion of the accrued owner's compensation expenses attributable to the employees' share of Federal and State withholding taxes?
2005D28 97-1566 04-0062 Was the Centers for Medicare and Medicaid Service's denial of the Provider's request for new provider exemption proper?
2005D34 98-1658 45-0124 Whether the Intermediary properly applied the "Pickle Amendment" in calculating the Provider's Disproportionate Share Hospital (DSH) adjustment.
2005D35 99-1345 55-7729 Whether the liabilities claimed by the Provider are reimbursable under the Medicare principles.
2005D36 02-0216; 02-0217 03-0064 1. Were the Intermediary's adjustments reducing the Provider's Indirect Medical Education (IME) full-time equivalent (FTE) resident count for time spent by residents in research proper?; 2. Were the Intermediary's adjustments reducing the Provider's FTE resident count for IME and Direct Graduate Medical Education (GME) for time spent by residents on vacation proper?
2005D37 01-2620 14-7112 Were the Intermediary adjustments applying Medicare's salary equivalency guidelines to services performed by Provider's employee physical and occupational therapists proper?
2005D38 02-2031 45-2049 Whether the Intermediary erred in denying the Provider a continuous improvement bonus ("CIB") for fiscal year ending August 31, 1999.
2003D53 99-2359 05-5039 1. Was the Intermediary's adjustment to advertising costs proper?; 2. Was the Intermediary's adjustment to tax penalties proper?
2005D40 00-2981 41-5122 Whether the Centers for Medicare & Medicaid Services' (CMS) denial of St. Joseph's Health Services of Rhode Island Transitional Care Center's request for exemption from the skilled nursing facility (SNF) routine cost limit (RCL) as a new provider was proper
2005D41 99-4038 36-0066 Whether for purposes of the Provider's disproportionate share (DSH) calculation, the Provider is entitled to an increased number of days of care rendered to eligible Medicaid beneficiaries.
2005D42 01-3257 33-0215 Whether for purposes of the Provider's disproportionate share calculation, the Provider is entitled to an increased number of days of care rendered to eligible Medicaid beneficiaries.
2005D43 00-0909G Various Should the Intermediary reclassify the Provider's Federal Insurance Contributions Act (FICA) tax expense from the Employee Benefits cost center to the Administrative and General cost center (A&G)?
2005D44 99-4061 50-5504 Whether CMS' denial of the Provider's request for an exemption to the routine cost limits for skilled nursing facilities as a new provider was proper.
2005D45 02-1213 22-0163 Was the Centers for Medicare and Medicaid Services' (CMS) denial of the Provider's request for an exemption to the end stage renal disease (ESRD) composite rate proper?
2005D46 98-2583 50-0124; 50-5492 Was the Provider entitled to a "new provider" exemption from Medicare's routime cost limits for its hospital-based skilled nursing facility (SNF)?
2005D47 02-2129; 04-1734 05-0281 Whether the Provider is entitled to include in the Medicaid proxy of the DSH payment calculation patient days associated with patients who otherwise were entitled to benefits under both Medicare & Medicaid who were treated in the Provider's sub-acute unit on days when those patients were not entitled to Medicare Part A skilled nursing facility (SNF) benefits.
2005D48 95-0777 33-0225 Whether the Intermediary's application of the reasonable compensation equivalent limits was proper.
2005D49 Various 36-0125; 36-0187; 36-0027; 36-0009; 36-0068 Whether the Intermediary improperly excluded patient days related to Ohio's Hospital Care Assurance Program (HCAP) in the providers' disproportionate share calculations.
2005D50 89-1584 45-0101 1.Whether capitalized interest that may have been amortized in future years can be expensed in the current year when future cost reports are no longer subject to reopening.; 2. Whether the Intermediary's determination of allowable interest expense which deducted Hillcrest Medical Tower [HMT] interest from allowable versus total expense is proper.
2005D51 98-2210 10-5319A Whether the Intermediary properly reclassified the Provider's square footage costs for its common areas from the Administrative and General cost center to the Plant Operations, Maintenance and Repair cost center.
2005D52 99-1511G Various Whether the Intermediary properly reclassified the Providers' square footage costs for its common areas from the Administrative and General cost center to the Plant Operations, Maintenance and Repair cost center.
2005D39 99-2779; 02-1243 36-0242 Whether the Intermediary's adjustment to disallow the interest paid to the Ohio State University Hospitals was proper.
2005D53 97-1198; 99-0246; 99-0247 05-0357 Did the Provider supply sufficient information to enable the Centers for Medicare and Medicaid Services to make a decision regarding the Provider's request for an exemption to Medicare's routine service cost limits for skilled nursing facilities (SNF)?
2005D54 03-0045; 03-0046 45-0130 Whether the Intermediary's classification of the Provider's home health agency (HHA) as a 'new provider' for purposes of determining the per-beneficiary limits was proper?
2005D55 00-3322 39-0263 Whether the Intermediary's adjustment disallowing the Provider's loss on sale of assets is proper?
2005D56 99-3095 45-0272 Whether observation days and swing bed days should reduce the number of available beds for the purpose of calculating the Provider's eligibility for disproportionate share (DSH) payments.
2005D57 99-3096 45-0272 Whether observation days and swing bed days should reduce the number of available beds for the purpose of calculating the Provider's eligibility for disproportionate share (DSH) payments.
2005D58 99-0832 45-0272 Whether observation days and swing bed days should reduce the number of available beds for the purpose of calculating the Provider's eligibility for disproportionate share (DSH) payments.
2005D59 01-0728 45-0272 Whether observation days and swing bed days should reduce the number of available beds for the purpose of calculating the Provider's eligibility for disproportionate share (DSH) payments.
2005D60 02-1126 33-3531 Whether the denial of the Provider's request for an exception to the renal dialysis composite rate by the Centers for Medicare and Medicaid Services (CMS) was proper.
2005D61 99-1543; 00-1001 39-7573 Whether the Intermediary's adjustments applying the physical therapy salary guidelines to fee-for-service employee compensation was proper.
2005D62 01-0077 25-5234 Whether the Intermediary's adjustment removing the Provider's 'grossing up' of costs and charges for drugs charged to patients was proper.
2005D63 98-1913 06-7188 Whether the Intermediary's adjustment applying the Adjusted Hourly Salary Equivalency Amount, (commonly referred to as the Salary Equivalency Guidelines (SEGs) or 'physical therapy compensation guidelines') to fee-for-service employees compensation was proper.
2005D64 98-1922 05-6169 Whether the Intermediary's adjustment to allow only a 15% increase in the therapy rate for physical therapy supervisors was proper.
2005D65 00-3600 45-7661 Whether the Intermediary properly disallowed interest expense incurred in connection with the Provider's deferred compensation plan.
2005D66 00-3299 19-7213 1. Whether the Intermediary's adjustments applying the physical therapy salary guidelines to fee-for-service employee compensation were proper.; 2. Whether the Intermediary's adjustment to reduce allowable related party rental expense was proper.
2002D24 01-0198 42-5018 1. Was the Intermediary's adjustment combining all SNF and NF cost charges, days, and statistics into one cost center proper?; 2. Was the Intermediary's determination that payroll records were not adequate to support nursing service cost allocation to the SNF distinct part proper?; 3. Was the Intermediary's determination that the allocation of nursing time resulted in an inequitable allocation of cost to the SNF distinct part proper?; 4. Was the Intermediary's decision to disregard statistics and supporting documentation for the allocation of all other general service costs to the SNF distinct part proper?
2002D37 94-3225G, 94-1910G, 93-0483G, 93-0284G, 94-0209G, 95-1245G, 96-0976G, 98-0179 Various Whether the Intermediaries' application of reasonable compensation equivalent ("RCE") limits issued by HCFA to limit hospitals' compensation to physicians for Medicare Part A services in cost reporting periods commencing in 1984 to the Providers' physician compensation for hospital services in cost reporting periods commencing in 1987 through 1994 was proper.
2002D25 01-0200 42-5102 1. Was the Intermediary's adjustment combining all SNF and NF cost charges, days, and statistics into one cost center proper?; 2. Was the Intermediary's determination that payroll records were not adequate to support nursing service cost allocation to the SNF distinct part proper?; 3. Was the Intermediary's determination that the allocation of nursing time resulted in an inequitable allocation of cost to the SNF distinct part proper?; 4. Was the Intermediary's decision to disregard statistics and supporting documentation for the allocation of all other general service costs to the SNF distinct part proper?
2002D27 99-3872 55-7633 1. Was the Intermediary's adjustment disallowing unsupported compensation paid to the Medical Director proper?; 2. Was the Intermediary's adjustment reducing compensation paid to the Director of Nursing to a reasonable amount proper?; 3. Was the Intermediary's adjustment to the Administrator's salary proper?
2002D21 96-1820 44-7442 Was the Intermediary's adjustment to the Provider's cost report to remove legal fees proper?
2002D22 01-0199 42-5112 1. Was the Intermediary's adjustment combining all SNF and NF cost charges, days, and statistics into one cost center proper?; 2. Was the Intermediary's determination that payroll records were not adequate to support nursing service cost allocation to the SNF distinct part proper?; 3. Was the Intermediary's determination that the allocation of nursing time resulted in an inequitable allocation of cost to the SNF distinct part proper?; 4. Was the Intermediary's decision to disregard statistics and supporting documentation for the allocation of all other general service costs to the SNF distinct part proper?
2002D26 96-0623 23-0227 Whether the Provider's renal dialysis exception request (the "Exception Request") should be deemed to have been approved, pursuant to 42 U.S.C. Section 1395rr(b)(7), where the Centers for Medicare & Medicaid Services ("CMS") rendered the determination within sixty days but neither the Intermediary nor the Provider received notice of the determination within sixty working days.
2002D20 98-2883 06-5332 Were the Intermediary's adjustments to the Provider's depreciation expense related to the sale and leaseback of the facility proper?
2002D23 96-1189; 97-0797R 24-0038 Whether state-funded days may qualify as Medicaid-eligible days for purposes of the Provider's disproportionate share calculation?
2002D29 98-0452 16-0026 Did the Provider qualify for a payment adjustment due to a decline in its discharges for fiscal year ending June 30, 1995?
2002D28 96-1240 05-0224 1. Was the Intermediary's treatment of cell biology laboratory expense and revenue proper?; 2. Was the Intermediary's determination of reimbursable Medicare bad debts proper?; 3. Was the Intermediary's treatment of the rental expenses for the nursing administration and OB education departments proper?; 4. Was the Intermediary's determination of nonreimbursable costs for the unused space cost center proper?
2005D67 98-2026 41-0007 Whether a resident's research time must be directly related to the disgnosis and usual care of an individual patient in order to include such time in the Full-Time Equivalent (FTE) count for Indirect Medical Education (IME) purposes, and, if so, can the Provider prove that the research time it seeks to include in its FTE count for IME purposes was spect in research directly related to the diagnosis and usual care of individual patients for the fiscal year ended (FYE) 9/30/96.
2005D69 01-3317 39-7086 Whether the Intermediary's adjustment of accounting fees was proper.
2005D70 98-1725; 99-2325; 02-1682 21-7084 1. Whether the Intermediary's adjustment applying the Salary Equivalency Guidelines (SEGs) or "physical therapy compensation guidelines" to fee-for-service employee compensation was proper (Case Nos. 98-1725 (FYE 6/30/95) and 99-2325 (FYE 6/30/96)).; 2. Whether it was proper for the Intermediary to make an ajustment reclassifying interest expenses. (case No. 02-1682 (FYE 6/30/99)).
2002D17 00-1736 39-7095 Was the Intermediary's reclassification of the salaries and benefits attributable to the unallowable activities from the administrative and general ("A & G") cost center to a non-reimbursable cost center proper?
2002D14 94-3354; 95-1196 05-0040 Was the Intermediary and Center for Medicare and Medicaid Services ("CMS," formerly the Health Care Financing Administration) denial of the Provider's request for a change in its base period for purposes of the TEFRA rate of increase ceiling for its PPS-exempt psychiatric unit in the fiscal years ending ("FYE") June 30, 1992 and June 30, 1993 proper?
2002D10 97-3094 06-7199 Was the Intermediary's adjustment disallowing yellow page advertisement expense proper?
2002D11 98-1968 33-5521 Was the Intermediary's adjustment to unpaid interest expense proper?
2002D13 01-3205G 50-0023; 44-0131; 45-0059 Whether the Intermediary improperly determined the Provider's DSH adjustments by excluding observation bed days from the DSH bed day calculation in violation of the applicable regulation and manual provisions.
2002D16 98-2627 39-0073 Was the Intermediary's adjustment to the Provider's number of beds by 116 and corresponding revision of the Provider's reimbursement for indirect medical education costs proper?
2002D15 97-1432 20-0066 1. Was the Intermediary's denial of the Provider's request for a sole community hospital (SCH) decreased volume adjustment proper?; 2. Does the Board have jurisdictional authority to allow the Intermediary to adjust Provider's Medicare reimbursement for fiscal year (FY) 1994 to include an allowance for Medicare/Medicaid crossover bad debt?
2002D12 00-0479 15-7425 Was the Intermediary's adjustment reclassifying a portion of the Hospice Director's salary proper?
2002D09 00-1180 06-7256 1. Was the Intermediary's adjustment to reclassify cost to the Community Education cost center proper?; 2. Was the Intermediary's adjustment to reclassify travel expense to the Community Education cost center proper?
2002D01 00-1056, 99-3600, 00-1057 45-0352 Were the Intermediary's adjustments to the number of available beds for disproportionate share (DSH) qualification purposes proper?
2002D06 98-0511 03-5145 Did the Intermediary calculate the provider's bad debts properly?
2002D05 96-0550 19-5258 Was the Intermediary's denial of a routine cost limit exemption as a new provider proper?
2002D03 98-3317G; 98-2888G 03-0002, 03-0065, 03-0001, 03-0089 Was the Intermediary's adjustment to home office interest expense proper?
2002D07 98-0490 49-0009 Was the Intermediary's computation of the Provider's graduate medical education cost proper?
2002D02 97-1280G Various Did the Intermediary properly reimburse the Provider for drugs and medical supplies purchased from a related party?
2002D04 95-0620 36-0163 Was the Intermediary's adjustment with respect to parking garage revenues proper?
2002D08 97-1048 42-0030 1. Was the decision of the Health Care Financing Administration ('HCFA'), pursuant to its HCFA Pub. 15-1 Section 2534.5, to refuse to grant an exception for that portion of the Provider's per diem costs which exceed the Routine Cost Limit ('RCL'), but which do not exceed 112 percent of the total peer group mean cost, arbitrary, capricious, an abuse of discretion or not in accordance with law?; 2. Was the Intermediary's adjustment reclassifying the Provider's costs from direct to indirect cost centers arbitrary, capricious, an abuse of discretion or not in accordance with law?; 3. Was the Intermediary's application of the low occupancy adjustment in HCFA Transmittal No. 378, HCFA Pub. 15-1 Section 2534.5.A, arbitrary, capricious, an abuse of discretion or not in accordance with law?
2001D50 98-0787 36-0006 1. Was the Intermediary's adjustment relating to the determination and calculation of intern and resident FTEs for purposes of the indirect medical education payment proper?; 2. Was the Intermediary's adjustment relating to the determination and calculation of intern and resident FTEs for purposes of the direct medical education payment proper?
2001D51 96-0166 04-3001 Is the Intermediary barred from recovering an overpayment resulting from the issuance of the September 30, 1995 corrected Notice of Program Reimbursement (NPR) for the Intermediary's Notice of Reopening dated January 14, 1987?
2001D54 97-1736 44-0161 Was the decision of the Health Care Financing Administration ('HCFA'), pursuant to its Provider Reimbursement Manual ('PRM') Section 2534.5, to deny an exception for that portion of the Provider's per diem costs which exceed the Routine Cost Limit, but which do not exceed 112% of the total peer group mean cost, arbitrary, caprious, an abuse of discretion or not in accordance with law?
2001D53 96-0180 33-0285 Did the Intermediary use the correct reasonable compensation equivalent ('RCE') limits to disallow a portion of the Provider's hospital-based physicians' compensation?
2001D52 97-2064R, 97-2148R, 98-0474 (On the Record) 43-0077 Whether, with respect to the Joint Nursing Education Program, the provisions of Section 4004(b) of the Omnibus Reconciliation Act of 1990 ('OBRA 1990') are applicable to the cost years at issue, and if so, whether the Provider meets the criteria set forth in Section 4004(b)(2) of OBRA 1990 for payment of the claimed costs as reasonable costs?
2001D48 00-1179 25-7305 1. Was the Intermediary's adjustment, at the Home Office level, to the owner's bonus for untimely liquidation proper?; 2. Was the Intermediary's adjustment, at the Provider level, to employee bonuses for untimely liquidation proper?
2001D41 96-0102 17-0001 Did HCFA properly determine that the SNF routine cost limits exception request was not timely filed?
2001D43 89-1522R 05-0327 Was the Provider's computation of the self-disallowance amount of investment income offset against interest expense proper?
2001D47 96-0225 14-7525 Was the compensation paid to HCC's owner reasonable?
2001D42 95-1143 33-0285 Was the Intermediary's application of the reasonable compensation equivalent (RCE) limits to disallow a portion of the Provider's provider-based physician compensation proper?
2001D44 97-1917 37-7093 Was the Intermediary' adjustment to physical therapy labor costs proper?
2001D49 95-1217 36-0017 Was the Intermediary's adjustment disallowing portions of the Part A physician compensation paid by the Provider based on the application of the 1984 reasonable compensation equivalents proper?
2001D40 97-0843 01-0079 Was the Intermediary's disallowance of the Provider's Medicare Part B bad debts for deductibles and coinsurance proper?
2001D46 99-2365G 06-7032; 06-7201 Were the Intermediary's adjustments to physical therapy costs proper?
2001D45 98-0095 05-7465 Was the Intermediary's adjustment reclassifying the community liaison's compensation to a non-reimbursable cost center proper?
2001D32 97-2651, 97-2652, 97-2653, 97-2654 50-0012; 50-5481 Did the Health Care Financing Administration ("HCFA") properly deny the Provider's request that its skilled nursing unit ("SNU") receive an exemption from the routine cost limits ("RCLs") as a new provider under 42 C.F.R. Section 413.30(e)?
2001D33 00-1745 14-5736 Was the Intermediary's denial of the Provider's request for an exception to the cost limits relating to the provision of atypical services that were necessary for the efficient delivery of needed health care services proper?
2001D38 98-2619 01-5049 1. Was the Health Care Financing Administration's ("HCFA's") methodology as set forth in Transmittal No. 378 for determining the amount of the exception from the routine cost limits ("RCLs") for hospital-based skilled nursing facilities ("HB-SNFs") and as applied by the Intermediary to the Provider for fiscal year ended ("FYE") December 31, 1995, a proper interpretation of the Medicare statute and regulations?; 2. Did the Intermediary properly deny the Provider a rollover interim exception for FYE December 31, 1995?
2001D30 97-0160 10-4549 Was the Intermediary's adjustments to the Provider's therapy costs proper?
2001D37 94-2298, 95-1213, 96-0132, 96-2235, 98-0023, 99-0057, 98-2943 34-0054 Was the Intermediary's adjustment to the disproportionate share amount proper?
2001D35 96-0343 36-0003 1. Was the Intermediary's reclassification of the Provider's allocation of certain administrative salaries and fringe benefits from various ambulatory service areas back to A&G costs proper?; 2. Was the Intermediary's emergency room physician billing revenue against emergency room expense rather than A&G expenses proper?
2001D31 00-0573G Various 1. Was the Intermediary's reclassification of routine restorative therapy aide salaries from the physical therapy cost center to the SNF participating and non-participating cost centers proper?; 2. Was the Intermediary's reclassification of the salary used for the employee health and welfare worksheet B-l overhead allocation basis proper?
2001D34 95-1001G 01-0055, 01-7013, 01-7020, 01-7048, 01-7072 1. Was the Intermediary's adjustment to the Provider's allowable costs based on the recapture of depreciation proper?; 2. Does the Intermediary's recapture of depreciation due to a gain on the sale of depreciable assets affect the Provider's calculation of equity capital for prior use?
2001D39 00-2472 21-7008 Was the Intermediary's adjustment subjecting the compensation of employed physical therapists paid on a per visit basis to the contract physical therapy guidelines proper?
2001D36 97-0475 36-0003 1. Was the Intermediary's reclassification of allocation of certain administrative salaries and fringe benefits proper?; 2. Was the Intermediary's adjustment to clinic dietitians' salary and fringe benefit costs proper?
2005D68 99-2385 15-5281 1. Whether the Intermediary's adjustment of the square footage statistic for the Physical Therapy department was proper.; 2. Whether the Intermediary's adjustment disallowing owners' compensation was proper.; 3. Whether the Intermediary's denial of the Routine Cost Limit exception request due to the Provider's failure to respond to a documentation request timely was proper.
2006D20 96-1822; 97-1579; 98-1827; 99-2061 22-0077 a. Whether the Centers For Medicare and Medicaid Services' (CMS') determination of the Provider's Medicare Part A / Supplemental Security Income (SSI)percentage, commonly known as the Medicare fraction component of the disproportionate share (DSH)percentage, is incorrect; and, if so, b. Whether the Provider is entitled to (a) an order from the Board directing CMS to correct such determination and the Intermediary to implement and pay any additional amounts due the Provider as the result of such correction; or (b) an order from the Board granting other appropriate relief.
2001D27 99-0095 26-7262 Was the Intermediary's adjustment to remove excess key employee compensation proper?
2001D20 96-1308 45-7751 1. Was the Intermediary's disallowance of subscription and publication costs proper?; 2. Did the Intermediary properly disallow a portion of the owner's compensation?
2001D26 96-1477, 97-1703, 97-2763 29-0007 Was the Intermediary's determination that the Provider was not eligible for Medicare reimbursement for the disproportionate share adjustment under Section 1886(d)(5)(F)(i)(II) of the Social Security Act proper?
2001D28 97-2018; 99-0881 39-5742 1. Were the Intermediary's adjustments reclassifying Director of Nursing and Assistant Director of Nursing costs from the Administrative and General Cost Center to the Nursing Administration Cost Center proper?; 2. Were the Intermediary's adjustments reclassifying Social Services costs proper?; 3. Were the Intermediary's adjustments reclassifying over-the-counter drug costs and incontinency costs proper?
2001D29 97-0159 10-4549 Was the Intermediary's adjustments to the Provider's therapy costs proper?
2001D24 97-1699 33-0154 Was the Intermediary's adjustment disallowing certain expenses of compensating hospital based physicians pursuant to the 1984 Reasonable Compensation Equivalency limits proper?
2001D22 98-0229 14-7483 Was the Intermediary's adjustment to skilled nursing and HHA visits proper?
2001D25 99-3163 14-7017 1. Was the Intermediary's adjustment to the Provider's Administrative and General (A&G) cost center proper?; 2. Was the Intermediary's reclassification adjustment of delivery expenses claimed by the Provider proper?; 3. Was the Intermediary's reclassification adjustment of courier costs claimed by the Provider proper?; 4. Was the Intermediary's adjustment to home office Business Development and Managed Care salaries proper?
2001D23 94-1039; 94-1040 23-0001 Whether the Provider is entitled to interest under 42 U.S.C. Section 1395g(d) for any amounts paid by the Intermediary relating to the Provider's 1990 and 1991 fiscal years, and if so, for what period of time?
2001D10 93-1355 45-0388 Whether the Intermediary erred in determining that there was no capital related interest with respect to interest expense incurred on that portion of the 1989 bonds used to repay the Provider for assets purchased six to twelve months prior to the bond issuance?
2001D11 95-2183; 97-3095 36-0051 Did the Intermediary use the correct reasonable compensation equivalent ("RCE") limits to disallow a portion of the Provider's hospital-based physicians' compensation?
2001D13 95-2033, 96-1979, 97-1498, 98-2049 04-0036 Were the Intermediary's adjustments disallowing pass-through cost reimbursement of nursing education costs proper?
2001D14 95-1296 33-0106 Did the Intermediary use the correct reasonable compensation equivalent ("RCE") limits to disallow a portion of the Provider's hospital-based only physicians' compensation?
2001D19 91-1844 05-0457 Did the Intermediary properly adjust outpatient surgery, anesthesia and supply charges?
2001D16 95-2234, 97-0068, 97-2678 22-7029 1. Was the Intermediary's adjustment reclassifying advertising costs to a non-reimbursable cost center proper? (1993, 1994, 1995) ; 2. Was the Intermediary's adjustment reclassifying fundraising costs to a non-reimbursable cost center proper? (1994)
2001D17 97-2425 05-0455 1. Was the Intermediary's adjustment reclassifying the Provider's costs from direct to indirect cost centers proper?; 2. Was the Health Care Financing Administration's ("HCFA's") refusal to grant an exception from that portion of the Provider's per diem cost which do not exceed 112 percent of the total peer group mean cost proper? (On the record.)
2001D02 96-0423G, 99-0448G, 99-2082G 05-5916, 05-5053, 05-6261, 55-5658 Were the Intermediary's adjustments to disallow costs related to the Provider's airplane proper
2001D09 92-0111 51-0039 Was the Intermediary's analysis and application of the Medicare "Spend down" ("S-D") procedure for curing $4 million dollars of unnecessary borring ("UB" proper?
2001D03 92-1220; 93-0473 05-0025 Was the Intermediary's adjustment to the number of available beds for indirect medical education ad
2001D05 97-0693 05-0390 Was the Intermediary's determination of inpatient and outpatient Medicare bad debts proper?
2001D04 98-0627 15-4014 1. Was the Intermediary correct in its disallowance of Provider component hours for provider-based physicians?; 2. Was the Intermediary correct in its adjustments to total charges and Medicare charges for the clinic cost center?
2001D08 94-3107 33-0058 Was HCFA's denial of the Provider's ESRD composite payment rate exception proper?
2001D07 97-2509 14-5111 Was the Intermediary's adjustment to the routine cost limit proper?
2001D01 99-1249 14-5335 Is the Provider entitled to an exception to the skilled nursing facility routine service cost limits for fiscal year ending 1995?
2001D06 97-0139R 39-5095 Was the Intermediary's reclassification of employment taxes proper?
2005D71 02-0399, 02-1946 15-0029 Were the Intermediary's adjustments to the count of full-time equivalent interns and residents proper?
2005D72 99-2472 05-0603 Whether CMS' denial of the Provider's request for a new provider exemption based upon a finding of an untimely submission in response to a request for additional documentation was proper.
2006D01 98-0502 24-0010 Was the Intermediary's denial of the Provider's request for an adjustment to its TEFRA target amount due to untimely filing of a request proper?
2006D02 02-1686 23-0020 Is expedited judicial review (EJR) appropriate for the question of whether the Centers for Medicare & Medicaid Services (CMS) undercounted the patient days for patients entitled to Supplemental Security Income (SSI) which is used to compute the disproportionate share (DSH) adjustment?
2006D03 02-1765, 02-1766, 02-1767, 03-0825 31-4013 Whether the Intermediary's adjustments to disallow reimbursement for physicians' professioanl services on a reasonable cost basis was proper.
2006D04 99-1295 15-5478 Was the Intermediary's adjustment to owners' compensation proper?
2006D05 94-2729 14-0119 1. Whether the Intermediary's adjustment to and calculation of the Provider's disproportionate share hospital payment (DSH) was proper, specifically relating to the inclusion of general assistance days.; 2. Whether the Intermediary's calculation of the number of interns and residents and the amount of allowable costs for fiscal year 1991 for purposes of the Provider's graduate medical education programs (GME) was proper.; 3. Should the Intermediary have reclassified expenses relating to the Inn at University Village as investment losses and offset such losses against investment income rather than disallowing them entirely?
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?
2006D08 03-0009G Various Whether the Intermediary's adjustments reallocating key employee and owners' bonuses were proper.
2006D09 04-0412 26-0039 Whether the Intermediary's computation of the adjustment due the Provider for a decrease in discharges experienced in FY 2000 was correct.
2006D10 03-1555, 04-0387 45-0162 Whether or not Highland Medical Center has 100 or more available beds for Medicare disproportionate share adjustment qualification and payment purposes.
2000D06 96-0053G 46-5067, 46-5068, 49-5049, 46-5075 Did the Intermediary improperly disallow the time studies the Providers used for allocation of nursing administration, medical records and social services?
2000D01 97-0602 07-7133 Was the Intermediary's adjustment to disallow franchise fees correct?
2000D03 97-2434 05-0109 Did the Intermediary properly implement PRRB Decision No. 96-D35?
2000D07 94-2649 45-0037 1. Was the HHA cafeteria allocation statistic proper?; 2. Were the HHA administrative costs proper?
2000D04 94-0426, 94-0429 03-0002 Must the Provider have a written agreement with its related facilities in order to have the resident rotations included in its GME count?
2000D05 94-0327 14-0032 Was the Health Care Financing Administration's ("HCFA") denial of the Provider's request for classification as a sole community hospital proper?
2000D10 94-3018, 94-3019, 94-3020, 94-3021, 95-2194 39-5580 1. Was HCFA's decision limiting SNF routine cost limit exception relief for fiscal years 1987 through 1990 and 1993 proper?; 2. Was HCFA's denial of the Provider's request for an exception to its routine cost limits for fiscal years ended June 30, 1991 and 1992 due to untimely filing proper?
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?
2000D14 95-1201 03-0024 1. Were the Intermediary's adjustments excluding certain interest expense proper?; 2. Were the Intermediary's adjustments grossing up days and charges for employee patients proper?
2000D11 96-0498 16-0045 Was HCFA's determination denying the Provider's request for an exception to its routine cost limits for its atypical skilled nursing facility costs proper?
2000D12 95-0068 38-0024 Was the Intermediary's or HCFA's determination regarding the Provider's TEFRA exception request proper?
2000D08 95-0527 36-0163 Was the denial of Provider's End Stage Renal Disease ("ESRD") composite rate exception request based on atypical service intensity/patient mix proper?
2000D09 98-1081 06-7201 Were the Intermediary's adjustments to owners' compensation proper?
2006D14 03-0176 07-5407 Whether the Intermediary properly denied the Provider's new provider exemption request.
2006D11 02-0812 05-0069 Whether the denial of the Provider's request for an exception to the renal dialysis composite rate by the Centers for Medicare and Medicaid Services (CMS) was proper.
2006D13 01-2940 05-0145 Whether for purposes of the Provider's disproportionate share (DSH) adjustment calculation, the Provider is entitled to an increased number of days of care rendered to eligible Medicaid beneficiaries.
2006D12 99-3024 24-0093 Whether the Intermediary's 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.
2006D15 02-1526 19-7060 Whether the Intermediary's disallowance of medical director fees was proper.
1999D01 93-0824+ 18-0124 Was the Intermediary's adjustment toMedicare bad debts proper?
1999D02 92-1027 50-0054 Did the Intermediary properly include neonatal intensive care unit ("NICU") beds in the Provider's available bed count used for the indirect medical education ("IME") calculation?
1999D03 95-2373 10-7281 1. Was the Intermediary's adjustment to employee salary and benfits proper?; 2. Was the Intermediary's adjustment to Advertising proper?; 3. Was the Intermediary's adjustment to Deferred compensation proper?; 4. Was the Intermediary's adjustment topayroll benefits/ profit sharing proper; 5. Was the Intermediary's adjustment to dues and subscriptions proper?; 6. Was the Intermediary's adjustment to auto insurance and auto lease expense proper?; 7. Was the Intermediary's adjustment to liability insurance expense proper?; 8. Was the Intermediary's adjustment to professional accounting expense proper?; 9. Was the Intermediary's adjustment to salaries and benefits for intake coordinators proper?; 10. Was the Intermediary's adjustment to auto mileage/ allowance expense proper?; 11. Was the Intermediary's adjustment to staff travel/education expense proper?; 12. Was the Intermediary's adjustment to education/other expense proper?; 13. Was the Intermediary's adjustment to miscellaneous expense proper?; 14. Was the Intermediary's adjustment to bonus expense proper?; 15. Was the Intermediary's adjustment to owner's compensation expense proper?; 16. Was the Intermediary's adjustment to overhead expense proper?; 17. [withdrawn]
1999D04 95-0907 31-0073 Was the Intermediary's calculation of the Provider's disproportionate share hospital adjustment proper?
1999D05 94-2470 39-4023 Was the Intermediary's use of the reasonable compensation equivalent ("RCE") limits from 1984 to reduce the amount of reimbursable compensation paid to its hospital-based physicians ("HBPs") for fiscal year ended ("FYE") 1991 proper?
1999D06 93-1518+/C 51-0007 1. Was the Intermediary's treatment of equity income as investment income proper?; 2. Does 42 C. F. R. Section 412.106, as promulgated, violate the Medicare Act, the Administrative Procedure Act and/or the Constitution?
1999D08 96-0640 21-5264 1. Was HCFA's denial of the Provider's request for an exemption from the skilled nursing facility routine cost service limitation, as a new provider, Proper?; 2. Was the Intermediary's denial of the Provider's request for an exemption from the skilled nursing facility routine cost service limitations, based upon atypical services, without an occupancy adjustment, proper?
1999D09 94-2203 11-6571 Was the Intermediary's adjustment to bad debt proper?
1999D10 89-1103 05-0128 Was the Intermediary's adjustment to reclassify all identified purchased repairs and maintenance expences from the individual cost centers to the maintenance overhead cost center proper?
1999D11 97-0831 40-7014 Was the Intermediary's audit adjustment to durable medidcal equipment ("DME") bad debts proper?
1999D12 93-0451, 93-1941 44-7425 Was the Intermediary's adjustment of management fees proper?
1999D13 91-2935M 07-0016 Was the Intermediary's refusial to reclassify as graduate medical education ("GME") costs certain physician compensation costs and related secretarial compensation costs originally classified as non-GME operating costs on the Provider's GME base-year cost report proper?
1999D14 94-3074, 95-2199 14-0088 1. Was the Intermediary's calculation of the Provider's number of beds for purposes of determining the Provider's IME adjustment proper?; 2. Was the Intermediary's payments for outlier cases proper pursuant to 42 U.S.C. Section 1395ww(d)(5)9A0(iv), insofar as total outlier payments by the Secretary in the fiscal years in question were less than five percent of the total payments made based on DRG prospective payments for the years in question?
1999D15 94-0030 23-6563 1. Was the Intermediary's adjustment to Medicare charges relating to settlement data based on information contained in the PS&R report proper?; 2. Was the Intermediary's adjustment to Medicare payments proper?
1999D16 92-1962G Various Should the revised Dallas-Fort Worth wage indexes be effective October 1, 1991?
1999D17 91-2308, 94-2352, 94-1066 26-0021 Was the Intermediary's reclassification of the Provider's nursing school library costs from the nursing school cost center to the administrative and general cost center proper?
1999D18 94-2471 39-0142 Was the Intermediary's methodology for determining physicians'Part A costs (reasonable compensation equivalents) proper?
1999D19 95-1242+, 95-1242C 39-0118 Was the Intermediary's determination regarding the Provider's prospective payment system capital rate proper?
1999D20 91-1734 50-0025 Was the Intermediary's adjustment to bad debts proper?
1999D07 94-1896, 95-1021 19-0158 Was the Provider entitled to be reimbursed for the costs incured in connection with an abandoned hospital expansion project?
1999D22 93-1886 05-5837 Is the Provider entitled to the full exception request to the , which is sought from HCFA?
1999D23 93-0178, 93-0518, 92-1084 10-4013 Was the Provider entitled to an adjustment to the TEFRA rate of increase ceiling for the cost reoprt periods ended May 31, 1988, May 31 1989, and May 31, 1990?
1999D24 93-0688, 94-0445, 94-2071 45-0007 1. Were the Intermediary's disallowances of interest expense resulting from the sale of the Provider to Sid Peterson Memorial Hospital ("SPMH") proper?; 2. Were the Intermediary's adjustments to disallow public relations expense and establish a non-reimbursable cost center for marketing proper?
1999D25 94-2452 11-3027 Were the sale and lease of the Provider Transactions between related organations?
2006D16 04-0426 05-0122 Whether the Intermediary's disallowance of the Provider's inpatient and outpatient Medicare bad debts was proper?
2006D17 99-3635 22-5387 Whether CMS' denial of the Provider's request for an exception to the routine cost limits for skilled nursing facilities as a provider of atypical services was proper?
2006D18 00-0548, 00-0609 49-7033 Was the Intermediary's adjustment applying Medicare's Physical Therapy Compensation Guidelines to the Provider's employee physical therapists proper?
2006D19 04-0133 03-0101 Whether the Intermediary's adjustment of the Provider's disproportionate share (DSH) calculation was based upon a proper interpretation of the Medicare DSH statute as amended by the Benefits Improvement and Protection Act of 2000.
2006D06 97-2444, 98-2580, 99-3445, 99-3383G, 00-1426 37-7120, 37-7417 1. Whether the adjustments to the Providers' physical therapy costs were proper - applies to Case Nos. 97-2444, 98-2580, 99-3445 and 00-1426.; 2. Whether the adjustments to the Providers' travel costs were proper - applies to Case Nos. 97-2444 and 98-2580.; 3.Whether the adjustments to the Providers' home infusion costs were proper - applies to Case Nos. 99-3383G and 00-1426.
1999D21 91-2474M 22-0104 I. Was the Intermediary's reclassification of compensation for payroll physicians proper?; 2. Was the Intermediary's reclassification of teaching compensation for contract physicians proper?; 3. Was the Intermediary's disallowance of teaching time spent by contract physicians proper?
1999D26 94-1159 39-0142 Was the Intermediary's use of reasonable compensation equivalent ("RCE") limits fromm 1984 to reduce the amount of compensation paid by the Provider to its hospital-based physicians for fiscal year 1990 proper?
2006D21 01-0546G Various Whether the Intermediary appropriately denied the Provider's requests for an exception to the Medicare allowable hourly salary equivalency amount for physical therapy.
2006D22 01-0820 14-0052 Whether the Intermediary properly excluded patient days attributable to Medicare Health Maintenance Organization (HMO) encounters from the calcualtion of the Provider's disproportionate share adjustment.
2006D23 00-2689 39-0102 Whether the Intermediary's audit adjustments to the Medicare cost report that disallowed the loss on disposal of depreciable assets due to the facility's change of ownership (CHOW) were proper.
2006D24 03-0259; 03-0260 31-6597; 31-6625 Whether the Intermediary's adjustments were proper that disallowed the Providers' claimed Medicare Bad Debts, disallowed in a prior year period.
2006D25 01-1397; 01-1398 21-7118 1. Whether the Intermediary's application of Medicare's physical therapy guidelines to physical therapists paid on a per-visit basis was proper. (Applies to both cost reporting periods at issue - - case numbers 01-1397 and 01-1398.); 2. Whether the Intermediary's adjustment to include charity care home health visits in the calculation of the Provider's program reimbursement was proper. (Applies only to the Provider's fiscal year 1996 cost reporting period - - case number 01-1397.)
2006D26 02-0632 30-0003 Whether the denial of the Provider's request for an exception to the renal dialysis composite rate by the Centers for Medicare and Medicaid Services (CMS) was proper.
2006D27 00-1020 03-0030 Whether the Intermediary improperly failed to offset investment losses incurred by the Provider's home office against interest income earned on funds the Provider deposited with a trustee to retire the debt associated with an advance refunding transaction.
2006D28 04-0783; 04-0819 14-0007; 04-0093 Whether the Intermediary's adjustment to school of nursing costs was based upon a proper application of the effective date articulated in Section 6205(a)(2) of the Omnibus Budget Reconciliation Act of 1989.
2006D29 97-1202; 99-2900 33-0059 1. Were the Intermediary's adjustments offsetting rental income received by the Provider for employee housing against both operating and capital costs proper?; 2. Was the Centers for Medicare & Medicaid Services' methodology for determining the Provider's exceptions to the hospital-based skilled nursing facility cost limits proper?
2006D30 00-3284; 00-3619; 01-0598 19-5301; 19-5302; 19-5304 Whether the Intermediary's adjustments to reduce the Providers' outpatient therpay costs by 10 percent were proper?
2006D31 93-1227+; 93-1227C 05-0040 Whether the Provider is entitled to the benefit of the previously granted change in the TEFRA bas period, from fiscal year ending (FYE) June 30, 1985 to FYE June 30, 1988, for the purpose of applying the TEFRA limit for the Provider's FYE June 30, 1990.
2006D32 01-2850 37-0078 1. Whether the closing costs of $943,089, incurred for the sale of the hospital are allowable as a deduction from the salles price to determine gain or loss on the sale.; 2. Whether a portion of the sales proceeds received by the Provider from the sale of its hospital should be allocated to medical records and assembled work force assets to determine the amount of gain or loss on the sale.
1999D27 94-2772 45-0035 Was the denial of the Provider's request for an adjustment to the TEFRA limits because of untimely filing, proper?
1999D28 94-0152 39-0158 Was HCFA's denial of the Provider's request for an exceptionfor its TEFRA target rate adjustment for its exempt psychiatric unit for the fiscal year June 30, 1988 due to untimely filing, proper?
1999D29 92-0668 34-0113 Did the Intermediary properly reopen the Provider's cost report and recoup an overpayment made to the Provider?
1999D30 93-1376G Various Was the Intermediary's classification of the Louisianna franchise tax as an operating cost rather than a capital cost proper?
1999D31 93-1475 05-0329 Was the Intermediary's adjustment offsetting revenue associated with physician and guest meals, while, at the same time, setting up a nonreimbursable cost center for these nonallowable costs, proper?
1999D32 97-1195; 97-1192; 95-1564; 97-1191 23-7201 1. Was the Intermediary's adjustment to the asset valuation of the employee stock ownership plan (ESOP) proper? (For 1990, 1991, and 1992 only); 2. Was the Intermediary's adjustment to interest expense proper? (For 1992 and 1994 only)
2006D33 00-2873; 00-2874; 01-1931 09-7000 Whether the Intermediary's adjustment applying Medicare's Physical Therapy Compensation Guidelines to the Provider's employee physical therapists was proper.
2006D34 95-0315G 45-4069; 45-3038 Whether the Intermediary's denial of the Providers' request for an exception to the related organization principle for calendar years 1989 through 1992 was proper.
2006D35 01-0991 14-4646 1. Whether the Intermediary's adjustment to complete all cost reporting forms in conformity with current regulations and instructions was proper.; 2. Whether the Intermediary's adjustment to correct all math and flow-through errors arising on revision of the cost report was proper.; 3. Whether the Intermediary's adjustment to the amortization of start-up costs applicable to the 1998 cost reporting period was proper.; 4. Whether the Intermediary's adjustment to unsupported/unliquidated expenses related to accounting and consulting services, legal fees, computer billing expenses, housekeeping costs and accrued A&G costs was proper.; 5. Whether the Intermediary's adjustment reclassifying costs associated with medical and professional services was proper.; 6. Whether the Intermediary's adjustment to expenses associated with the Chicago Community Education Program was proper.; 7. Whether the Intermediary's adjustment to food costs from Sam's Club was proper.; 8. Whether the Intermediary's adjustment to unsupported interest and banking charges, contract labor, psychiatrist's services, professional services - group therapy and catering expenses was proper.; 9. Whether the Intermediary's adjustment to rent expense was proper.; 10. Whether the Intermediary's adjustment to depreciation expense was proper.; 11. Whether the Intermediary's adjustment reclassifying telephone and wire service expenses to the Administrative and General (A&G) cost center was proper.; 12. Whether the Intermediary's adjustment reclassifying security and maintenance expenses to the Plant Operations cost center was proper.; 13. Whether the Intermediary's adjustment incorporating Medicare charges per the Provider Statistical and Reimbursement Report (PS&R) dated 2/29/00 was proper.; 14. Whether the Intermediary's adjustment to reflect gross salaries statistics on Worksheet B-1 was proper.; 15. Whether the Intermediary's adjustment to the square footage statistics was proper.; 16. Whether the Intermediary's adjustment to reflect the settlement data shown on the PS&R dated 2/29/00 was proper.; 17. Whether the Intermediary's adjustment to bad debts was proper.
2006D36 02-2110G Various Whether the Intermediary properly determined that bad debts claimed related to uncollectible deductibles and coinsurance for services rendered to patients that were dually eligible for Medicare and Medicaid, also known as qualified Medicare beneficiaries (QMB), that were paid under the Medicare Part B fee screen do not constitute bad debts under applicable Medicare law and regulations.
2006D37 02-0140 07-0007 Whether the Intermediary's adjustment to disallow the Connecticut Sales Tax was proper.
2006D38 98-1822 07-0028 Whether the Intermediary's adjustment to disallow the Connecticut Sales Tax was proper.
2006D39 01-2871 05-0327 Whether the denial of the Provider's request for an exception to the end stage renal disease (ESRD) composite rate by the Centers for Medicare and Medicaid Services (CMS) was proper.
2006D40 01-2872 05-2550 Whether the denial of the Provider's request for an exception to the end stage renal disease (ESRD) composite rate by the Centers for Medicare and Medicaid Services (CMS) was proper.
1999D33 91-2887 14-0087 Was the Intermediary's netting of the balance due to Edgewood Hospital of liabilities owed to the program by Edgewood Medical Center proper?
1999D34 97-0354G Various Did the Providers properly classify workers' compensation costs under the category of administrative and general costs instead of employees benefits costs?
1999D35 89-1782R 33-0041 Were the Intermediary's adjustments reclassifying the lease rental costs reported as capital costs proper?
1999D36 91-1440 05-0194 Was the Intermediary's adjustment modifying the disproportionate share adjustment amount proper?
1999D37 84-0407; 88-1478 26-6512 Jurisdiction: 1. Were the Intermediary's PSRO and PIP deductions from the remittance advices in payment checks in the amount of $25,455 proper?; 2. Did the Intermediary fail to make timely reimbursement to the Provider for its covered services?; 3. Should the Intermediary reimburse the Provider for its cost of money by paying interest on all payments or awards granted by the PRRB?; 4. Was the Intermediary's adjustment to interim payments proper?; 5.Was the Intermediary's adjustment toerrors on non-covered charges proper?; 6. Did the Intermediary fail to make proper state Medicaid filings?; 7. Was the Intermediary's adjustment to the Provider of remittance advices and payment checks proper?; 8. Did the Intermediary fail to make timely reimbursement to the Provider for its covered services thereby entitling the Provider to interest on such late payments and on all payment checks granted by the PRRB?
1999D38 96-2150 22-5664 Was the Provider entitled to an exemption from the skilled nursing facility routine service cost limits as a "new provider"?
1999D39 93-1522 05-4003 Was the Intermediary's or the Health Care Financing Administration's ("HCFA") determination of the Provider's request for an adjustment to the rate-of-increase ceiling proper?
1999D40 88-0373 06-0098 Was the DRG amount, other than outlier payments, calculated correctly under Medicare law and PPS regulations?
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?
1999D42 92-0215; 94-0239 05-0226 Was the Intermediary's adjustment to offset investment income earned from a related organization proper?
1999D43 89-0910 05-0153 Was the Health Care Financing Administration's ("HCFA") refusal to excude the Campbell alcohol and chemical dependency recovery unit from the prospective payment system ("PPS") because it did not meet applicable State licensure law proper?
1999D44 96-0529 52-5394 Were the Intermediary's adjustments to ancillary cost centers proper?
1999D45 98-0105 23-6616 Was the Intermediary's adjustment to owner's compensation Proper?
1999D46 95-1043 39-5481 Was the Intermediary's determination that the transportation costs for services provided by Today's Staffing Services Incorporated were not reasonable, necessary or related to patient care proper?
1999D47 95-0931 01-0139 Was the Provider's request for an exception to its TEFRA target rate proper?
1999D48 95-0492E; 97-0952E;97-2389E 20-7026 1. Were the Intermediary's adjustments to building costs by the creation of separate cost centers and the elimination of common area costs proper?; 2. Was the Intermediary's adjustment reclassifying supervisor salaies and benefits proper?
1999D49 93-1505 22-0077 Was the Intermediary's disallowance of Medicare bad debts proper?
1999D51 94-0198 01-0079 Was the Intermediary's attempt to recover Disproportionate Share Hospital (DSH) payments from the Provider for FYs 89 and 90 proper?
1999D52 94-2925 28-0034 Was the Intermediary's disallowance of the Provider's excess dialysis costs, based upon the Health Care Financing Administration ("HCFA's") denial of the Provider's exception request, correct?
1999D53 94-1156 39-4023 Was the Intermediary's application of the 1984 Reasonable Compensation Equivalent (RCE) limits proper?
1999D54 97-3024 55-7160 Was the Intermediary's adjustment reclassifying non-allowable costs of community liason employees to a non-reimbursable cost center proper?
1999D55 94-2504 04-0022 Were the Intermediary's adjustments disallowing the pass-through of nursing education costs proper?
1999D56 96-0174G Various Were the Intermediaries' adjustments eliminating or disallowing the Providers' "gross-up" of drug charges and costs in order to allocate indirect costs to those cost centers correct?
1999D57 95-1188R 050235; 55-5046 Was the Intermediary's denial of the Provider's Routine Cost Limits exception proper?
1999D58 95-0308R 05-0235; 55-5046 Was the Intermediary's denial of the Provider's Routine Cost Limit exception proper?
1999D59 97-0139 39-5095 1. Was the Intermediary's reclassification of employment taxes proper?; 2. Was the Intermediary's adjustment to owner's compensation proper?
1999D60 96-2056 23-7141 1. Was the Intermediary's adjustment to interest expense relating to employment taxes proper?; 2. Was the Intermediary's adjustment to interest expense relating to property taxes proper?
1999D61 97-2340 01-5049 1. Was HCFA's methodology as set forth in Transmittal 378 for determining the amount of the exception from the routine cost limits for hospital-based skilled nursing facilities, and as applied by the Intermediary to the Provider for FYE December 31, 1994, a proper interpretation of the Medicare statute and regulations?; 2. Did the Intermediary properly deny the Provider a rollover interim exception for FYE December 31, 1994?
1999D62 96-0122 38-5161 Was the Intermediary's adjustment limiting contracted occupational therapy and speech therapy costs to $104 per hour proper?
1999D63 94-3180 36-0085 Was the Intermediary's adjustment to the outlier payments proper?
1999D64 96-1263 52-5419 Was the Intermediary's adjustment to apply the lower-of-costs or charges principle to the Provider's Part B cost of physical, occupational, and speech therapy properly applied?
1999D65 94-3026 19-7317 Was the Intermediary's adjustment to Worksheet A-8-3 proper?
1999D66 98-0211GE Various Did the Intermediary properly determine that the Providers had less than 100 "beds" for the fiscal years in question?
1999D67 96-0869 19-0207 Was HCFA's measurement of an exception to the cost limits for hosiptal-based SNFs from 112% of the mean hospital-based inpatient routine service costs, instead of from the hospital-based SNF routine cost limit, proper?
1999D68 98-2042; 98-2046 33-7005; 33-7002 This decision is a reissuance of the original PRRB Dec. No. 99-D68 issued on 9/17/1999. In the original decision, the Board modified the Intermediary's adjustment and specified a new utilization and apportionment statistic. The parties to the decision asked the Board to clarify how the adjustment should be implemented. This decision more clearly defines the adjustment methodology. ; 1. Was the Intermediary's adjustment to home health aide hours proper?; 2. Was the Intermediary's adjustment to public relations costs proper?; 3. Was the Intermediary's adjustment to medical supply costs proper?
1999D69 97-0503 21-5282 Was the Health Care Financing Administration's ("HCFA") denial of the Provider's request for an exemption to the routine cost limits as a new provider under 42 C.F.R. Section 413.30(e) proper?
1999D71 96-1086 44-0182 1. Was the Intermediary's adjustment disallowing Medicare reimbursement for a portion of the Provider's bad debts proper?; 2. Was the Intermediary's reclassification of home health agency costs proper?
1999D72 97-2381 26-7140 Did the Health Care Financing Administration ("HCFA") properly deny the Provider's request for an exception to the home health agency cost limits based on atypical services ?
1998D001 92-1498 14-0179 1. Was the Intermediary's necessity of borrowing determination with regard to the Provider's Illinois Health Facility Authority (IHFA) loan proper?; 2. Did the Intermediary properly include the Provider's neonatal unit beds and days in the indirect medical education (IME) and graduate medical education (GME) patient load calculation for the fiscal year ended June 30, 1989?; 3. Did the Intermediary properly allocate the Providers investment income consistent with the allocation of interest expense?
1998D002 91-1163E; 92-0895 24-0036 Was the Intermediary's adjustment excluding from capital-related costs the Provider's payments for the rental of a mobile magnetic resonance imaging ("MRI") unit proper?
1998D003 91-0133 03-4001 Is the Provider entitled to an adjustment to its TEFRA limits for malpractice insurance costs for FYEs June 30, 1986 and June 30, 1987?
1998D004 91-1441 06-0015 Was the Intermediary's adjustment reclassifying air ambulance lease rental payments from capital costs to operating expenses proper?
1998D005 96-2054 45-7789 Was the Intermediary's adjustment shifting nursing and home health aide costs to a privite duty nursing cost center proper?
1998D006 93-0228 24-0053 Did the Intermediary properly disallow the physician's Part A compensation?
1998D007 94-3386 33-7243 Was the Intermediary's adjustment reversing the direct assignment of the New York sub-unit costs proper?
1998D008 91-2866M 33-0214 Were the Intermediary's adjustments to the graduate medical education ("GME") base year costs proper?
1998D013 96-2058 10-5883 Is the Provider exempt from the skilled nursing facility ("SNF") routine cost limits as a "new provider"?
1998D014 92-0430 10-5201 Was the Health Care Financing Administration's (HCFA) denial of the Provider's exception request proper?
1998D016 85-1109 39-0079 Were the Intermediary's adjustments to the Provider's interest expense to account for the hospital's 1983 advance refunding of debt proper?
1998D017 89-0303 39-0079 Were the Intermediary's adjustments to the Provider's interest expense to account for the hospital's 1983 advance refunding of debt proper?
1998D018 93-1769 05-5632 Was the Intermediary's classification of the salaries of restorative nursing aides from the physical therapy cost center to the routine cost area proper?
1999D70 92-0110G Various Were the pre-composite rate End Stage Renal Disease (ESRD) screens invalid and therefore not applicable to limit the Providers reimbursement for ESRD treatments?
1999D50 95-0523; 96-0510 52-7143 Were the Intermediary's adjustments to reclassify certain costs and visits from skilled nursing to either other visits or private duty visits proper?
1998D019 91-2800M 05-0239 1. Was the retroactive audit of Graduate Medical Education (GME) costs proper?; 2. Was the Intermediary's determination classifying malpractice insurance costs as administrative and general costs rather than direct GME costs proper?
1998D020 91-2842M 05-0103 1. Was the retroactive audit of Graduate Medical Education (GME) costs proper?; 2. Was the Intermediary's determination classifying malpractice insurance costs as administrative and general costs rather than direct GME costs proper?
1998D011 95-0380 52-6514 Was the Intermediary's modification of cost reporting form 2088-79 for the calculation of reimbursable cost proper?
1998D021 89-2023 05-0179 Was the Intermediary's adjustment to the amortization of the loss on the sale of Turlock Community Hospital proper?
1998D015 91-2414M 24-0053 Was the Intermediary's denial of the reclassification of the accrued surgery residency costs from the operating room cost center to the interns and residents cost center in calculating the Provider's base year graduate medical education costs proper?
1998D022 93-1156 38-0018 Was the Provider's request to reopen the calculation of the disproportionate share adjustment to exclude employee self-insured days proper?
1998D023 95-1661 06-6549 Does the Provider Reimbursement Review Board have jurisdiction over Provider extension locations that are not surveyed for purposes of certification?
1998D024 92-0662 47-4001 Did the Health Care Financing Administration (HCFA) correctly conclude that the Provider's requests for adjustment to its Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA) limits were not timely filed and were therefore improper?
1998D025 95-0308 05-0235 Was the Intermediary's denial of the Provider's Routine Cost Limit exception proper?
1998D009 92-1679 39-0142 Was the Intermediary's application of the 1984 Reasonable Compensation Equivalent (RCE) limits proper?
1998D010 93-1749 10-6639 Was the Provider entitled to the lower of cost or charges (LCC) carryforward which was generated under the prior ownership?
1998D012 86-0429 05-0289 Was the Intermediary's denial of the full TEFRA incentive payment to the Provider proper?
1998D026 91-2673M 39-0028 1. Were the GME regulations at 42 CFR Section 413.86 valid?; 2. Were the HCFA GME Program Instructions (GME-PI) implementing the reaudit provisions of 42 CFR Section 413.86 valid?; 3. Was the Intermediary's adjustment reclassifying the GME costs for the Medical Library (ML) and Department of Continuing Education (DCE) to Administrative and General (A&G) proper?; 4. Was the Intermediary's adjustment reclassifying a portion of the teaching physicians salaries from GME to A&G proper?; 5. Was the Intermediary's adjustment reclassifying costs for the salaries and expenses related to GME support personnel from GME to A&G costs proper?; 6. Do the Intermediary's adjustments no. 3 and 6 violate the consistantcy rule stated in 42 CFR Section 412.113(b)(3) (1989)?; 7. Was the Intermediary's adjustment revising the number of FTE residents used in determining the Provider Average Per Resident amount proper?; 8. Was the Intermediary's failure to include the costs associated with the Provider's Anesthesiology and Radiology GME programs in the GME base year proper?; 9. Should the GME clinic costs, mistakenly classified as operating costs in the base year, be included when calculating the APRA?; 10. Should the GME laboratory costs, mistakenly classified as operating costs in the base year, be included when calculating the APRA?
2006D41 00-3942 14-7589 Whether the Intermediary's disallowance of accrued compensation for the Provider's President/Chief Executive Officer (CEO) and Vice-President/Operations Manager was proper.
2006D42 00-3347 34-6538 1. Was the Intermediary's adjustment to disallow costs due to missing records proper?; 2. Did the Intermediary improperly reopen the cost report?; 3. Was the Intermediary's adjustment to physical therapy salaries proper?; 4. Was the Intermediary's adjustment to the accrued 401(K) plan proper?; 5. Was the Intermediary's adjustment to the accrued payroll taxes proper?; 6, Was the Intermediary's adjustment to accrued profit sharing plan proper?; 7. Was the Intermediary's adjustments to accrued FICA and Federal withholding proper?; 8. Was the Intermediary's adjustment to health insurance cost paid on behalf of physical therapists proper?; 9. Was the Intermediary's adjustment to contract physical therapy and Quality Assurance consultant expenses proper?; 10. Was the Intermediary's adjustment to contracted occupational therapy proper?; 11. Was the Intermediary's adjustment to contracted speech therapy proper?; 12. Was the Intermediary's adjustment to auto expense proper?; 13. Was the Intermediary's adjustment to auto lease expense proper?; 14. Was the Intermediary's adjustment to administrative recruiting proper?; 15. Was the Intermediary's adjustment to telephone expenses proper?; 16. Was the Intermediary's adjustment to accounting expense proper?; 17. Was the Intermediary's adjustment to occupational therapy dues proper?; 18. Was the Intermediary's adjustment to administrative dues proper?; 19. Was the Intermediary's adjustment to nursing home rent expense proper?; 20. Was the Intermediary's adjustment to rent expense proper?; 21. Was the Intermediary's adjustment to office lease expense proper?; 22. Was the Intermediary's adjustment to other charges- occupational, physical and speech therapy proper?; 23. Were the Provider's requests for additional costs for depreciation, contracted occupational therapy services, recruiting- physical therapy, recruiting- administrative and accounting expenses proper?
2006D43 04-0025 17-0032 Whether the Provider was improperly denied a Medicare low-volume adjustment.
2006D44 04-0643 01-0092 Whether the Fiscal Intermediary/Centers for Medicare and Medicaid Services' (FI/CMS) denial of the request to include additional pension costs as wage-related costs for purposes of the Provider's FY 2004 wage index was proper.
2006D45 02-0224 39-0256 Was the Centers for Medicare and Medicaid Services' (CMS) denial of the Provider's request for an exception to the End Stage Renal Disease (ESRD) composite rate proper?
2006D46 03-0940 33-0078 Whether the Intermediary properly calculated the Provider's indirect medical education (IME) reimbursement for its fiscal year ending December 31, 1999.
2006D47 03-1587; 03-1592 14-0119 Whether the Intermediary should have used the "aggregation methodology" when implementing the updated reasonable compensation equivalent (RCE) limits on compensation paid to Provider's hospital-based physicians.
2006D48 98-2103; 99-1746; 00-2563; 03-0127; 03-0484; 03-1471; 03-1472 09-0007 Whether the Intermediary properly adjusted the Provider's available beds for the purpose of determining the amount of its indirect medical education payment.
2006D49 96-2013G 07-5234; 07-5210 Whether the Intermediary's adjustments to disallow rental expense as a cost incurred with a related organization were proper.
2006D50 01-1326G 07-5234; 07-5210; 07-5198 Whether the Intermediary's adjustments to disallow rental expense as a cost incurred with a related organization were proper.
2006D51 02-1212 52-0087 Whether the denial of the Provider's End Stage Renal Disease (ESRD) exception request was in compliance with 42 C.F.R. section 413.180(h), which states: "(h) Approval of an exception request. An exception request is deemed approved unless it is disapproved within 60 working days after it is filed with its Intermediary."
2006D52 04-0565 50-1304 1. Whether the Intermediary's adjustment to direct nursing costs was proper.; 2. Whether the Intermediary's adjustment increasing the total patient days to include respite care days was proper.
2006D53 96-0480 26-0104 Whether the Intermediary's adjustment that disallowed the consolidation of all of the Provider's therapy services into a single cost center was proper.
2006D54 02-1420 10-0122 Whether the Intermediary's adjustment of disproportionate share hospital (DSH) reimbursement based on its determination that the Provider had less than 100 available beds for DSH eligibility purposes was proper.
2006D55 98-0580; 98-0463 14-5314 Whether the Provider's exception requests to the skilled nursing facility (SNF) routine service cost limits under 42 C.F.R. Section 413.30(f) was properly denied because the Provider did not request the exceptions within 180 days of the original notices of program reimbursement.
2006D56 04-0660 05-0444 Whether the Provider's regular Medicare outpatient bad debts are not allowable until all collection efforts including those of a collection agency have ceased.
2006D57 05-0051 51-5028 Whether the Intermediary properly disallowed bad debts claimed for uncollectible deductibles and coinsurance related to therapy services furnished to Medicare beneficiaries dually eligible for Medicare and Medicaid, and paid under the Part B fee schedule.
2006D58 03-0895 34-0168 Whether the Intermediary's disallowance of Medicare bad debts claimed by the Provider was justified.
2007D01 97-0174 16-0024 Was the Intermediary's disallowance of the loss on disposal of assets resulting from a merger proper?
2007D02 03-0482G 31-0108; 31-0039; 31-0005 Whether it was proper for the Centers for Medicare and Medicaid Services (CMS) to include the 1999 information for Memorial Medical Center at South Amboy in the 2003 calculation of the Middlesex-Somerset-Hunterdon, New Jersey Metropolitan Statistical Area (MSA) Wage Index.
2007D03 04-0372 33-7089 Whether the Intermediary's adjustment to reconcile the fiscal year ended (FYE) 12/31/00 home health agency aide charges to the Provider Statistical & Reimbursement Report (PS and R) was proper.
2007D04 99-1159; 01-2664; 02-0866 20-0024 Whether the Intermediary's denial of the Provider's request for an adjustment to its TEFRA target amount 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.
2009D11 05-1360G; 05-1362G; 05-1363G; 05-1527G Various Whether the Intermediary improperly disallowed from the calculation of the Providers' Disproportionate Share Hospital (DSH) payments, patient days associated with Medicaid patients who were admitted to the hospital prior to the day of giving birth and that were characterized by the Intermediary as "labor days".
2009D10 07-1969G 19-5350; 11-5612; 15-5473; 11-5535 Whether the Intermediary's adjustments to disallow Medicare bad debts written off by Kindred Healthcare and claimed as worthless after the year end date of the terminating cost report it filed for each skilled nursing facility, due to change of ownership, were proper.
2007D12 03-1464 05-0308 Whether all of the Provider's outpatient total cost, total charges, and Medicare charges for separately billable End Stage Renal Disease (ESRD) drugs should be reported together on line 56 (drugs charges to patients), on line 57 (renal dialysis), or on a separate cost center line of the Medicare cost report.
2007D10 04-0209 13-0029 Whether the Intermediary was correct in its determination that no costs for physician assistant emergency room availability are allowable as Medicare Part A reimbursable expenses.
2007D09 01-3592G; 02-2153G; 03-0960G Various Whether the Intermediary properly calculated the Providers' 1996 Indirect Medical Education (IME) base year Full-Time Equivalency (FTE) cap specifically regarding residents rotating to nonhospital settings.
2007D08 05-0448 25-0085 Whether the Provider Reimbursement Review Board may grant jurisdiction for the adjustment included in the Provider's initial Notice of Program Reimbursement.; 2. Whether the Intermediary's adjustment to remove unliquidated liabilities in the year incurred was proper.
2007D07 01-1443; 01-1444 45-0011 Whether the Intermediary's made a proper determination that Provider should be paid at the prospective payment rate for rural providers after it was certified as a provider-based entity of a hospital entitled to receive the higher urban prospective payment rate.
2007D06 04-0575 17-0086 Whether the Intermediary's revised Notice of Program Reimbursement issued on July 25, 2003, that increased the Provider's Disproportionate Share Hospital (DSH) payment, included all Medicaid eligible days that would qualify for inclusion under HCFA Ruling 97-2.
2007D05 02-1833G Various Whether all the patient days related to patients that were eligible for medical assistance under an approved state Medicaid plan for such days were included in the Medicaid ratio of the Medicare disproportionate share hospital (DSH) payment calculation.
2011D06 05-0508G; 06-0784G; 07-0510G; 08-1412G Various Whether the Intermediary/Medicare Administrative Contractor properly calculated the Providers' 1996 resident cap for purposes of direct graduate medical education and indirect graduate medical education payments.
2011D08 09-1927 37-1633 1. Has the Provider demonstrated that it is entitled to a hearing before the Board because there is at least $10,000 in controversy?; 2. To what extent, if at all, Medicare's $397,228 demand for repayment from the Provider for fiscal year 2007, calculated pursuant to the existing regulation, would be decreased if the Provider's proposed manner of calculation is adopted.
2011D09 08-2162GC; 08-2165GC; 08-2186G; 08-2233GC et al Various Whether the Intermediary properly excluded the Ohio Hospital Care Assurance Program (HCAP) days from the Medicare disproportionate share hospital (DSH) calculation.
2011D10 00-3532G; 04-1657G; 06-0468G; 07-2031G; 08-2585G Various Whether the Intermediary's non-inclusion of the Indiana Hospital Care for the Indigent (HCI) program patient days as Medicaid eligible days, whether paid or unpaid, in the calculation of the Medicaid proxy for Medicare Disproportionate Share Hospital (DSH) eligibility and payment determinations, including any impact such would have on capital DSH, was proper.
2011D11 06-2033 01-0164 Whether the Centers for Medicare and Medicaid Services (CMS), reversal of the Provider's rural referral center (RRC) classification was proper.
2011D12 06-2376; 06-2377; 06-2378; 06-2379; 06-2381; 06-2383; 06-2385; 06-2410 Various Whether the Fiscal Intermediary properly adjusted the Providers' bad debts for the fiscal year ended December 31, 2004.
2011D13 08-1695 05-0746 Whether it was proper for the Centers for Medicare and Medicaid Service to reduce by two percent the Medicare annual payment update for Western Medical Center - Santa Ana for federal fiscal year 2008.
2011D14 06-1927G; 08-0138G; 09-1545GC Various Whether the Intermediary properly excluded Connecticut's State-Administered General Assistance (SAGA) program days from the Medicare disproportionate share hospital (DSH) calculation for fiscal year-ends (FYEs) September 30, 2001 through September 30, 2004 for the two hospitals in these group appeals.
2011D15 09-1796 05-0018 Whether the Provider is entitled to the full market basket update for Federal Fiscal Year ending 2009 under the Reporting Hospital Quality Data for Annual Payment Update Program.
2011D16 09-1058 33-0094 Was CMS' determination to reduce the Provider's inpatient prospective payment system market basket update for federal fiscal year (FY) 2009 by two (2.0) percentage points proper?
2011D17 05-1761 51-0022 Whether the provider has a right to a hearing on certain graduate medical education costs and kidney acquisition costs that were not claimed on the cost report.
2011D18 05-1032; 06-1173 09-0001 Whether the Intermediary properly extrapolated the sample error rate to the population in adjusting Medicaid eligible days.
2007D11 97-2446 05-0597 Whether the Intermediary's determination of reimbursable Medicare bad debts for beneficiaries without Medicaid eligibility (non-crossover beneficiaries) was proper.
2009D37 98-3491 39-0160; 39-5580 Whether the Centers for Medicare and Medicaid Services' methodology for determining the Provider's exception to the hospital-based skill nursing facility (HB-SNF) routine cost limit was proper.
2009D38 06-0316G; 06-0317G; 06-0318G; 06-0319G Various Whether the Intermediary improperly computed the numerator of the Medicaid fractions that were used to calculate the Provider's disproportionate share hospital (DSH) payments for fiscal years 1999, 2000, 2001, and 2002 by excluding inpatient days attributable to individuals who received assistance under the Massachusetts Uncompensated Care pool for such days.
2009D36 06-1080G; 06-1081G Various Whether the Intermediary"s adjustments to the Provider's reimbursable capital cost after denying "new hospital" status was proper.
2009D35 04-2261G Various Whether the Intermediary's calculation of the Provider's Medicare disproportionate share hospital (DSH) payments improperly omitted days attributable to patients who were dually eligible for Medicare Part A and Medicaid, but for which Medicare Part A did not make payment, from the numerator of the "Medicaid fraction" described in 42 U.S.C. Section 1395ww(d)(5)(F)(vi)(II) and 42 C.F.R. Section 412.106(b).
2009D34 99-1786; 99-2499; 00-2047; 01-1820 22-0042; 22-5699 1. Whether the Intermediary's audit adjustment disallowing the entire loss on the disposition of assets claimed by the Provider, when the Provider corporation merged with another provider corporation, were appropriate.; 2. Whether the Intermediary properly denied the Provider's application for a new provider exemption from the routine service cost limits (RCLs) for its hospital-based skilled nursing facility (HB-SNF).
2007D28 03-0513; 04-0456 44-0070 Whether the FYEs 6/30/00 and 6/30/01 ambulance cost per trip limits were improperly low because the Intermediary improperly applied the 5.8% outpatient operating cost reduction and the 10% outpatient capital cost reduction to base year costs utilized to calculate those limits.
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.
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.
2008D08 99-3188 45-7001 1. Whether the disallowance of $595,069 as an adjustment to administrative and general pooled costs related to a management service organization, Home Health First, was proper?; 2. Whether the disallowance of $35,390 to remove the portion of Home Health First management fees attributable to the cost of a deffered compensation plan for executives was proper.; 3. Whether the disallowance of $351,012 as cost in excess of the physical therapy salary equivalency guidelines (SEGs) was proper.
2007D18 02-2080 45-0688 Whether the Intermediary's determination of allowable Medicare bad debts based upon collection effort was proper.
2007D17 97-2936 05-0279 Whether the Intermediary improperly limited the Provider's hospital-based Skilled Nursing Facility's (SNF) routine cost limit exception amount to costs in excess of 112 percent of its peer group costs rather than costs in excess of the routine cost limit.
2007D16 03-0818 05-0578 Whether the Intermediary properly increased the number of available beds used to determine the Provider's indirect medical education (IME) payment.
2007D15 00-1836 21-7134 Whether the Intermediary's adjustment to disallow the cost of accrued compensatory time was proper.
2007D14 00-3662G; 00-3663G; 00-3664G; 02-0983G; 04-0180G; 04-0443G Various Whether the offshore captive investment limitations prescribed in section 2162.2.A.4 of the Provider Reimbursement Manual may properly be applied to disallow all of the premiums paid by the Providers to First Initiatives Insurance, Ltd. For the 1997-2002 cost reporting periods.
2007D67 03-0522G Various Whether the Intermediary failed to properly adjust the wage data for Rochester General Hospital used in the calculation of the Federal Fiscal Year (FFY) 2003 Wage Index for The Rochester, New York Metropolitan Statistical Area (MSA).
1998D030 90-2029 05-0388 Was the Intermediary's adjustment disallowing the costs associated with the repossessed equipment proper?
1998D029 89-1782 33-0041 Were the Intermediary's adjustments reclassifying the lease rental costs reported as capital costs proper?
1998D028 87-0480E 33-0085 Was the Intermediary's denial of the Provider's request for rural referral center status for the fiscal year ended December 3, 1986 proper?
1998D027 95-1188 05-0235 Was the Intermediary's denial of the Provider's Routine Cost Limit exception proper?
2007D24 03-1199G Various Whether the Intermediary should include all MediKan patient days, primary and secondary, in the Providers' disproportionate share hospital (DSH) calculation.
2007D23 01-2214 22-0060 Whether the Intermediary's denial of the application of Jordan Hospital for a new provider exemption from the routine cost limits for its provider-based skilled nursing facility was justified.
2007D22 01-0654; 02-0235 01-7009 Whether the relevant claims were timely filed by Alacare under 42 C.F.R. Section 424.44.
2007D21 03-0268; 03-0269 05-0045 Whether the Intermediary's adjustments disallowing the Provider's regular Medicare bad debts were proper.
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?
2007D19 99-3470; 99-3471 39-0037; 39-0036 Whether the Intermediary's denial of a loss on disposition of assets due to a consolidation of Sewickley Valley Hospital and The Medical Center of Beaver was correct.
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?
1998D031 91-2986M 33-0153 Were the Intermediary's adjustments made foe graduate medical education (GME) settlement purposes proper?
1998D032 95-0495 39-0181 Was the Intermediary's adjustment disallowing the Provider's claimed loss on disposal proper?
1998D033 95-2125 53-7025 Did the Intermediary properly disallow a portion of the owner's compensation?
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?
1998D035 93-2004 10-0114 Does the recapture of depreciation due to the gain on the sale of depreciable assets have any effect on the Provider's equity capital for prior years?
1998D036 93-0337 05-0034 Was the Provider's request for an adjustment to the TEFRA target amount for the 1989 fiscal year filed on a timely basis?
1998D037 93-0145 52-0091 Was the Intermediary's denial of sole community status under 42 C.F.R. Section 412.92 proper?
1998D038 95-2447 17-7215 1. Was the Intermediary's adjustment to the administrative and general seminar costs proper?; 2. Was the Intermediary's adjustments disallowing health education compensation and nursing compensation proper?
1998D039 97-0111G; 97-0112G Various Were the Intermediary's adjustments to occupational therapy and speech therapy costs proper?
1998D040 96-2419 52-5569 Should the Provider be granted a "new Provider" exemption from the routine cost limits in accordance with 42 C.F.R. Section 413.30(e)?
1998D042 93-0048 05-0102 Was the Intermediary's adjustment disallowing Medicare bad debts proper?
1998D041 93-0590 36-0062 Was the Intermediary's adjustment offsetting employee benefits proper?
1998D043 92-0033 50-0044 Was the Intermediary's denial of the Provider's request for an adjustment to its TEFRA target rate for its rehabilitation unit proper?
1998D044 96-0320 14-7273 Was the Intermediary's adjustment reducing allowable owner's compensation correct?
1998D046 92-1582 39-6563 Was the Intermediary's adjustment to the Provider's reasonable costs proper?
1998D047 96-2128 39-0023 Was the Provider's request for additional adjustment payments for routine and ancillary services under 42 C.F.R. Section 413.40(g)(3) timely?
1998D048 97-0050G Various Did the Intermediary properly adjust the Provider's occupational and speech therapy costs?
1998D049 91-2824M 14-0180 1. Was the Intermediary's adjustment reclassifying physcian salaries for medical education from interns and residents to the administrative and general cost center proper?; 2. Was the Intermediary's adjustment disallowing 50 percent of the Chicago Medical School ("CMS") faculty salaries related to teaching of undergraduate medical students proper?; 3. Was the Intermediary's adjustment reclassifying the salary of a fellow from interns and residents to the adults and pediatric cost center proper?; 4. Was the Intermediary's adjustment of the weighted average full-time equivalence of the interns and residents proper?; 5. Was the Provider's request for Hill Burton 3 percent interest subsidy in total allowable costs proper?; 6. Was the Intermediary's failure to include expenses related to graduate medical education ("GME") which was not filed on the Medicare cost report proper?; 7. Should the laundry and linen statistic be adjusted to include laundry processed for residents?; 8. Should the meals served statistic be adjusted to include meals consumed by residents in the GME base period?; 9. Should the square footage statistic be adjusted to include residents sleeping and conference rooms?
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?
2007D68 99-2630; 00-3142;01-1808; 02-1095; 03-1383; 01-2158 24-0063; 24-0210 1. Whether the Intermediary's exclusion of certain non-Medicaid general assistance and other state-only funded patient days (General Assistance Days or GADs) from the Provider's Medicaid Proxy was proper based on the instruction contained in Program Memorandum A-99-62. (St. Joseph's for FYE 1997 through 2000); 2. Whether Medicare + Choice days were properly treated in the Provider's disproportionate share hospital (DSH) calculation. (St. Joseph's for FYE 1998, 1999 and 2000); 3. Whether the Intermediary properly excluded, for indirect medical education (IME) and direct graduate medical education (DGME) reimbursement purposes, certain resident rotations at related non-hospital locations. (St. Joseph's for FYE 1997, 1998 and St. John's for FYE 1998)
2007D71 00-3350 34-6538 1. Was the Intermediary's adjustment to Medicare bad debts proper? (Provider Issue 1); 2. Were the Intermediary's adjustments to salaries - administrative proper? (Provider Issue 2); 3. Was the Intermediary's adjustment to salaries - physical therapy proper? (Provider Issue 2); 4. Was the Intermediary's adjustment to salaries - speech therapy proper? (Provider Issue 2); 5. Was the Intermediarys adjustment to salaries - occupational therapy proper? (Provider Issue 2); 6. Was the Intermediary's adjustment to other charges - physical therapy proper? (Provider Issue 3); 7. Was the Intermediary's adjustment to other charges - speech therapy proper? (Provider Issue 3); 8. Was the Intermediary's adjustment to other charges - occupational therapy proper? (Provider Issue 3); 9. Was the Provider's request for additional costs for depreciation proper? (Provider Issue 4 and Intermediary Issue 17 in Initial Position Paper)
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)
2007D72 00-3351 34-6538 1. Was the Intermediary's adjustment to bad debts proper?; 2. Was the Intermediary's adjustment to salaries proper?; 3. Was the Intermediary's adjustment to contracted labor proper?; 4. Was the Intermediary's adjustment to travel and lodging expense proper?; 5. Was the Intermediary's adjustment to utilities expense proper?; 6. Was the Intermediary's adjustment to office supply expense proper?; 7. Was the Intermediary's adjustment to dues and subscriptions expense proper?; 8. Was the Intermediary's adjustment to professional fees proper?; 9. Was the Intermediary's adjustment to other expenses proper?; 10. Was the Intermediary's adjustment to rent expense proper?; 11. Was the Intermediary's adjustment to additional accounts payable/capital related costs proper?; 12. Was the Intermediary's adjustment to interest expense proper?; 13. Was the Intermediary's adjustment to advertising expense proper?; 14. Was the Intermediary's adjustment to home office costs proper? (Provider's Issue 15); 15. Were the Provider's requests for the inclusion of costs incurred in settling the cost report after termination from the Medicare program proper? (Provider's Issue 14)
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)
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?
2008D13 00-1904G Various Whether the Intermediary's calculation of the disproportionate share hospital (DSH) payment was proper.
1998D055 93-0846 36-5746 Was the Intermediary's adjustment of the nursing cost proper?
1998D054 91-1799 41-0005 Was the Intermediary correct in applying reasonable compensation equivalent calculations to physicians who are employees of the management firm with which the hospital contracted to provide administrative services in the hospital's exempt psychiatric unit?
1998D053 96-0229 45-7663 1.Was the Intermediary's adjustment disallowing a portion of interest cost incurred proper?; 2. Was the Intermediary's proposed adjustment disallowing all interest cost related to accounts receivable financing proper?
1998D052 92-1562 45-0068 1. Was the Intermediary's adjustment of depreciation on equipment placed at the Provider by the University of Texas Health Science Center at Houston proper?; 2. Was the Intermediary's disallowance of the Provider's claimed loss on disposal of certain depreciable assets proper?
1998D051 95-2407G Various Whether the physical therapy salary equivalent guidelines as issued and applied to the Providers are arbitrary, capricious and/or not in accordence with 42 C.F.R. Section 413.106 or other law?
2011D39 09-0206GC Various Whether inpatient days for Medicaid-eligible patients who were enrolled in a Medicare+Choice (M+C) plan under Part C of the Medicare statute were properly excluded from the numerator of the Medicaid fraction that is used to calculate the disproportionate share hospital (DSH) payment.
2011D40 10-0069GC Various Whether inpatient days for Medicaid-eligible patients who were enrolled in a Medicare+Choice (M+C) plan under Part C of the Medicare statute were properly excluded from the numerator of the Medicaid fraction that is used to calculate the disproportionate share hospital (DSH) payment.
2011D41 04-1753G; 04-1824G; 04-1825G; 05-0375G; 05-1794G; 06-1093G; 07-0888GC; 09-2062GC; 10-0941GC; et al Various Whether Medicare+Choice (M+C) days should be included in the Medicaid fraction used to calculate the disproportionate share hospital (DSH) adjustment.
2011D42 98-2219; 98-2218; 01-2534; 03-1358 45-0610 Does the Board have jurisdiction over the issue of whether the Provider is entitled to be reimbursed for the interest implicit in the capital lease of the hospital facilities and equipment?
1998D045 92-0507 05-0457 Did the Intermediary properly adjust outpatient surgery, anesthesia and supply charges?
1998D060 89-1568 37-0094 Was the Intermediary's offset of investment income earned on the Provider's funded depreciation account against interest expense proper?
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?
1998D059 93-1280 40-0098 Was the Intermediary's disallowance of the Provider's request for a reevaluation of assets and allowance of interest expense due to a change in ownership proper?
1998D057 94-1800C 29-0021 Was the revision to the hospital-specific portion of the Provider's payment under the Medicare prospective payment system made by the Provider's fiscal Intermediary pursuant to a revised Notice of Reimbursement dated August 31, 1993, valid?
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.
2007D74 00-3354 42-6548 1. Was the Intermediary's adjustment to Medicare bad debts proper?; 2-5. Were the Intermediary's adjustments to salaries - administrative, physical therapy, occupational therapy, and speech therapy - proper?; 6. Was the Intermediary's adjustment to travel expense - administrative proper?; 7. Was the Intermediary's adjustment to telephone expense proper?; 8. Was the Intermediary's adjustment to consultant expense proper?; 9. Was the Intermediary's adjustment to rent expense proper?; 10-12. Was the Intermediary's adjustment to other charges - physical, speech and occupational therapy proper? (Provider's Issue 10)
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.
2008D16 89-1584 45-0101 1. Whether capitalized interest that may have been amortized in future years can be expensed in the current year when future cost reports are no longer subject to reopening.; 2. Whether the Intermediary's determination of allowable interest expense which deducted Hillcrest Medical Tower (HMT)interest from allowable versus total expense is proper.; 3. Whether the Intermediary's adjustment to disallow accrued FICA expense is proper.; 4. Whether the Intermediary's adjustment to the cafeteria revenue offset is proper.; 5. Whether the Intermediary's adjustment to limit bond cost amortization is proper.; 6. Whether the Intermediary's adjustment to disallow debt cancellation costs is proper.; 7. Whether the Intermediary's adjustment to disallow depreciation expense is proper.; 8. Whether the Intermediary's determination that a portion of the 1985 bonds were unnecessary is proper.; 9. Whether the Intermediary's adjustment to disallow accrued zero coupon bond interest expense is proper.
2008D14 01-0215 39-5526 Whether the Intermediary's adjustment to remove Nursing Administration, Medical Records, and Social Services allocation statistics from the Provider's ancillary cost centers on the Medicare cost report were 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.
1998D062 94-3278 23-0132 Was the denial of the TEFRA exception request proper?
1998D063 96-0535 18-0127 Were the Intermediary's adjustments to Medicare bad debts proper?
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).
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.
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.
1998D058 85-0058 33-0136 Was the Intermediary's refusal to reopen the Provider's cost reports for the fiscal years ending December 31, 1979, and December 31, 1980, an abuse of discretion?
1998D064 96-0340 36-5946 Was HCFA's denial of the Provider's request for an exemption fron the routine cost limit ("RCL") as a new provider proper?
1998D065 96-1352; 96-1353 14-7472 Were the Intermediary's adjustments to disallow legal fees deemed not related to patient care proper?
1998D066 94-0070 36-0054 Does the Provider meet the criteria for receiving disproportionate share payments based on application of undisputed facts?
1998D067 94-1389E; 94-1390E; 94-1525E 39-4001 Did the Intermediary err in reopening the Provider's cost reports to calculate Graduate Medical Education reimbursement?
1998D068 92-1805; 93-0196; 94-0366; 95-0672; 96-0750; 97-0104 14-7407 1. Was the Intermediary's adjustments offsetting key employees' compensation proper?; 2. Was the Intermediary's adjustments to disallow Christmas gifts made to employees and third parties proper?; 3. Was the Intermediary's adjustments to offset charitable contributions proper?; 4. Was the Intermediary's adjustments to the Board of Directors' fee proper?; 5. Was the Intermediary's adjustments to coinsurance amounts proper?; 6. Was the Intermediary's adjustments to Medicare program visits proper?; 7. Was the Intermediary's adjustments to medical supply charges proper?; 8. Was the Intermediary's adjustments offsetting legal service fees proper?; 9. Was the Intermediary's adjustments offsetting auto expense proper?; 10. Was the Intermediary's adjustments applying sequestration factors proper?
2010D27 04-0114G; 05-0286G; 06-0943G; 06-1377G; 07-0311G; 04-0940 Various Whether the Intermediary underpaid the Providers' fiscal years 2000 through 2004 Medicare operating and capital disproportionate share hospital (DSH) adjustments by not including the Providers' New Jersey Charity Care Program (NJCCP) inpatient days in the calculations of the numerator of the Medicaid proxy.
2010D28 05-0289 33-0224 Whether the Intermediary properly adjusted the Provider's Family Practice residency program direct graduate medical education (DGME) and indirect medical education (IME) full-time equivalent (FTE) count for the fiscal year ended December 31, 2000.
2010D29 08-1848; 09-1547; 10-0106; 06-1773; 07-2384; 08-2266; 09-1565 10-1406; 10-1416 Was the Intermediary's adjustment disallowing bad debts arising from coinsurance and deductibles for dual eligible Medicare and Medicaid beneficiaries proper?
2010D30 09-0071 11-0034 Whether the Board has jurisdiction over the Provider's appeal of the question of whether the disproportionate share (DSH) adjustment was incorrectly determined due to a significant error in the Supplemental Security Income (SSI) percentage where the request for hearing was filed more than three years after the issuance of the NPR.
2010D31 09-0072 11-0034 Whether the Board has jurisdiction over the Provider's appeal of whether the disproportionate share (DSH) adjustment was incorrectly determined due to a significant error in the Supplemental Security Income (SSI) percentage where the appeal was not filed within 180 days of the issuance of the final determination.
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.
1998D056 93-0509 05-0381 Was the Intermediary's refusal to reopen the Provider's cost reports an abuse of discretion?
1998D069 90-0989 41-0001 Was the Health Care Financing Administration's ( 'HCFA' ) denial of the Provider's request for reconsideration of the TEFRA exception request proper?
1998D070 94-1740 05-0183 Did the Intermediary's Notice of Reopening (NPR) and issuance of a revised NPR meet the requirements of 42 C.F.R. Sections 405.1885 and 405.1887?
1998D071 95-2007 05-0457 Was the Intermediary's refusal to reopen the Provider's cost report an abuse of discretion?
1998D072 90-1070 04-0062 1. Were the Intermediary's adjustments to record rent expense for lease equipment as administrative and general costs, rather than capital-related costs proper?; 2. Were the Intermediary's adjustments denying treatment of costs relating to the installation of the Hopital Information System as start-up costs proper?
1998D073 91-2671M 23-0032 Was the Intermediary's denial of the Provider's request to revise the 1985 base year average per resident amount to include pathologists teaching expenses proper?
1998D074 93-0513 11-0198 Was the Intermediary's elimination of space rental costs proper?
1998D076 94-0353 23-0032 Was the Intermediary's denial of the Provider's request to revise the 1985 base year average per resisent amount proper?
1998D077 94-2804 45-0137 Was the Health Care Financing Administration's ("HCFA") denial of the Provider's application for an exception/ adjustment to the TEFRA limit for the fiscal years ended ("FYE") September 30,1987, 1988 and 1989 proper?
1998D079 95-0436 05-0183 Was HCFA's denial of an exception to the routine cost limit filed within 180 days of the revised NPR in accordance with the Medicare statutes and regulations?
1998D080 93-0054 15-4033 Was the issue relating to denial of new provider exemption proper and should the Provider's base year be changed from fiscal 1984 to 1990?
2010D32 05-1693; 05-1694 36-0175 Was the Intermediary's adjustment to include outpatient observation bed days in the bed count for purposes of calculating the Provider's indirect medical education (IME) reimbursement proper?
2010D33 05-0171G; 05-0172G; 05-0173G; 06-0153G; 07-0453G; 08-1308G; 09-0964GC Various Whether days for which patients received charity care in Pennsylvania were required by the Medicare statute to be included in the numerator of the Medicaid proxy of the Medicare DSH calculation.
2010D34 08-0382; 08-0383 19-1555 Whether the Intermediary followed the proper reopening procedures prior to the issuance of the Intermediary's letter dated June 11, 2007 (Notice of Effect of Inpatient Day Limitation and Hospice Cap Amount) recalculating the hospice cap for years ending October 31, 2003 and October 31, 2004, respectively.
2010D35 98-0850G; 09-1633GC; 09-1634GC; 09-1635GC; 07-2034G; 07-2032G; 07-2033G Various Whether the Centers for Medicare and Medicaid Services' methodology for determining the exception from the routine cost limits (RCL) for hospital-based skilled nursing facilities (HB-SNF) was proper.
1998D075 88-1339 10-0060 Did the Intermediary correctly apply the lower of cost or charge limit?
1998D078 91-1509 05-0040 Was the Health Care Financing Administration's ("HCFA") denial of portions of the Provider's request for exceptions and adjustments to the rate of increase ceiling ("TEFRA Limit") for the exempt psychiatric unit proper?
1998D081 92-2398 42-T078 Was HCFA's denial of the Provider's request for an adjustment to its TEFRA target rate for certain costs proper?
1998D083 92-1569 05-0191 Was the Provider's request for an adjustment to the TEFRA limits for the fiscal year ended June 30, 1989 timely?
1998D084 96-0066G Various Was the Intermediary's inclusion of neonatal intensive care unit ("NICU") beds in the indirect medical education ("IME") calculation proper?
1998D085 96-0378 05-0281; 55-5294 Should the Provider's Medicaid patient days in its "subacute unit" be included in calculating the disproportionate share hospital ("DSH") adjustment?
2007D25 06-0110G; 06-0111G 67-7270: 37-7097 Whether the Intermediary's adjustment to include the Dixie Diamond Ranch as an "other" component on Schedule G of the home office cost statement was proper?
2009D39 04-1799G Various Whether inpatient hospital days attributable to individuals who applied to the Providers for, and received, assistance under Georgia's Indigent Care Trust Fund ("ICTF") should be counted in the number of Medicaid-eligible days in the numerator of the Medicaid fraction used to calculate the Medicare disproportionate share hospital (DSH) payments to the Providers.
2009D40 05-1291; 05-1292; 05-1293 10-4504; 10-4561; 10-4560 Whether the Intermediary's adjustments reflected in the revised Notices of Program Reimbursement (NPR), that reduced allowable home office costs, were proper.
2009D41 05-0350; 06-0452 33-0004 Whether the intermediary properly adjusted the Provider's direct graduate medical education (DGME) and indirect medical education (IME) full-time equivalent (FTE) count for the fiscal years ended December 31, 2000 and December 31, 2001.
2009D42 Various 26-2011; 26-2010 Whether the Intermediary's adjustments treating the Management Services Corporation (MSC) pool payments the Providers received as provider refunds, which were offset against the allowable provider tax expense, were proper.
2010D01 01-2484 06-0024 Whether the Intermediary's determination that the resident time was not spent in the hospital complex was proper and with respect to some residents, the resident time was adequately documented as occurring in the contested area.
2010D02 06-1078G; 06-1079G Various Whether the Intermediary's adjustments to the Provider's reimbursable capital costs after denying "new hospital" status was proper.
2010D03 07-0793G Various Did the Centers for Medicare & Medicaid Services (CMS) err in calculating a budget neutrality adjustment to the PPS standardized amount to account for the effect of the rural floor on the wage index?
2007D26 04-1774 42-0023 1. Whether the Intermediary properly adjusted the Provider's Medicare bad debts.; 2. Whether the Intermediary properly adjusted the Provider's medical benefit plan costs.
2007D27 04-0552 24-0001 Whether the FY 2000 ambulance cost trip limits were improperly low because the Intermediary improperly applied the 5.8% outpatient operating cost reduction and the 10% outpatient capital cost reduction to base year costs utilized to calculate those limits.
2007D29 02-0361G Various Whether Arizona state-funded days, such as Medically Needy/Medically Indigent (MN/MI), Eligible Low Income Children (ELIC), and/or Eligible Assistance Children (EAC) qualify as Medicaid days for purposes of determining the Provider's Medicare Disproportionate Share Hospital (DSH) adjustments for fiscal years 1994 through 2000.
2007D30 99-2858 17-0122 Whether the Intermediary's computation of the IME and DGME count as it relates to the following components was correct: a) Family practice rotations to the continuity care clinic; b)Internal medicine rotations to the St. Joseph campus of the Provider; c)Exclusion of psychiatric rotations in clinical research activities from IME FTE Count
2007D31 01-3521G 31-0015; 31-0051 Whether the cost report instructions improperly apply the indirect medical education (IME) full-time equivalent (FTE) cap to discharges prior to October 1, 1997.
2007D32 00-2803 52-0174 Whether the Intermediary's determining disallow post-retirement health benefits costs for a terminated provider was proper.
2007D33 04-2009 45-1320 Whether the Provider is eligible to receive payment on a reasonable cost basis for anesthesia services provided in its critical access hospital (CAH) by certain qualified non-physician anesthetists pursuant to 42 C.F.R. Section 412.113(c).
2007D34 06-0456 05-0222 Whether the Intermediary improperly excluded from the Disproportionate Share Hospital (DSH) Medicaid fraction days attributable to the labor and delivery portion of stays of maternity patients who occupied licensed inpatient beds located in Labor, Delivery, Recovery and Postpartum (LDRP) rooms.
2010D04 05-0917; 05-0916 26-4020 Whether the Intermediary properly declined to establish a per-resident amount (PRA) and full-time equivalent (FTE) cap applicable to Provider's graduate medical education (GME) costs.
2010D05 03-0859G; 04-1027G; 05-1256G Various Whether Intermediary properly excluded New Jersey Charity Care Program (NJCCP) days from the Medicare disproportionate share (DSH) calculation for fiscal year-ends (FYEs) 2000 to 2002 for the hospitals in this group appeal.
2010D06 08-0429 42-0078 Whether the intermediary's disallowance of resident time spent in didactic activities for purposes of the indirect medical education adjustment was proper.
2010D07 06-0301; 06-0302 16-0083 Whether the Intermediary improperly calculated the Provider's Medicare disproportionate share hospital (DSH) payment by excluding patient days attributable to hospital inpatients who were eligible for Medicaid and enrolled in Medicare Part A for all or a part of the period at issue.
2010D08 08-2068 37-1633 1. Has the Provider demonstrated that it is entitled to a hearing before the Board because there is $10,000 in controversy?; 2. To what extent, if at all, Medicare's $720,991 demand for repayment from the Provider for fiscal year 2006 would be decreased if the Provider's proposed manner of calculation of the amount of the hospice cap is adopted in lieu of the Intermediary's calculation which was issued pursuant to the existing regulation.
2010D09 00-3325 05-0146; 05-7037 Whether the Provider timely filed its Tax Equity and Fiscal Responsibility Act (TEFRA) exception request.
2010D10 98-3417G Various Whether the Intermediary's deletion of therapy costs from line 25, column 9 of Worksheet B-1 of the Providers' Medicare cost reports is proper and in accordance with Medicare cost reporting practices and procedures.
2010D11 04-0228G Various Whether the various Intermediaries properly disallowed reimbursement to the Providers for uncollected coinsurance and deductible amounts relating to outpatient therapy services claimed as bad debt during the Providers' respective cost-reporting years ending in 2001.
2010D37 02-0816 22-5681 Was the Intermediary's denial of the Provider's request for a new provider exemption from Medicare routine service cost limits proper in light of the standards set forth in St. Elizabeth's Medical Center of Boston, Inc. v. Thompson, 396 Fed. 3rd 1228 (D.C. Cir. 2005)?
1998D082 94-2577 17-0086 Was the Intermediary's reopening of the Medicare cost report to reduce reimbursement for indirect medical education ("IME") expense proper?
1998D086 94-3045 33-2546 Was the Intermediary's denial of the Provider's request for an exception to its End-Stage Renal Disease ("ESRD") composite rate proper?
1998D087 97-0682G Various Were the Intermediary's adjustments to occupational and speech therapy costs proper?
1998D088 90-1201;91-1310 45-0021 1. Was the Intermediary's adjustment offsetting intercompany interest income proper?; 2. Was the Intermediary's adjustment disallowing staff physician Part A salary costs proper?; 3. Was the Intermediary's adjustment offsetting investment income earned on loans to physicians proper?; 4. Was the Intermediary's adjustment disallowing intercompany interest expense proper?
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?:
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?
1998D091 95-1921 05-0468 Should the Provider's Medicaid patient days in its "subacute unit" be included in calculating disproportionate share hospital ("DSH") adjustment?
1998D092 95-0303 05-4078 Was the Intermediary's adjustment to the property tax expense proper?
1998D093 92-0591 16-0083 Was the Intermediary's allowcation of the Provider's physician billing costs proper?
1998D094 95-0100 39-0110 Did the Intermediary use the proper bed count when computing the Provider's indirect medical education ("IME") adjustment for fiscal year 1992?
1998D095 97-2589 10-0237 Did the Intermediary improperly reopen the Provider's fiscal year ended ("FYE") september 30, 1001 cost report? adjustment to
1998D096 97-3046 67-7584 Were the cost limits issued prospectively by New Mexico Blue Cross Blue Shield for FY 95 and as applied in FY 95, correct or were the lower cost caps retroactively applied in FY 96 by Palmetto (the successor Intermediary) correct?
2008D18 01-0801 14-0174 Whether the Intermediary's adjustment disallowing the loss on disposal of depreciable assets through consolidation was proper.
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.
1998D108 96-0568G Various Was the Intermediary's audit adjustments reducing charges for occupational and speech therapy services based upon the prudent buyer concept proper?
1998D107 96-2053G Various Was the Intermediary's audit adjustments reducing charges for occupational and speech therapy services based upon the prudent buyer concept proper?
1998D106 96-0175G Various Were the Intermediary's audit adjustments reducing charges for occupational and speech therapy services based upon the prudent buyer concept proper?
1998D105 96-0590 50-5344 Was the Intermediary's audit adjustment reducing charges for occupational and speech therapy services based upon the prudent buyer concept proper?
1998D104 94-0284G Various Was the Intermediary's inclusion of neonatal intensive care unit ("NICU") beds in the indirect medical education ("IME") calculation proper?
1998D103 93-0429 05-0230 Was the Intermediary's adjustment offseting revenue associated with physician and guest meals, while, at the same time, setting up a nonreimbursable cost center for these nonallowable costs, proper?
1998D102 94-1146 36-0045 Was the Intermediary's calculation of the number of full-time equivalents ("FTEs") when counting thw number of interns and residents for FYE December 31, 1989 proper?
1998D101 89-0706 05-0578 Was the Intermediary's determination of the amount of Medicare outlier payments proper?
1998D100 93-1013 05-0152 Did the Intermediary abuse its discretion in refusing to reopen the Provider's cost reports for the fiscal Years ("FYE") ended June 30, 1982 and 1983?
1998D099 89-1522 05-0327 Was the Provider's computation of the self-disallowance amount of investment income offset against interest expense proper?
1998D098 89-1753 05-0450 Was the Provider's request for additional payment due to volume decrease, properly made within 180 days from the date of the revised Notice of Program Reimbursement (NPR)?
1998D097 97-3047 67-7413 Were the HHA cost limits issued prospectively by New Mexico Blue Cross Blue Shield for FY 95 and as applied in FY 95, correct or were the lower costs limits retroactively applied by Palmetto (the successor Intermediary) correct?
2008D15 00-1182 39-0242 Whether the Intermediary's denial of the loss on disposal of assets claimed by Allentown Osteopathic Medical Center (AOMC) was proper?
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.
2010D40 01-1346G Various Whether the Intermediary's calculation of the Providers' Medicare disproportionate share hospital ("DSH") payments improperly excluded "expansion waiver" days attributable to patients who received medical assistance through Tennessee's Medicaid demonstration project waiver program approved by the Secretary under section 1115 of the Social Security Act ("section 1115").
2010D41 04-0495G Various Whether the Intermediary erred in excluding certain contract labor costs, home office costs, and wage-related costs that were claimed by Bon Secours-DePaul Medical Center, Maryview Medical Center, and Mary Immaculate Hospital (collectively, the "Bon Secours Hospitals") and used to calculate the federal fiscal year 2004 wage index for the Norfolk Metropolitan Statistical Area ("MSA").
2010D42 98-1025 23-0029 1. Whether the Medicare bad debt payment was computed properly.; 2. Whether the Medicaid Proxy component of the disproportionate share hospital (DSH) adjustment was computed properly.; 3. Whether the Medicare Proxy component of the disproportionate share hospital adjustment must be remanded to the Intermediary without adjudication by the Board pursuant to CMS Ruling No. 1498-R.
2010D43 02-0162 10-5990 In light of the August 29, 2007 Remand Order from the Administrator of the Centers for Medicare and Medicaid Services ("CMS"), what is the proper regulation and manual provision to apply to the facts of this case and what is the relevance of the Provider's cost reporting period and skilled nursing facility's ("SNF") Medicare certification date with respect to the reimbursement scheme that should govern payments?
2010D44 04-2270; 07-0278; 07-1351; 08-0169 37-0202 Whether the hospital as a new provider is entitled to capital hold-harmless methodology under the prospective payment system beyond the 10-year transition period.
2010D45 04-0380; 05-1209; 06-0688 03-0064 1. Whether the Intermediary properly excluded resident rotations for research and other scholarly activities when calculating the resident full time equivalent (FTE) count for indirect medical education (IME) adjustment purposes.; 2. Whether the Intermediary's calculation of the new program add-on to the Provider FTE cap was improper by virtue of the fact that it omitted time spent by residents in research and scholarly activities.
2000D22 96-1930; 97-1708; 98-2034 34-0061 Did the Intermediary properly use the Reasonable Compensation Equivalent limits from 1984 to reduce the amount of reasonable compensation paid by the Provider to its hospital-based physicians for 1993, 1994 and 1995?
2000D23 96-1736 31-0062 1. Was the Intermediary's calculation of the number of maintained beds proper?; 2. Was the Intermediary's adjustment excluding certain resident Full-Time Equivalents (FTEs)proper?; 3. Was the Intermediary's adjustment excluding certain allowable fringe benefits proper?; 4. Was the Intermediary's adjustment disallowing certain amounts related to contract labor proper?; 5. Was the Intermediary's adjustment disallowing certain amounts related to Part B physician salaries and hours proper?
2000D24 94-0302G; 94-0304G Various Were the Intermediary's adjustments to the Providers' home office cost statementsproper?
2000D25 95-0326 50-0057 Were HCFA's determinations of the Provider's ESRD exception requests proper?
2000D26 95-1566 31-0075 Was the Intermediary's failure to apply updated reasonable compensation equivalents limits proper?
2000D27 96-0036 36-0085 Was the Intermediary's adjustment to the outlier payments proper?
2000D28 91-2846M 33-0354 Was the Intermediary's failure to include supervising physician costs in the Provider's final base-year average per resident graduate medical education (GME) amount proper?
2000D29 91-2887 14-0087 Was the Intermediary's netting of the balance due to Edgewater Hospital of liabilities owed to the program by Edgewater Medical Center proper?
2000D30 95-0459 05-0684 Was the Intermediary's elimination of square footage statistics for the fourth floor storage area correct?
2000D48 96-0861 24-2004 Was the Intermediary's adjustment to disallow the Minnesota Care Tax proper?
2000D49 96-0804 24-0003 Was the Intermediary's adjustment to disallow the Minnesota Care Tax proper?
2000D50 96-0918 51-0001 Was the Intermediary's adjustment reclassifying the depreciable assets as "new" capital proper?
2000D47 96-0644 24-0063 Was the Intermediary's adjustment to disallow the Minnesota Care Tax proper?
2000D46 97-2385 36-6007 Is the Provider entitled to an exemption from the routine cost limits ("RCL") as a new provider under 42 C.F.R. section 413.30(e)?
2000D45 94-0614 14-0087 Was the Intermediary's calculation of the Provider's disproportionate share ("DSH") adjustment proper?
2000D44 94-0616 14-0087 Was the Intermediary's calculation of the Provider's disproportionate share ajustment ("DSH") proper?
2000D43 96-0527 01-0068 Was the Intermediary's adjustment disallowing portions of compensation paid to physicians based on the application of the 1984 reasonable compensation equivalents ("RCE") proper?
2000D42 95-0577 39-0049 Was HCFA's denial of the Provider's request for an exception to the renal dialysis composite rate based on atypical service intensity proper?
2000D41 96-2423 33-0048 Was the Intermediary's refusal to increase the Provider's disproportionate share percentage to include eligible Medicaid days where Medicare was the primary payor proper?
2000D40 95-0535 52-0098 Was HCFA's denial of the Provider's request for an exception rate for self-dialysis training using an accelerated method proper?
2000D39 91-2592M; 94-0951; 94-0952; 94-0953; 94-1386 49-0063 1.Whether the Intermediary proper omitted all of the pathology teaching costs incurred in the Graduate Medical Education ("GME") base year from the GME costs used to compute the Provider's average per resident amount ("APRA")?; 2. In the alternative, whether the Intermediary properly included the 4.42 full-time equivalent ("FTE") residents who worked in the approved pathology program during the GME base year in the resident count used to compute the APRA?
2000D38 98-0273 45-6689 Was the Intermediary's adjustment to the accrued salaries proper?
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?
2000D36 97-0795 01-7009 Was the Intermediary's adjustment calculation proper to bring the expenses of Healthstar, Inc., a related party, to the cost of ownership?
2000D35 97-2148 43-0077 1.Was the Intermediary's classification of School of Nursing Joint Education Program cost proper; 2. Was the Intermediary's adjustment eliminating Part A hours for Medical Directors proper?
2000D34 97-2064 43-0077 Was the Intermediary's classification of School of Nursing Joint Education Program cost proper?
2000D31 96-2587 34-7021 Was the Intermediary's adjustment disallowing the Provider's employee recruitment expense proper?
2000D32 98-0448 24-0053 Was the Intermediary's disallowance of the physician Part A compensation due to inadequate physician time studies proper?
2000D33 97-2391 33-0158 Were the Intermediary's adjustments to the reasonable compensation equivalent ("RCE") limits proper?
2000D52 96-2570 16-0059 Was the Intermediary's adjustment disallowing the Provider's loss on the sale of its assets proper?
2000D53 88-0649 22-3026; 22-5190 Was HCFA's methodolgy for measuring the entitlement of hospital-based skilled nursing facilities ("HB-SNF") to exception relief under 42 C.F.R. section 413.30(f) and HCFA's denial of the Provider's fiscal year ("FY") 1985 exception request proper?
2000D54 96-2623 05-0559 Did the Intermediary properly include the Provider's inpatient Part B charges with outpatient Part B charges, subjecting the inpatient Part B charges to the 5.8% outpatient cost reduction?
2000D51 95-2202 33-0399 Was the Intermediary's adjustment reducing the allowable cost to charge retio that should be applied to outpatient charges proper?
2000D55 97-1810 10-7123 Was the Intermediary's adjustment to the Provider's visit statistic proper?
2000D56 96-1215 44-0072 1. Was the Intermediary's adjustment disallowing Medicare reimbursement for a portion of the bad debts proper?; 2. Was the Intermediary's reclassification for home health agency costs proper?
2000D58 96-2027; 97-2271 53-0002 Was the Provider entitled to an exception to the home health agency ("HHA") cost limits for the fiscal years ended June 30, 1993 and June 30, 1994?
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?
2000D59 96-2619 03-5104 Was the Intermediary's adjustment disallowing indigent Part B bad debts proper?
2009D25 00-3473G Various Whether the Intermediary properly excluded Connecticut's State-Administered General assistance (SAGA) program days from the Medicare disproportionate share hospital (DSH) calculation for fiscal year-ends (FYEs) 1994 to 1998 for hospitals in this group appeal.
2007D35 95-0795; 97-1098; 00-3556G; 01-2892G; 01-2936G; 01-2937G; 02-1810G; 03-1423G Various Whether the Intermediary improperly omitted certain inpatient hospital days from the numerator of the Medicaid low-income proxy used to calculate the Providers' disproportionate share hospital (DSH) adjustment.
2007D36 98-2095 33-7019 1. Whether the Intermediary's adjustment to related party transaction cost was proper.; 2. Whether the Intermediary's adjustment to disallow portions of membership dues expense was proper.; 3. Whether the Intermediary's adjustment to disallow certain meeting/conference expenses was proper.
2007D37 00-0774 53-7025 Whether the Intermediary's disallowance of accrued employee benefit costs that were not liquidated within one year after the end of the Provider's cost reporting period was proper.
2007D38 00-01032; 01-2147 24-5610 Whether the denial of the Provider's request for a new provider exemption from the skilled nursing facility routine cost limits was proper.
2007D39 04-0644 23-0230 Whether the Intermediary properly determined the full-time equivalent (FTE) intern and resident count for purposes of computing the Provider's indirect medical education adjustment (IME) and the direct graduate medical education (DGME) payment.
2007D40 04-2269 05-0150 Whether the Provider's regular Medicare outpatient bad debts are not allowable until all collection efforts including those of a collection agency have ceased.
2000D60 95-0079; 95-2394; 96-0287 26-7002 1. Was the Intermediary's adjustment disallowing the salary and related expenses of the Director of the Volunteer Department proper?; 2. Was the Intermediary's adjustment disallowing the expenses of the television recruitment advertisement proper (FY 93 only)?
2000D61 96-2534 23-0132 Was the denial of the TEFRA exception request proper?
2000D63 97-0643; 98-0770; 99-3555; 99-0613 55-7253 1. Was the Intermediary's adjustment to Physical Therapy costs proper?; 2. Was the Intermediary's adjustment to owner's compensation proper?
2000D64 96-0847 24-0106 Was the Intermediary's adjustment offsetting the Provider-paid surcharge (tax) to the Minnesota Medicaid Program proper?
2000D65 91-2887R 14-0087 Was the Intermediary's netting of the balance due to Edgewater Hospital of liabilities owed to the program by Edgewater Medical Center proper?
2000D66 92-0209; 94-2362; 98-0428; 99-0130; 99-0131 01-0068 Was the Intermediary's adjustment disallowing portions of compensation paid to physicians based on the application of the 1984 reasonable compensation equivalents proper?
2000D67 94-0654 45-0358 Was the Intermediary's adjustment reclassifying costs related to equipment which was part of a aupply purchase agreement proper?
2000D68 99-0286 31-7062 1. Was the interest paid on working capital loans from the Friend Center Fund and commercial banks necessary and allowable?; 2. Was the interest paid to Cadwalder Properties, a related party, allowable as an ownership cost under 42 C.F.R. section 413.153?
2000D69 90-1357 05-0076 Was the Provider entitled to an adjustment to its TEFRA target rate as a result of the addition of cardiovascular surgery services during the last three months of its TEFRA base year?
2000D70 97-0407 36-0125; 36-6048 Did HCFA properly deny a new provider exemption request for the Provider's distinct part skilled nursing facility inder 42 C.F.R. section 413.30(e)?
2000D62 92-0668R 34-0113 Did the Intermediary properly reopen the Provider's cost report and recoup an overpayment made to the Provider?
2000D71 95-1279; 95-1280 13-0037 Were the Intermediary's adjustments disallowing costs associated with the Certified Nurse Anesthetist proper?
2000D72 93-1920; 94-0007 05-0226 Do equitable tolling principles apply to a matter of law to PRRB appeals under section 1878 of the Social Security Act, codified at 42 C.F.R. section 1395oo, and Boards appeals under the regulations at 42 C.F.R. Subpart R?
2000D73 94-1477; 94-1520 45-0023 Were the Intermediary's initial, amended and reopening adjustments to interest expense and bond related cost proper?
2000D74 88-1494G; 88-1495G; 88-1496G Various Should the federal portion of the prospective payment system ("PPS") rate be adjusted because it was based on 1981 hospital cost report data which incorporated an invalid method of reimbursing malpractice costs, that is, the 1979 malpractice rule?
2000D75 93-0073G; 92-1509G; 93-0888G Various Should the federal portion of the prospective payment system ("PPS") rate be adjusted because it was based on 1981 hospital cost report data which incorporated an invalid method of reimbursing malpractice costs, that is, the 1979 malpractice rule?
2011D19 09-0003GC; 04-2135G; 04-2136G; 04-2137G; 06-1907G; 06-1906G; 08-2753GC; 08-2757GC; 08-2847GC Various Whether the Intermediary should include dual-eligible, Medicare + Choice (M + C) patient days in the numerator of the Medicaid proxy in determining Medicare reimbursement for disproportionate share hospital (DSH) payments in accordance with the Medicare statute at 42 U.S.C. Section 1395ww(d)(5)(F)(vi)(II).
2011D20 08-2752GC; 04-2131G; 04-2132G; 04-2133G; 04-2134G; 08-2845GC; 08-2756GC Various Whether for fiscal years 1995-1998 the Intermediary should include dual-eligible, Medicare health maintenance organization (HMO) patient days in the Medicaid proxy in determining Medicare reimbursement for disproportionate share hospital (DSH) payments in accordance with the Medicare statute at 42 U.S.C. Section 1395ww(d)(5)(F)(vi)(II).
2011D21 04-0327; 04-0328 45-0728 Whether the Provider is entitled to payment of "fair compensation" pursuant to 42 C.F.R.Section 413.13.
2011D22 04-0661; 04-0663 45-0705 Whether the Provider is entitled to payment of "fair compensation" pursuant to 42 C.F.R. Section 413.13.
2011D23 05-0476 45-0068 Whether the Intermediary properly disallowed the loss claimed by Hermann Hospital representing a complete write-off of the book value of its depreciable assets as a result of the merger with the Memorial Hospital System.
2011D25 00-2803 52-0174 Whether the Provider's post-retirement health benefit costs are allowable costs in the Provider's terminating cost report under Provider Reimbursement Manual (PRM) Section2176.
2011D26 08-0384 19-1555 Whether a full or partial waiver is permissible for the Provider's hospice inpatient day limitation overpayment for the cap year November 1, 2004 through October 31, 2005.
2011D27 08-1474 33-0005 1. Whether the Intermediary's adjustment of the Provider's direct Graduate Medical Education per resident amount was proper.; 2. Whether the Intermediary properly excluded research time the Provider alleges was related to patient care from the Full Time Equivalent resident count for direct Graduate Medical Education and Indirect Medical Education.
2010D12 06-2136G; 07-2590G;08-2765GC;082961GC;08-2963GC; 08-2964GC Various Whether the Intermediary's disallowance of the Illinois provider tax assessment was proper.
2010D13 06-1800 10-1440 Was the Intermediary's adjustment disallowing bad debts arising from coinsurance and deductibles for dual eligible Medicare and Medicaid beneficiaries proper?
2010D14 05-0828 10-0061 Whether the provider has a right to hearing on correction of its cost report to reclassify certain nurse expenses.
2010D15 08-1816 36-0151 Does the Board have jurisdiction over the resident-to-bed ratio where an alleged error in the filed cost report was discovered by the Provider after the final determination was issued?
2010D16 07-2546; 07-2547; 07-2548; 07-2549 22-1990 Whether the Fiscal Intermediary's denial of the Provider's nursing education program costs as pass-through costs was valid when that denial was based on a finding that the Commission for the Accreditation of Christian Science Nursing Organization/Facilities, Inc. (Commission) is not a "recognized national professional organization for the particular activity" under the provisions of 42 C.F.R. section 413.85(e) for purposes of accrediting the Provider's nursing education programs.
2010D17 07-2533; 08-0470 05-1991 Whether the Fiscal Intermediary's denial of the Provider's nursing education program costs as pass-through costs was valid when that denial was based on a finding that the Commission for the Accreditation of Christian Science Nursing Organization/Facilities, Inc. (Commission) is not a "recognized national professional organization for the particular activity" under the provisions of 42 C.F.R. section 413.85(e) for purposes of accrediting the Provider's nursing education programs.
2010D18 07-2532 05-1993 Whether the Fiscal Intermediary's denial of the Provider's nursing education program costs as pass-through costs was valid when that denial was based on a finding that the Commission for the Accreditation of Christian Science Nursing Organization/Facilities, Inc. (Commission) is not a "recognized national professional organization for the particular activity" under the provisions of 42 C.F.R. section 413.85(e) for purposes of accrediting the Provider's nursing education programs.
2010D19 07-2538; 07-2544 45-1990 Whether the Fiscal Intermediary's denial of the Provider's nursing education program costs as pass-through costs was valid when that denial was based on a finding that the Commission for the Accreditation of Christian Science Nursing Organization/Facilities, Inc. (Commission) is not a "recognized national professional organization for the particular activity" under the provisions of 42 C.F.R. Section 413.85(e) for purposes of accrediting the Provider's nursing education programs.
2010D20 00-4034G; 00-4035G; 00-4036G; 05-0157G Various Whether the Providers have been properly paid for bad debts for Medicare deductible and coinsurance amounts associated with Medicaid eligible inpatients for services between May 1, 1994 and June 30, 1998.
2010D21 07-2829 10-1472 Was the Intermediary's adjustment disallowing bad debts arising from coinsurance and deductibles for dual eligible Medicare and Medicaid beneficiaries proper?
2010D22 04-2157; 05-0706 39-0204; 39-0022 Whether General Assistance (GA) days should be added to the numerator of the "Medicaid" proxy in the Disproportionate Share (DSH) payment calculation.
2010D23 07- 0459; 07-2370 03-5143 Whether the CMS must-bill policy applies to the Provider's dual-eligible bad debts when the Provider did not participate in the Medicaid program.
2010D24 01-2257 12-0001 Whether First Coast Service Options, Inc. (Intermediary) improperly excluded patient days associated with patients who were dually eligible for both the Medicare and Medicaid programs but for such days there was no Medicare Part A payment or coverage available (dual eligible days) from the numerators of both the Medicaid and Supplemental Security Income (SSI) percentages of the Medicare disproportionate share hospital (DSH) computation for purposes of The Queen's Medical Center's (Provider) fiscal year ended June 27, 1998 (FYE 6/27/98) Medicare cost report.
2010D25 08-0251G Various Whether the CMS must-bill policy applies to the Providers' dual-eligible bad debts when the Providers did not participate in the Medicaid program.
2010D26 05-1790G Various Should patient days associated with Medicare Part A and Title XIX eligible patients that were not included in the Supplemental Security Income (SSI) percentage factor of the Medicare disproportionate share formula be included in the Medicaid days factor or the SSI percentage factor used in the determination of their Medicare Disproportionate Share Hospital (DSH) payment in accordance with the Medicare DSH statute at 42 U.S.C. Section 1395ww(d)(5)(F)(vi)?
2011D24 03-1199G 17-0040; 17-0086; 17-0122 Whether the Intermediary should include all MediKan patient days, primary and secondary, in the Providers' disproportionate share hospital (DSH) calculation.
2000D76 98-0455 26-7281 1. Was the Intermediary's adjustment disallowing salaries and benefits proper?; 2. Was the Intermediary's adjustment to automobile expense peoper?; 3. Was the Intermediary's adjustment to square footage proper?; 4. Was the Intermediary's adjustment reversing the Provider's reclassification of physical therapy costs proper?; 5. Was the Intermediary's adjustment to physical therapy salaries and bebfits proper?
2000D77 97-2085 05-7470 Was the Intermediary's disallowance of interest expense proper?
2000D78 98-2068G 05-7470; 55-7643; 55-7625 Was the Intermediary's disallowance of interst expense proper?
2000D79 98-1396G Various Was the Intermediary's adjustment to worker's compensation expense proper?
2000D80 96-0184G Various Whether the claims of welfare bad debt under Provider Reimbursement Manual Part 1, Section 322, must be based on a bill to the Medicaid agency, and if not, what must the Provider document to recieve bad debt reimbursement?
2000D81 96-2281G Various Whether HCFA's methodology of determining the amount of the exception from the routine cost limits for freestanding skilled nursing facilities (SNF) as set forth in HCFA Pub. 15-1, Section 2534.5, Transmittal No. 378, is correct?
2009D22 99-1340 39-0028 Whether interest is due on the continuing underpayments that exist as a result of the fiscal Intermediary's 10 year delay in implementing the PRRB's case number 91-2673.
2009D23 99-0584R (on Remand) 39-0080 Whether the Jeanes Hospital merger was a bona fide sale.
2009D24 99-2786 22-0118 Whether the Intermediary's disallowance of the Provider's claim for a loss in connection with its October 1, 1996 statutory merger was proper.
2000D82 96-2052 52-5504 Was the Intermediary's recalculation of the Provider's gross-up method proper?
2000D83 Various Various Was the Intermediary's inclusion of maintenance treatments in the Provider's cost aportionment statistics for Medicare reimbursement proper?
2000D84 95-0711 52-0094 Did HCFA inappropriately deny the Provider's end stage renal disease ("ESRD") composite rate exception request for atypical service intensity (patient mix) on the grounds that the Provider did not file a fully documented exception request?
2000D85 96-2085 05-0090 Was the Intermediary's calculation of the Skilled Nursing Facility (SNF) Routine Cost Limits (RCL) proper?
2000D86 97-2707 45-0717 1. Was the Intermediary's adjustment reclassifying the Provider's cost from direct to indirect cost centers proper?; 2. Did the Intermediary properly apply the low occupancy adjustment in HCFA Transmittal No. 378 to HCFA Pub. 15-1 section 2534.5A?; 3. Was HCFA's refusal to grant an exception for that portion of the Provider's per diem costs which does not exceed 112% of the total peer group mean cost proper?
2000D87 95-0634 05-0017 Was HCFA's denial of the Provider's routine cost limit (RCL) exception request proper?
2000D88 99-3515G Various Were the Intermediary's adjustments reclassifying workers' compensation and unemployment insurance expenses from the administrative and general cost center to the varying cost centers where employees were assigned proper?
2000D89 97-2390 52-0109 Were the Intermediary's adjustments offsetting investment income related to the sale of HMO stock proper?
2000D90 97-2601 20-0016 Was the Intermediary's denial of the Provider's request for a sole community hospital decreased volume adjustment proper?
2010D36 07-2626G; 06-2111GC; 09-2298GC Various Should the Provider Reimbursement Review Board grant the Providers' request for expedited judicial review (EJR) over the validity of the provisions of the Centers for Medicare & Medicaid Services Ruling CMS-1498-R, which if valid, render moot and deny jurisdiction over the dual-eligible group appeals?
2007D41 04-0805 05-4135 Whether the Intermediary's decision to deny the Provider's request for an adjustment/exception to its Tax Equity and Fiscal Responsibility Act (TEFRA) target amount was proper.
2007D42 00-1882G Various Whether the Intermediary's adjustments disallowing the loss claimed by Medicare Providers on the disposition of assets resulting from the statutory merger of California Medicorp into Presbyterian Health Services Corporation were proper.
2007D43 98-1942 44-0048 Whether the Provider is entitled under CMS Program Memorandum (PM) A-99-62 to include Social Security Act, Section 1115 waiver days for the expanded Medicaid populations (a/k/a TennCare) days in the Medicaid component of the disproportionate share hospital (DSH) calculation.
2007D44 01-2519 45-0039 Whether the Provider timely filed additional information required to entitle it to an exemption from the skilled nursing facility (SNF) routine cost limit under 42 C.F.R. section 413.30(e).
2007D45 02-0162 10-5990 Whether the Centers for Medicare and Medicaid Services (CMS) properly denied the request(s) of the Provider for an exemption from the Routine Service Cost Limits (RCLs) for the fiscal year ended December 31, 1998.
2009D27 05-1370 52-0051 Whether the Medicare statute requires the Provider's Long Term Respiratory Unit (LTRU) days to be excluded from the Medicaid Proxy of the Medicare DSH calculation under 42 U.S.C. Section 1395ww(d)(5)(F)(vi)(II).
2009D26 Various Various Whether the Intermediary properly excluded dual eligible patient days from the Medicaid eligible days in determining the Medicaid percentages that were used for the disproportionate share hospital (DSH) adjustment payments.
2009D33 06-0814 45-0296 Whether the Intermediary's adjustment of the disproportionate share hospital (DSH) reimbursement, based on its determination that the Provider had less than 100 available beds for DSH eligibility purposes, was proper.
2009D32 05-1133; 06-0127 05-0234 1. Whether the Intermediary's calculation of the Provider's disproportionate share hospital (DSH) payments, as it pertains to subacute unit days was proper.; 2. Whether the Intermediary's calculation of the Provider's disproportionate share hospital (DSH) payments, as it pertains to Medicare Part A exhausted days for dual eligible patients was proper.
2009D31 05-2010 45-0299 Whether the Intermediary's adjustment of Disproportionate Share Hospital (DSH) reimbursement, based on its determination that the Provider had less than 100 available beds for DSH eligibility purposes, was proper.
2009D30 04-2128G Various Whether the exclusion of patient days attributable to Medicare + Choice (M+C) enrollees from the Medicaid fraction in calculating the Providers' disproportionate patient percentages contravenes the statute and regulations.
2009D29 98-0892 17-0122 Whether the Intermediary's adjustments disallowing a loss claimed by St. Francis Regional Medical Center upon its consolidation with St. Joseph Medical Center to form Via Christi Regional Medical Center was proper.
2009D28 04-0597G; 05-0663G; 06-0682G; 03-0282G; 04-0598G Various Whether paid lunch period time should be added to hours used to calculate the Providers' hourly wage rates.
2007D50 00-1757; 00-1859; 01-0958; 03-0180; 04-0110 44-0049 Whether the Intermediary's adjustment to the Provider's per resident amount (PRA) was proper.
2007D49 01-1010 38-0033 1. Whether the exception review process engaged in by the Health Care Financing Administration (HCFA) and the Fiscal Intermediary violated due process and fundamental fairness, including violations of the time limits established by federal regulation and the Provider Reimbursement Manual so as to cause the exception request to be deemed approved in full.; 2. Whether HCFA and the Fiscal Intermediary improperly denied the Tax Equity and Fiscal Responsibility Act (TEFRA) adjustment in its entirety, when at a minimum Oregon Medical Professional Review Organizations (OMPRO's) independent medical review supported a reduced exception amount.; 3. Whether HCFA and the Fiscal Intermediary erred in denying the Provider's revised TEFRA exception request without correcting the Intermediary's use of an incorrect TEFRA target rate.
2007D48 05-0310 23-2029 Whether the Intermediary and CMS erred in denying the Provider's rate adjustment request made under the Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA).
2007D47 05-0658 45-7789 1. Whether the Intermediary properly allocated home office cost from the finalized home office cost statement to the Provider.; 2. Whether the Intermediary's adjustment to the salaries, benefits and mileage of the program managers was proper.; 3. Whether the Intermediary's adjustment to Dara Stewarts's salary and benefits was proper.; 4. Whether the Intermediary's reopening was proper.
2007D46 97-1239; 97-1240 21-5279; 21-5280 Whether the Intermediary properly denied requests by Franklin Square and Good Samaritan for New Provider Exemptions from the routine cost limits for fiscal years ending 6/30/97 and 6/30/98.
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.
2008D28 02-0463 03-7205 Whether the Intermediary properly reclassified professional fees from the Administrative and General (A and G) -reimbursable cost center to the A and G-Shared cost center for the cost reporting period ending December 31, 1999.
2008D27 05-1219 17-1302 Was the Intermediary's adjustment to the provider's claimed owner's compensation proper?
2008D30 02-0050; 02-0615 14-4036 1. Whether the Intermediary properly adjusted Medicare bad debts.; 2. Whether the Intermediary properly adjusted the Provider's treatment of asset relifing.; 3. Whether the Intermediary properly adjusted public relations and marketing expenses.; 4. Whether the Intermediary properly adjusted officers' life insurance and wind down expenses. (Fiscal year ended (FYE) 10/31/99 only)
2008D29 05-0133G; 05-243G Various Was the Provider's reimbursement for indirect medical education (IME) and direct graduate medical education (DGME) for Medicare managed care patients properly disallowed for fiscal year 1999 and fiscal year 2000 for failure to file UB92s in accordance with CMS instruction.
2008D31 02-0705 05-0241 Whether the Intermediary may recoup an overpayment relative to the Provider's 1987 cost reporting period through a revised Notice of Program Reimbursement (NPR) issued in January 2002.
2008D32 03-0778; 04-0914 23-0216 1. Whether the Provider was required to submit a claim to the Michigan Medicaid program and to obtain a Medicaid remittance advice in order to receive Medicare reimbursement for Part B bad debts relating to services furnished to patients dually eligible for Medicare and Medicaid.; 2. Whether the sampling methodology used by the Intermediary for determining the Provider's entitlement to bad debt payment for the fiscal year ended 6/30/2000 was proper. (CN: 03-0778 only)
2008D33 98-0019; 02-0785 22-5682 1. Whether the Provider is entitled to a new provider exemption from the skilled nursing facility (SNF) routine service cost limits under 42 C.F.R. section 1413.30(e) for the cost reporting year ended December 31, 1995.; 2. Whether the Intermediary's denial of the Provider's request to be reimbursed the Transitional Period Rate for SNFs under 42 C.F.R. section 413.340(e) for the cost reporting year ended December 31, 1999 was proper.
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)
2008D39 00-1456 39-0098 Whether the Intermediary's adjustments disallowing the loss on disposal of depreciable assets through consolidation were proper.
2008D37 04-1083; 04-1091; 04-1093; 04-1950 22-0033 1. Whether the Intermediary improperly computed the numerator of the Medicaid fractions that were used to calculate the Provider's disproportionate share hospital (DSH) payments for fiscal years (FYs) 1999, 2000, 2001, and 2002 by excluding inpatient days attributable to individuals who were both eligible for medical assistance under an approved Medicaid State plan and enrolled in a Medicare +Choice (M+C) plan for such days.; 2. Whether the Intermediary improperly computed the numerators of the Medicaid fractions that were used to calculate the Provider's DSH payments for FYs 1999, 2000, 2001 and 2002 by excluding inpatient days attributable to individuals who allegedly received assistance under the Massachusetts Uncompensated Care Pool for such days.; 3. Whether the Intermediary improperly computed the Medicaid fraction that was used to calculate the Provider's DSH payment for fiscal year 2002 by i) excluding from the numerator inpatient days attributable to individuals who were in a labor and delivery room at the census-taking hour and who had not previously occupied a routine bed and ii) including such days in the denominator.; 4.Whether the Medicare/Supplemental Security Income (SSI) fraction that was used to calculate the Provider's DSH payment for FY 1999 should be recalculated, or, in the alternative, whether the Medicare SSI fraction should be revised.
2008D38 00-1454 39-0067 Whether the Intermediary's adjustments disallowing the loss on disposal of depreciable assets through consolidation were proper.
2008D40 06-0987 27-1328 Whether the Intermediary's adjustment to Certified Registered Nurse Anesthetist (CRNA) cost was proper.
2008D41 06-0614 23-0097 Whether the Intermediary correctly limited the Provider's ambulance reimbursement to its charges.
2008D43 04-1792; 05-2073; 05-2074; 05-2154; 06-0010; 06-0300 37-0078 Whether the Intermediary properly adjusted the Provider's indirect medical education full-time equivalent (FTE) cap?
2008D42 04-0393G 23-0412; 23-0270; 23-0176 Whether as a result of underpayment of Medicare reimbursement during the ten-year transition period of the Capital Prospective Payment System (CPPS), the Providers are entitled to a payment of interest under the Medicare statute, 42 U.S.C. Section 1395g(d), the applicable Medicare regulation, 42 C.F.R. Section 405.378, and the Medicare Intermediary Manual (CMS Pub. 13-2) Section 2219.
2007D78 02-0328; 03-0383; 04-0283; 05-1327 05-0396 1. Whether the Intermediary improperly disallowed direct graduate medical education (DGME) and indirect medical education (IME) payments with respect to discharge of Medicare beneficiaries who were enrolled in the Medicare + Choice or other Medicare risk plans in fiscal years ending December 31, 1998, 1999, 2000 and 2001.; 2. Whether the Intermediary improperly disallowed residents' time spent in non-provider settings within the scope of the Provider's approved medical residency training programs from the Provider's full-time equivalent resident counts for DGME and IME purposes.
2008D01 05-0686 15-0011 Whether the recission of the hospital's approved request for Sole Community Hospital (SCH) status was proper.
2008D03 01-2270; 02-1573; 03-1015 10-0032 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 the Medicare + Choice or other Medicare risk plans in fiscal years ending June 30, 1998, June 30, 1999, and December 31, 1999.
2008D02 01-1674G Various 1. Whether the Providers entitled to have general relief (GR) days included in the calculation of their disproportionate share percentage to the hold harmless provisions of Program Memorandum A-99-62.; 2. Whether the failure to allow the Providers to include GR days in the calculation of their disproportionate share percentage was arbitrary and capricious and in violation of law.
2008D05 06-1478 31-5381 Whether the Intermediary properly adjusted Medicare bad debts.
2008D07 03-1056 52-0051 1. Whether the CMS improperly calculated St. Mary's Hospital's Medicare disproportionate share hospital (DSH) adjustment by excluding fifty two (52) patient days from the Supplemental Security Income (SSI) fraction.; 2. Whether the Intermediary improperly calculated St. Mary's Medicare DSH adjustment by excluding 366 Long Term Respiratory Unit (LTRU) patient days from the Medicaid proxy of the DSH calculation.
2008D44 03-1643 37-0190 Whether the Intermediary properly treated the Provider as an acute care prospective payment system (PPS) facility instead of an excluded cancer hospital.
2008D06 99-3140 05-0369 Whether the Intermediary improperly allowed 0.54 intern and resident full time equivalent (FTE) for indirect medical education (IME) purposes on the Provider's fiscal year ended December 31. 1996 cost report.
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)
2008D45 05-1891; 05-1887; 04-1831; 05-0731; 06-1938 14-0228 Whether the Intermediary's adjustments reducing the 1996 base year IME/GME FTE count for osteopathic and allopathic medicine interns and residents and their effect on the May 31, 1999 through May 31, 2003 FTE counts are correct.
2011D43 05-0023 33-0201 Whether the Provider's cost reimbursement should be computed taking into account the charges included in the Provider's log of late charges which have not been billed to Medicare.
2011D44 05-1144 33-0201 Whether the Provider's cost reimbursement should be computed taking into account the charges included in the Provider's log of late charges which have not been billed to Medicare.
2011D45 05-1802 39-3050 Whether the Intermediary properly reimbursed the Provider based on the blended rate for inpatient rehabilitation facilities (IRF) versus the 100 percent federal prospective payment system (PPS) rate for IRFs.
2011D46 08-1452; 08-1800; 08-2699; 08-2533; 08-2534; 08-1156; 08-2532; 09-0914 Various 1. Whether the Intermediary's adjustment to the direct graduate medical education and indirect medical education counts for residents training at the Kalamazoo Center for Medical Studies/Michigan State University nonhospital site clinics was proper.; 2. Whether the Intermediary's calculation of Borgess Medical Center's Supplemental Security Income percentage, the proportion of the patients eligible for Medicare Part A or Part C who are also eligible for supplemental security income, for cost reporting period ending June 30, 2003 was proper.
2011D47 09-2261CG 23-0024; 23-0104; 23-0273; 23-0277 Whether the Intermediary properly disallowed the Providers' pension costs for the fiscal year ended December 31, 2006 in determining the Medicare geographical wage index for federal fiscal year (FFY) 2010.
2012D01 Various Various 1. Whether the Fiscal Intermediary and CMS properly determined the Wage Indexes for St. Elizabeth Medical Center (18-0035); St. Luke Hospital East (18-0001); St. Luke Hospital West (18-0045); Mercy Hospital Anderson (36-0001); University Hospital, Inc. (36-0003); Jewish Hospital (36-0016); Mercy Hospital Fairfield (36-0056); Mercy Franciscan Hospital Western Hills (36-0113); Fort Hamilton Hospital (36-0132); Christ Hospital (36-0163); Mercy Franciscan Hospital - Mt. Airy (36-0234); and Mercy Hospital Clermont (36-0236) and the Cincinnati-Middletown, OH-KY-IN Core Based Statistical Area (CBSA) for Federal Fiscal Year 2009.; 2. Whether the fiscal intermediary and the Centers for Medicare and Medicaid properly determined the Wage Indexes for St. Elizabeth Medical Center (18-0035) and the Cincinnati-Middleton, Ohio-Kentucky-Indiana Core Based Statistical Area (CBSA).
2012D02 08-2202; 08-2203 25-0117 1. Whether CMS is precluded from recovering the alleged overpayments from the Provider's fiscal year end 12/31/97 and 10/31/98 cost reports due to the Intermediary's issuance of the Notice of Program Reimbursement over ten years after the cost report year ends.; 2. Whether the Intermediary improperly disallowed bad debts claimed and costs related to the hospital's unduplicated census for fiscal year ends 12/31/97 and 10/31/98.
2012D03 09-0957 23-0021 Whether the Intermediary's disallowance of Medicare bad debts that had been referred to an outside collection agency was proper.
2011D28 08-2579 05-0126 Did CMS properly reduce the Provider's federal fiscal year (FFY) 2008 inpatient prospective payments system market basket adjust by two (2.0) percentage points?
2011D29 05-0148 31-0091 Whether the Intermediary properly included all appropriate Medicaid eligible days in calculating the Provider's disproportionate patient percentage for purposes of the Medicare disproportionate share hospital (DSH) adjustment under the Prospective Payment System (PPS) for inpatient operating and capital costs for the fiscal year ended (FYE) December 31, 2001.
2011D30 07-0084GC Various Whether the Fiscal Intermediary improperly disallowed the Provider's claimed Medicare bad debts solely on the ground that accounts related to such bad debts were still pending at outside collection agencies.
2011D31 04-0848 09-0001 Whether the Intermediary's adjustments of the Provider's bad debts, because they were written off while they remained at an outside collection agency, were appropriate.
2011D32 06-2319 06-0009 Whether the Intermediary properly disallowed the Provider's entire Medicare disproportionate share hospital (DSH) payment.
2011D33 08-1168; 08-1169; 08-1170; 08-1171; 09-0911; 09-0130; 09-1195 19-0090 Whether the Provider is eligible to be classified and reimbursed as a Medicare Dependent Hospital (MDH) for the fiscal years ended (FYEs) 2/31/01, 12/31/02, 12/31/03, 12/31/04, 12/31/05, 03/31/07, and 03/31/08.
2011D34 05-1740G Various Whether the Intermediary improperly disallowed direct graduate medical education (DGME) and indirect medical education (IME) payments related to managed care days, discharges, and simulated payments solely on the grounds the provider failed to submit UB 92 claim forms for Medicare managed care.
2011D35 09-1970 14-0094 Whether CMS properly reduced the Provider's Outpatient Prospective Payment System (OPPS) Calendar Year (CY) 2009 market basket update by two (2.0) percentage points.
2011D36 06-1431; 06-2384 40-0110 Whether the Intermediary improperly excluded certain days attributable to Puerto Rico Medicaid enrollees who were classified by the Administration De Seguros De Salute De Puerto Rico as category six, for which Puerto Rico receives no Federal matching funds in computing the fraction reflecting the percentage of inpatients who were entitled to medical assistance under an approved state plan (the Medicaid fraction) for purposes of the Medicare disproportionate share hospital calculation.
2011D37 06-0867GC; 08-2122GC; 08-1592GC Various Should patient days attributable to Medicare beneficiaries who elected to enroll in a Medicare+Choice (M+C) plan be included in the numerator of the Medicaid fraction that was used to calculate each of the Providers' Disproportionate Share Hospital (DSH) payments under Section 1886(d)(5)(F) of the Social Security Act (42 U.S.C. Section 1395ww(d)(5)(F)), and 42 C.F.R. Section 412.106 for the cost reporting periods at issue?
2011D38 07-0522 50-1312 Whether the Intermediary's adjustment to the Provider's ambulance service rates was proper.
2007D76 00-3355 42-6548 1. Was the Intermediary's adjustment to salaries proper?; 2. Was the Intermediary's adjustment to contract labor proper?; 3. Was the Intermediary's adjustment to advertising expense proper?; 4. Was the Intermediary's adjustment to utilities expense proper?; 5. Was the Intermediary's adjustment to travel expense proper?; 6. Was the Intermediary's adjustment to rent expense proper?; 7. Was the Intermediary's adjustment to professional fees proper?; 8. Was the Intermediary's adjustment to office expense proper?; 9. Was the Intermediary's adjustment to dues and subscriptions proper?; 10. Was the Intermediary's adjustment to physical therapy - total charges proper?; 11. Was the Intermediary's adjustment to home office costs proper? (Provider Issue 12); 12. Was the Provider's request for costs incurred in settling the cost reports after termination from the Medicare program proper? (Provider Issue 11)
2007D51 01-0883 20-0018 Was CMS' denial of the end stage renal disease (ESRD) composite rate exception correct based on applicable Medicare law? (Case 2004D26 was remanded by the US District Court)
2007D52 02-0530G Various Whether St. Luke's Hospital's letter of March 8, 2001 requesting corrections to its hospital wage data for its fiscal year ended 6/30/1999 (including documentation contained in Exhibit 1-7) satisfied the requirements established by CMS (then HCFA) set forth in 66 Fed. Reg. 39828 -39871 (Aug 1, 2001) for a timely request to the hospital's intermediary to correct any incorrectly reported wage data on its cost report for purposes of the wage data correction process.
2007D53 00-1081 08-0003 Whether the Intermediary's application of the reasonable compensation equivalent (RCE) limits was proper.
2007D54 00-1411 39-0128 Whether the Intermediary properly disallowed the Provider's loss on disposal of depreciable assets as a result of the merger with UPMC Braddock, a subsidiary of the University of Pittsburgh Medical Center (UPMC).
2007D55 02-1565; 03-0517; 04-0338 23-0070 1. Whether the Intermediary properly determined the full-time equivalent (FTE) intern and resident count for purposes of computing the Provider's indirect medical education (IME) adjustment and the direct graduate medical education (DGME) payment for FYEs 6/30/99, 6/30/00 & 6/30/01.; 2. Whether bank fees claimed by the Provider are allowable interest related costs. (FY 6/30/99); 3. Whether the hospital-based physician compensation should be reimbursed under Medicare Part A or Part B. (FY 6/30/99); 4. Whether the proper statistic to allocate housekeeping costs is hours worked or square footage. (FY 6/30/00); 5. Whether the Intermediary properly adjusted the hospital's cafeteria costs by removing all non-administrative Home Health Agency (HHA) FTEs from the Worksheet B-1 statistical base. (FY 6/30/00); 6. Whether the Intermediary properly disallowed the allocation of nursing administration costs to the HHA. (FY 6/30/00); 7. Whether the Intermediary properly weighted Worksheet B-1 statistics to account for the psychiatric unit being closed during the year. (FY 6/30/00); 8. Whether the Intermediary properly adjusted the rehabilitation unit hospital-based physician compensation from Medicare Part A to Part B. (FY 6/30/00).
2007D56 04-0823 35-0070 Whether the Provider is entitled to Transitional Outpatient Payments (TOPs).
2007D57 00-2326 14-0088 Whether the time spent by residents conducting research in the Provider's facility as part of an approved residency program should be in the Indirect Medical Education FTE calculation.
2007D58 03/0759 22-0089 Whether the Provider's Notice of Program Reimbursement (NPR) dated September 24, 2002 was an original or a revised NPR.
2008D04 04-1796 22-0070 Whether the Intermediary's determination of the Provider's dental intern and resident count for purposes of calculating its direct and indirect medical education adjustment was accurate.
2008D11 03-1549 31-0001 Whether the Medicare fiscal intermediary erred by not including 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 in the calculation of the disproportionate share hospital (DSH) payment for fiscal year 2002.
2008D09 03-0811 04-0091 Whether the Provider's Disproportionate Share Hospital (DSH) adjustment was correctly calculated.
2008D10 02-0363 31-0001 Whether the Intermediary's adjustments to the Provider's direct graduate medical education and indirect medical education full-time equivalent counts were proper.
2008D12 04-1491; 04-1495; 04-1496 18-0080 Whether the Intermediary properly adjusted Medicare bad debts accounts considered indigent by the Provider.
2008D35 05-2054 36-0112 1. Whether the Intermediary's adjustment to include outpatient observation bed days in the bed count for purposes of calculating the Provider's indirect medical education (IME) reimbursment was proper.; 2. Whether the Intermediary's adjustment to include Medicaid outpatient observation days when determining disproportionate share hospital (DSH) eligibility and payment was proper.
2008D34 02-1010; 02-0892; 02-1663; 02-2148; 30-0597; 03-1011; 04-0021; 04-0022 23-0053 1. Whether the Intermediary properly excluded FTEs attributable to rotations by residents in certain unaccredited training programs.; 2. Whether the Intermediary properly excluded IME FTEs attributable to time spent by residents in research that was required by the residents' approved medical residency programs.(On the Record); 3. Whether the Intermediary properly excluded FTEs attributable to resident leave time when it is taken during rotations in which the resident is conducting reserarch.; 4. Whether the Intermediary properly excluded from the FTE cap, FTes attributable to time spent by residents in new programs.
2008D36 99-3519M 05-0625 Whether the Intermediary may refuse to apply a revised graduate medical education base year average per resident amount to the subsequent cost years that fall outside the three-year reopening period set forth in 42 C.F.R. Section 405.1885.
2009D01 96-1627G 39-0001 Whether the Medicaid percentage component of the Provider's disproportionate share hospital (DSH) adjustment has been properly computed to contain all Medicaid patient days including Medicaid eligible days.
2001D18 99-2430; 00-0769 17-7087 1. Was the Intermediary's adjustment to owner's compensation proper?; 2. Was the Intermediary's adjustment to community liason salary and benefits proper?; 3. Was the Intermediary's adjustment to franchise fees proper?
2001D15 94-0463 24-0053 Were the Intermediary's adjustments to SNF routine cost limits proper?
2001D21 97-1287 37-0161 Were the Intermediary's adjustments reducing the loss on asset disposal proper?
2009D09 07-1153 27-1325 Whether the Intermediary's disallowance of the Provider's certified registered nurse anesthetist (CRNA) on-call costs was proper.
2009D08 98-3176G 05-0008; 05-0058; 05-0132; 05-0152; 05-0655 Whether the Centers for Medicare and Medicaid Services' (CMS) methodology for determining the Providers' exception to the hospital-based skilled nursing facility cost limits was proper.
2009D07 05-1420G Various Whether the Intermediary's adjustment to utilization review costs was proper.
2009D06 04-1790G 03-0002; 03-0065; 03-0018 Whether the Intermediary improperly omitted certain inpatient hospital days from the numerator of the Medicaid low-income proxy used to calculate the Providers' disproportionate share hospital (DSH) adjustment.
2009D05 06-1300; 06-1301; 06-1307 03-0103 Whether the Intermediary used proper cost to charge ratios in calculating the Provider's outlier payments.
2009D03 04-2130G 50-0024 Whether the Intermediary should include dual-eligible, managed care days in the Medicaid proxy in determining Medicare reimbursement for disproportionate share hospital (DSH) payments in accordance with the Medicare statute at 42 U.S.C. Section 1395ww(d)(5)(F)(vi)(II).
2009D04 04-1915 03-0023 Whether the Intermediary properly calculated and applied the Provider's ambulance cost per trip limit.
2009D02 04-0596G Various Whether the intermediary properly determined the Rochester New York Metropolitan Statistical Area (MSA) wage index for fiscal year 2004 in a manner that reflected the relative hospital wage level in that geographic area as compared to the national average.
2007D66 01-3169; 03-1194 23-5472; 23-0121 Whether the Intermediary improperly limited the Provider's hospital-based Skilled Nursing Facility's (SNF's) routine cost limit exception amount to costs in excess of 112 percent of its peer group costs rather than costs in excess of the routine cost limit.
2007D65 03-0132 44-0048 1. Whether the Centers for Medicare and Medicaid Services (CMS) properly disallowed the Provider's request for an exception to its Skilled Nursing Facility (SNF) Routine Service Cost Limit(RCL).; 2. Whether the Provider is entitled under CMS Program Memorandum (PM) A-99-62 to include the Social Security Act, Section 1115 waiver days for the expanded Medicaid populations (a/k/a Tenn Care) days in the Medicaid component of the disproportionate share hospital (DSH) adjustment calculation.
2007D64 04-0831; 04-0833 08-5034 1. Whether the Intermediary's notification of the opening of the Provider's 1996 and 1997 final settled cost reports was timely pursuant to regulatory standards.; 2. Whether the sampling methodology used by the Intermediary to disallow charges for the Provider's rehabilitation services was proper.
2007D63 03-0721; 04-0473 23-0059 Did the Intermediary properly calculate the Provider's disproportionate share payment adjustment in accordance with Medicare regulations as set forth in 42 C.F.R. Section 412.106?
2007D62 96-2468 05-0279 Whether the Intermediary's determination of non-allowable physician office and vacant space costs was proper.
2007D61 96-1582 33-0059 Whether the Intermediary improperly limited the Provider's hospital-based Skilled Nursing Facility's (SNF's) routine cost limit exception amount to costs in excess of 112 percent of its peer group costs rather than costs in excess of the routine cost limit.
2007D59 05-1792 05-0260 Whether the Intermediary properly required the use of a full year's Medicaid days in the Disproportionate Share Hospital (DSH) calculation based on its interpretation of the Benefit Improvements and Protection Act (BIPA) of 2000.
2007D60 04-1341; 04-1369 65-0001 Whether the Intermediary's adjustment disallowing the Provider's claimed withholding tax expense was proper.
2005D33 03-0055 05-8034 Was the Intermediary's adjustment to start-up costs proper?
2004D45 00-2151G Various 1. Whether the Intermediary's disallowance of the Provider's therapy management fees was Proper?; 2. If the Providers are found to be entitled to a reversal of the Intermediary's disallowance, does the Board have subject matter jurisdiction to determine what entity is entitled to payment?
2004D34 99-3196; 00-0018 39-7001 Were the Intermediary's adjustments applying Medicare's Physical Therapy Compensation Guidelines to the Provider's employee physical therapists proper?
2004D12 97-1685 23-0122 For purposes of allocation of Administrative and General costs, should the Part B physicians' compensation and related fringe benefits be included in total expenses of the private physician practices?
2011D01 06-0419G; 06-1433G; 06-1482G; 06-1451G; 07-0020G Various Whether the Intermediary has improperly adjusted the Providers' direct graduate medical education (GME) intern and resident full-time equivalent (FTE) counts for their respective fiscal years ended (FYE) 12/31/1999 through 12/31/2003 by disallowing various FTEs associated with rotations to the Providers' outpatient medical office clinics in FYE 12/31/1996, the GME FTE cap base year.
2011D02 06-1009; 07-0237 06-0031 Whether the Intermediary improperly recouped alleged overpayments resulting from an incorrect cost-to-charge ratio (CCR) calculated and applied by the Intermediary to determine outlier payments made to the Provider for inpatient rehabilitation services furnished during the cost reporting periods at issue.
2011D03 08-0298G Various Whether the Intermediary's adjustments to the Providers' Medicare bad debts were proper.
2011D04 06-0828 05-0090 Whether the Intermediary's reclassification of clinic meals statistics on Worksheet B-1 from the reimbursable "clinic" cost center (clinic) to a non-reimbursable cost center was proper.
2011D05 05-2270 19-7717 Whether the Provider Statistical and Reimbursement Reports (PS&Rs) used to settle the Provider's cost reports for the fiscal years ended May 31, 1998 and March 17, 1999 are accurate.
2010D53 05-1261 23-0053 1. Whether the Intermediary properly determined the Provider's full time equivalents (FTEs) counts used for purposes of calculating payment for direct graduate medical education (DGME) and indirect medical education (IME), based on its exclusion of residents in other approved programs, including unaccredited programs.; 2. Whether the Intermediary properly determined the Provider's FTE counts used for purposes of calculating payment for IME based on its exclusion of residents' time for research.
2010D52 Various Various Whether Medicare+Choice (M+C) days should be included in the Medicaid fraction used to calculate the disproportionate share hospital (DSH) adjustment.
2010D51 04-2159 18-0141 Whether the Intermediary improperly reduced the Provider's numbers of resident full-time equivalents ("FTEs") used for purposes of Medicare direct graduate medical education ("GME") and indirect graduate medical education ("IME") based on its contention that the Provider did not meet the written agreement requirement for counting resident time spent in non-provider settings in 42 C.F.R. Sections 412.105 and 413.86.
2010D50 06-1889; 06-1886; 06-1890; 02-1517; 06-1888; 06-1887; 06-0755; 06-0524; 06-1142 03-0061 1. Whether the Provider's nursing education program qualified as provider-operated.; 2. Whether, assuming the Provider's nursing education program did not qualify as provider-operated, the Provider is entitled to receive an additional payment to account for services provided to Medicare managed care patients (fiscal years 2000-2003 only).
2010D49 10-0056 37-1635 Whether the amount in controversy requirement under 42 C.F.R. Section 405.1835 is satisfied.
2010D48 Various Various Should the ProviderReimbursement Review Board grant the Provider's request for expedited judicial review (EJR) over the validity of the provisions of the Centers for Medicare & Medicaid Services Ruling CMS-1498-R, which if valid, render moot and deny jurisdiction over these appeals of the disproportionate share adjustment (DSH) supplemental security income (SSI) issue?
2010D47 08-2017 14-0132 Whether the Provider Reimbursement Review Board has jurisdiction over Medicaid eligible days that were not specifically considered within the implementation of a revised Notice of Program Reimbursement (NPR).
2010D46 97-0206 05-0008 Whether the Intermediary properly denied the Provider's Tax Equity and Fiscal Responsibility Act (TEFRA) exception request because of the timeliness of the request.
2012D04 09-0894; 08-1351; 09-0892 23-0142 Did the Oakwood Annapolis Family Practice Residency Program, which received "provisional accreditation" from the Accreditation Council for Graduate Medical Education (ACGME) meet the definition of a "new" program in 2004.
2012D05 02-0531G Various 1. Did the Intermediary err in refusing to exclude Provider's "bonus" or "call back" hours paid from its Federal Fiscal Year (FFY) 2002 wage index calculations?; 2. Did the Intermediary err in refusing to include salary costs for Provider's Senior Vice President of Medical and Academic Affairs (Medical Director) from its FFY 2002 wage index calculations?; 3. Did the Intermediary err in refusing to include Provider's costs for contracted pathology services in its FFY 2002 wage index calculations?; 4. Did the Intermediary err in refusing to include Provider's costs for contracted perfusionist services in its FFY 2002 wage index calculations?; 5. Did the Intermediary err in refusing to include Provider's costs related to its self-insured workers' compensation fund in its FFY 2002 wage index calculations?; 6. Did the Intermediary err in refusing to include Provider's costs associated with an on-site day care center in its FFY 2002 wage index calculations?
2012D06 10-1386GC Various Whether inpatient days for Medicaid-eligible patients who were enrolled in a Medicare+Choice (M+C) plan under Part C of the Medicare statute were properly excluded from the numerator of the Medicaid fraction that is used to calculate the disproportionate share hospital (DSH) payment.
2012D07 06-1709; 05-0627; 06-0192; 06-1710 28-0081 Were the Intermediary's adjustments to disallow the Provider's indirect medical education (IME) and direct graduate medical education (DGME) reimbursement for its graduate medical education activities correct?
2012D08 96-0819; 97-1814 14-0119 1. Did the Intermediary properly calculate the number of interns and residents for FY 1993 for purposes of the Provider's graduate medical education?; 2-A. Were the Intermediary's adjustments to the Provider's bed count as used for purposes of the indirect medical education (IME) calculation proper?; 2-B. In calculating the Provider's bed count as used for purposes of the IME calculation, should there have been a reduction for beds used for observation purposes?; 2-C. For purposes of the Provider's intern and resident count for IME, was the Intermediary correct in disallowing research rotations for residents participating in an approved medical residency program at the Provider?
2012D09 00-2351 14-0119 5-A. Were the Intermediary's adjustments to the Provider's bed count as used for purposes of the indirect medical education (IME) calculation proper?; 5-B. In calculating the Provider's bed count as used for purposes of IME calculation, should there have been a reduction for beds used for observation purposes?; 5-C. For purposes of the Provider's intern and resident count for IME, was the Intermediary correct in disallowing research rotations for residents participating in an approved medical residency program at the Provider?
2012D10 98-0460 05-0211 Whether the District of Columbia District Court's memorandum decision issued in this case finding the Secretary's methodology was improper under the precedent established in. Alaska Professional Hunters Association, Inc. vs. FAA, 177 F.3d 1030 (D.C. Cir. 1999) ("Alaska Hunters"), also applies to the Secretary's low occupancy adjustment.
2012D11 07-0900; 06-1259; 07-0824; 09-0905; 09-0908; 09-0903; 09-0904 05-0464 Whether the Intermediary improperly eliminated all direct medical education and indirect medical education reimbursement for the Provider's family practice residency program for fiscal years ended May 31, 2001 through May 31, 2007.
2012D12 06-0269 26-0027 Whether the Intermediary's determination of additional amounts paid to the Provider for nursing and allied health (N&AH) education costs associated with Medicare+ Choice (M+C) enrollees was proper.
2012D13 02-0529G Various Whether the Fiscal Intermediary and the Centers for Medicare and Medicaid Services (CMS) appropriately included certain paid hours not actually worked by Parkview Health System (Parkview) employees for purposes of calculating the federal fiscal year 2002 wage index for the Fort Wayne, Indiana, Metropolitan Statistical Area (MSA).
2012D14 09-0704 07-0034 Whether the Provider Reimbursement Review Board has jurisdiction over Medicaid eligible days for which there was no adjustment made by the Intermediary within the Notice of Program Reimbursement.
2012D15 09-0008 19-1555 Whether a full or partial waiver is permissible for the Provider's hospice inpatient day limitation overpayment for the cap year November 1, 2005, through October 31, 2006.
2011D07 00-1489 05-0107 Whether a loss on disposal of assets is required to be recognized by Medicare as a result of the April 24, 1997 statutory merger of the Provider.
2012D16 07-0552; 07-2253 28-0081 Were the Intermediary's adjustments to disallow the Provider's indirect medical education (IME) and direct graduate medical education (DGME) reimbursement for its graduate medical education activities correct?
2012D17 04-2249G; 10-0431GC; 10-432GC; 10-433GC; 10-434GC; 10-435GC; 10-0436GC; 04-2265G; 10-1206GC; 10-1211GC; 10-1212GC; 10-1213GC; 10-1214GC; 10-1215GC; 10-1216GC; 10-1217GC; 05-1862G; 10-1218GC; 10-1219GC; 10-1220GC; 10-1221GC; 10-1222GC; 10-1223GC; 10-1224GC; 06-1816G; 10-1225GC; 10-1226GC; 10-1227GC; 10-1228GC; 10-1229GC; 10-1230GC; 10-1231GC; 12-1232GC; 07-1466G; 09-2301G; 09-0811GC; 11-0082GC; 10-1090GC; 11-0081GC; 10-0183GC; 11-0079GC; 11-0080GC; 10-1095GC Various Whether days associated with patients covered under the New Jersey Charity Care Program should be included in the numerator of the Medicaid proxy of the Medicare disproportionate share hospital (DSH) calculation pursuant to § 1886(d)(5)(F)(vi)(II) of the Social Security Act, as amended.
2012D18 08-1404 36-0152 Did the Intermediary properly disallow Medicare bad debt expense- specifically, did the Intermediary correctly disallow those claims from the sample review where the Provider was unable to produce all of the documentation from the patient file used to substantiate the indigency determination.
2012D19 02-0387GC Various Whether the Intermediary's adjustments to the Laundry and Linen and the Central Service and Supply statistics were proper.
2012D20 08-1417 14-0124 Whether the Intermediary's exclusion of the physician malpractice expense from Worksheets A-8-2 and D-9 of the cost report was proper.
2012D21 97-2425R 05-0455 Whether the Secretary's failure to reclassify costs in the peer group construction was arbitrary, capricious or plainly erroneous?
2012D22 08-1580; 10-0178; 10-0179 22-2006 Whether the allocation of the physician costs between Part A and Part B was proper.
2012D23 07-2273G Various Whether days associated with patients covered under the Colorado Indigent Care Program (CICP) should be included in the numerator of the Medicaid proxy of the Medicare disproportionate share hospital (DSH) calculation pursuant to § 1886(d)(5)(F)(vi)(Il) of the Social Security Act, as amended (Act).
2012D24 07-0624; 08-0441; 08-2005; 09-0768 14-0228 Whether the Intermediary's adjustments reducing the 1996 base year IME/GME FTE  count for osteopathic and allopathic medicine interns and residents and their effect on the May 31, 2004 through May 31, 2007 FTE counts are correct.
2012D25 10-1237; 10-1236; 10-1235; 12-0034; 12-0033 31-0058 Whether the Provider Reimbursement Review Board ("Board") has jurisdiction over the calculation of the Provider's 1996 Indirect Medical Education ("IME") Cap Reduction for the redistribution of unused residency slots.
2013D01 07-2447G 39-0009; 39-0147 Whether medical assistance/general assistance days associated with patients covered under the Pennsylvania State Plan should be included in the numerator of the Medicaid proxy of the Medicare disproportionate share hospital (DSH) calculation pursuant to §1886(d)(S)(F)(vi)(II) of the Social Security Act, as amended (Act).
2013D02 06-1735G 16-0067; 28-0013 Whether days associated with patients covered under the Iowa State Plan should be included in the numerator of the Medicaid proxy of the Medicare disproportionate share hospital (DSH) calculation pursuant to § 1886(d)(5)(F)(vi)(II) of the Social Security Act, as amended (Act).
2013D03 06-1318; 07-1386 20-0009 Whether the Intermediary's exclusion of the crossover bad debts for cost reporting periods ended September 30, 2002 and September 30, 2003 due to a lack of documentation was proper.
2013D04 11-0160 10-4993 Whether the Intermediary properly removed total costs and total payments.
2013D05 11-0570 20-0050 Was Maine Coast Memorial Hospital's request to be designated as a Sole Community Hospital properly denied?
2013D06 08-0105GC 44-0176; 44-0063 Whether the Intermediary's adjustments to remove Medicare bad debts from the Providers' cost reports were proper?
2013D07 Various Various Whether the Intermediary improperly eliminated or reduced the pension and postretirement benefit ("PRB") costs of the University of California medical centers ("UC Providers"), and the pension costs of the Catholic Healthcare West medical centers ("CHW Providers") for the purposes of computing their prospective payment system ("PPS") wage indexes for federal fiscal years ("FFYs") 2007 and 2008.
2013D08 04-0376; 05-01805 36-0009 Whether the Intermediary improperly calculated reimbursement for the Provider's skilled nursing facility unit during the skilled nursing facility PPS (prospective payment system) transition period.
2013D09 09-0480G, 09-0383G, 09-0491G, 09-0487G, 07-2217G, 07-2291G Various Whether the Intermediary's reopening adjustment to exclude Type 6 Medicaid dual eligible days from the Providers' Medicaid fraction used in the calculation of the disproportionate share hospital adjustment was proper.
2013D10 07-2274G Various Whether days associated with patients covered under the Missouri State Plan should be included in the numerator of the Medicaid proxy of the Medicare disproportionate share hospital (DSH) calculation pursuant to the Social Security Act, as amended (Act).
2013D11 10-0236 15-0011 Whether the Medicare Administrative Contractor's (MAC) denial of Marion General Hospital's Sole Community Hospital Low Volume Adjustment was proper based on procedural and timing requirements.
2013D12 06-0680G 23-0217; 23-0075 Whether the Intermediary appropriately included wage data from Trillium Hospital for purposes of calculating the Federal Fiscal Year 2006 hospital wage index ("FFY 2006 Wage Index") for the Battle Creek, Michigan Metropolitan Statistical Area.
2013D13 03-0262,04-1461,05-0450, 06-1449, and 09-0710 31-0119 Whether the Medicare administrative contractor properly determined that the Provider was not entitled to reimbursement for medical education pass-through costs related to the university's nursing education and allied health program because the Provider did not meet the requirement of operating the program.
2013D14 08-2778 42-0023 Whether the Intermediary's determination not to increase certain Medicare cost outlier payments was proper, where the outliers were underpaid because of an erroneous overpayment of DSH, which was a factor in the outlier amount calculation and which the MAC subsequently recouped without recalculating the affected outliers.
2013D15 07-0235 26-0183 Whether the Intermediary used the correct number of days when computing the disproportionate share percentage when the cost-reporting periods overlapped April1, 2004.
2013D16 05-1479G Various Whether time spent in research when the residents were assigned to the inpatient prospective payment system portion and/or the outpatient department of the Providers should be included in the full-time equivalent counts ("FTE") for indirect medical education ("IME") payment in the Providers' IME FTE Count Cost Reports pursuant to 42 C.F.R.§ 412.105 (1999).
2013D17 09-0234 23-2553 Whether CMS' denial of the Provider's request for an exception to the ESRD composite rate was proper?
2013D18 00-0655G Various Whether the methodology of the Centers for Medicare and Medicaid Services for determining the Providers' exception to the hospital-based skilled nursing facility ("HB-SNF") routine cost limit was proper.
2013D19 03-1339 25-0031 Did the Intermediary correctly determine the Provider's disproportionate share hospital ("DSH")payment for the fiscal period November 1, 1998 to June 30, 1999?
2013D20 07-0401 32-0085 Whether the Intermediary's determination that the Provider should be reimbursed under the federal rate of the inpatient prospective payment system for capital costs for the fiscal year end 2003 was proper.
2013D21 07-2446G 23-0046 Whether days associated with patients covered under the Michigan Indigent/Charity Care Program should be included in the numerator of the Medicaid proxy of the Medicare disproportionate share hospital ("DSH") calculation pursuant to§ 1886(d)(5)(F)(vi)(II) of the Social Security Act, as amended.
2013D22 02-1305 39-0097 Whether the Intermediary's adjustment disallowing therapy services claims pursuant to a comprehensive medical review was proper?
2013D23 07-2057G; 07-2058G; 07-2059G; 07-2060G; 07-2061G; 07-2308G and 09-1563G Various Whether the Intermediary properly excluded Medicaid eligible Florida Charity Care and Low­ Income days from the disproportionate share hospital ("DSH") calculation.
2013D24 08-0120G 18-0116; 18-0132 Whether days associated with patients covered under the Kentucky Hospital Care Program ("KHCP") should be included in the numerator of the Medicaid proxy of the Medicare disproportionate share hospital ("DSH") calculation pursuant to§ 1886(d)(5)(F)(vi)(II) of the Social Security Act as amended.
2013D25 12-0250 14-7244 Whether the imposition of a 2 percent reduction in the Medicare payments to the home health agency for calendar year 2012 was proper?
2013D26 12-0407 14-7970 Whether the imposition of a 2 percentage point reduction in the annual market basket percentage update for CMK Home Health Agency, Inc.'s Medicare payments for calendar year 2012 was proper?
2013D27 12-0180 45-9410 Whether the imposition of a 2 percent reduction in the Medicare payments to the home health agency for calendar year 2012 was proper.
2013D28 12-0208 67-7207 Whether the imposition of a 2 percent reduction in the Medicare payments to the home health agency for calendar year 2012 was proper?
2013D29 12-0251 23-7251 Whether the imposition of a 2 percent reduction in the Medicare payments to the home health agency for calendar year 2012 was proper?
2013D30 12-0410 49-7593 Whether the imposition of a 2 percent reduction in LivinRite Home Health Services' Medicare payments for calendar year 2012 was proper.
2013D31 12-0411GC Various Whether the imposition of a 2 percent reduction in All Care Home Health, All Care Home Health of San Gabriel, and Comcare Home Health, Inc. Medicare payments for calendar year 2012 was proper.
2013D32 12-0408 45-3108 Whether the imposition of a 2 percent reduction in Carinosa Healthcare, Inc.'s Medicare payments for calendar year 2012 was proper?
2013D33 12-0409 67-9201 Whether the imposition of a 2 percent reduction in MS Healthcare Center, Inc.'s Medicare payments for calendar year 2012 was proper?
2013D34 07-2753 47-0006 Whether the Provider documented that it experienced in a cost-reporting period compared to the previous cost-reporting period a decrease of more than 5 percent in its total number of patient discharges due to circumstances beyond its control in accordance with 42.U.S:C. § 1395www(d)(5)(D)(ii).
2013D35 06-0328 36-0180 Whether the contractor's decision to exclude certain physician Medicare Part A administrative costs under time study codes L and O from the Provider's fiscal year (FY) 2002 wage index data in calculating the FY 2006 wage index should be reversed?
2013D36 09-1573GC 18-0011; 18-0045 Whether days associated with patients covered under the Kentucky Hospital Care Program should be included in the numerator of the Medicaid proxy of the Medicare disproportionate share. hospital ("DSH") calculation pursuant to §1886(d)(5)(F)(vi)(II) of the Social Security Act as amended.
2013D37 Various Various Whether the Fiscal Intermediaries' adjustments to pension costs for the affected providers resulted in erroneous wage indices for the areas where adjustments were made.
2013D38 00-3186G; 04-0361G; 05-0439G; 06-1812G: 08-1845G; 09-1503GC; 09-1581GC; 09-1743GC; 10-0088GC; 10-0129G; 10-0190GC Various Should patient days associated with the Medically Indigent and General Assistance/Unemployable Programs in Washington State be included in the numerator of the Medicaid fraction of the Medicare Disproportionate Share Hospital ("DSH") payment calculation formula in accordance. with 42 C.F.R. § 412.106(b)(4) and § 1886(d)(5)(F)(vi)(II)1 of the Social Security Act?
2013D39 02-1590 15-0084 Whether the Provider Reimbursement Review Board ("Board") has jurisdiction over Ambulatory Surgery Costs and Organ Acquisition Costs where the Intermediary made no audit adjustment to the cost report?
2013D40 Various Various Whether State only eligible (but unpaid) patient days (commonly referred to as General Assistance or GA days), were erroneously excluded from the Medicaid proxy in the Disproportionate Share Hospital (DSH) calculations.
2013D41 11-0708G; 11-0710GC; 11-0711GC; 11-0712GC; 11-0713GC; 11-0714GC; 11-0716GC; 11-0718GC and 11-0724GC Various Whether CMS properly omitted from the Providers' DSH calculation the patient days of individuals who were Supplemental Security Income ("SSI") recipients but who had the amount of their cash payments reduced to zero while they remained in a nursing home?
2013D42 06-0984 22-0001 Whether the observation bed days for the Provider's fiscal year ending September 30, 2003 ("FY 2003") were properly netted from the calculation of the bed count for purposes of qualifying for a disproportionate share hospital ("DSH") payment, the DSH calculation?
2014D01 06-0615; 06-0651; 06-2373 18-0038 Whether medical assistance/general assistance days associated with patients covered under the Kentucky State Plan should be included in the numerator of the Medicaid proxy of the Medicare disproportionate share hospital ("DSH") calculation pursuant to § 1886(d)(5)(F)(vi)(II) of the Social Security Act, as amended.
2014D02 09-1888; 09-1889 and 10-1057GC 01-1600 and 01-1662 Whether the Providers' cap liability for 2006-2008 should be recalculated in light of SouthernCare Hospice's monetary settlement of the qui tam lawsuits filed against it in the United States District Court for the Northern District of Alabama at case numbers 2:05-cv-00873 and 2:07-cv-02325
2014D03 08-2838 07-0033 Whether the Provider Reimbursement Review Board ("Board") has jurisdiction over a claim for Medicaid Eligible Days for which there was no adjustment made by the Intermediary within the Notice of Program Reimbursement.
2014D04 11-0010 25-1627 Notice of Effect of Inpatient Day Limitation and Hospice Cap Amount
2014D05 07-2069 39-5110 Whether the Intermediary's adjustment to disallow Medicare Bad Debts on the Medicare Cost Report was proper.
2014D06 07-2006GC 39-5680, 39-5047 and 39-5409 Whether the Intermediary's exclusion of unbilled crossover bad debts was proper.
2014D07 12-0144 31-0031 Whether CMS improperly denied the Provider's request to be reclassified as a rural hospital.
2014D08 07-1797; 08-1631; 11-0211; 11-0596; 11-0609 22-0162 Whether the Medicare Administrative Contractor (MAC)erred in disallowing certain of the costs associated with Dana Farber Cancer Institute (the "Provider") state provider tax expense in the Provider's Fiscal Year 2004 through Fiscal Year 2008 cost reporting periods.
2014D09 07-2350 51-0086 Was the Intermediary's adjustment to reclassify Rural Health Clinic visits associated with contracted physicians, and the associated full-time equivalents ("FTEs") from cost report Worksheet M-2, line 9 to Worksheet M-2, line 1, correct?
2014D10 06-1337 and 07-1505 20-0033 Whether the Medicare Administrative Contractor (MAC) erred by excluding outside rotations from the Provider's Graduate Medical Education (GME) and Indirect Medical Education (IME) full time equivalent (FTE) count?
2014D11 07-0847 and 07-0306 31-0014 1. Whether a provider's collection effort on inpatient and outpatient bad debts must include personal telephone calls to patients to comprise a reasonable collection effort. 2. Whether the Intermediary incorrectly determined that the regulations affirmatively preclude a write off of bad debts prior to 120 days after the first bill is sent. 3. Whether days associated with patients covered under the New Jersey Charity Care Program should be included in the numerator of the Medicaid proxy of the Medicare disproportionate share hospital ("DSH") calculation pursuant to 42 U.S.C. § 1395ww(d)(5)(F)(vi)(II).
2014D12 10-1135, 10-1136 and 10-1138 05-0146 Whether the Intermediary properly offset investment income against operating and capital-related interest expense for the fiscal years ending September 30, 2004, September 30, 2005, and September 30 2006?
2014D13 08-0611GC; 08-0619GC and 08-0621GC Various Whether the Intermediary's adjustments to remove the Medicare bad debts claimed by the Provider while the debts were still at the collection agency were proper?
2014D14 05-1891; 05-1887; 04-1831; 05-0731 and 06-1938 14-0228 Whether the Temporary Cap Increase Exception applies to the Provider's 1996 base year IME/GME FTE count for osteopathic and allopathic medicine interns and residents and the caps application to the May 31, 1999 through May 31, 2003 FTE counts?
2014D15 10-0386 16-0013 Whether the Medicare Administrative Contractor improperly calculated the Provider's sole community hospital volume decrease adjustment by excluding certain variable and semi-fixed costs?
2014D16 10-0859 16-0214 Whether Wisconsin Physicians Service, the Medicare Administrative Contractor, properly calculated the Medicare dependent hospital volume decrease adjustment for Lakes Regional Healthcare, the Provider, for fiscal year 2006, by improperly excluding certain variable and semi-fixed costs?
2014D17 07-1917G 18-0038; 18-0130; 18-0138; 18-0104; 18-0103; 18-0080 1. Whether the inclusion of surgical technicians, mental health technicians, and heart center recovery technicians in the all-others category instead of the nursing aides, orderlies and attendants category in the Provider's occupational-mix survey was correct. 2. Does the fact that CMS and its Intermediaries did not classify medical technicians uniformly and that some medical technicians are classified in nursing aides, orderlies and attendants category for some other hospitals, even while the Intermediary was excluding them from that category here, require that they be reclassified here as nursing aides, orderlies and attendants, and that the Provider's occupational mix adjustments be recalculated?
2014D18 04-1350; 05-1139; 06-1473; 06-1477; 04-1348; 05-1185; 06-1353; 06-1303 and 07-1344 15-0132 and 15-0002 Whether the Medicare Administrative Contractor's disallowance of Methodist Hospital's bad debt claims should be reversed.