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 by its Medicare contractor or by the Centers for Medicare & Medicaid 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.


Showing 1-10 of 1154 entries
Decision # Case # Provider # Issue
2019D35 18-1391 06-0107 Whether the Provider should be subject to a one-fourth reduction in its Federal Fiscal Year ("FFY") 2019 Annual Percentage Update ("APU") for noncompliance with the Hospital Inpatient Quality Reporting ("IQR") Program requirements.
2019D34 07-2227GC; 07-2762GC; and 08-1704GC Various Whether the Providers engaged in "reasonable collection efforts," notwithstanding their differential treatment of Medicare and non-Medicare bad debts, in light of the Board's decisions in Reed City Hosp. v. BlueCross BlueShield Ass'n ("Reed City") and St. Francis Hosp. & Med. Ctr. v. BlueCross BlueShield Ass'n ("St. Francis").
2019D33 17-1237GC Various Whether the Medicare Contractor's adjustments disallowing the administrative and general costs ("A&G") that Mercy Medical Center - Sioux City ("MMC-SC") allocated to the appealing group members (Baum Harmon Mercy Hospital and Oakland Mercy Hospital) were proper.
2019D32 17-1878 11-0032 The sole issue in this appeal is the methodology used to calculate the Volume Decrease Adjustment ("VDA") payment.
2019D31 17-1879 11-0032 The sole disputed issue in this appeal is the methodology used to calculate the Volume Decrease Adjustment ("VDA") payment.
2019D30 18-0934 29-1502 Whether the imposition of a two percent reduction in the fiscal year ("FY") 2018 Medicare payments for Southwest Medical Associates Hospice and Palliative Care ("SMA" or "Provider") was proper.
2019D29 13-0122GC Various Whether the Medicare Contractor's must-bill policy applies to the Providers' dual eligible bad debts when the Providers did not participate in the Medicaid program.
2019D28 15-3457GC Various Whether the Medicare administrative contractor's inclusion of the sequestered payments never actually paid to the Providers in its calculation of the Providers' hospice cap liabilities was improper.
2019D27 17-1392 23-0092 Did the Medicare Contractor properly calculate the per-resident amount ("PRA") for Medicare payment of direct graduate medical education ("DGME")?
2019D26 16-0140 67-1710 1.) Whether the sequestration amount should be included when calculating the aggregate payment made to Novus Health Services ("Novus" or "Provider") as the reduction in payment through sequestration does not constitute actual Medicare payments made to Novus. 2.) Whether Palmetto GBA c/o National Government Services' ("Medicare Contractor" or "NGS")reopening(s) is/are invalid, as the Medicare Contractor failed to comply with applicable Medicare statutes, regulations, and guidelines when doing so.
Page Last Modified:
08/24/2018 11:27 PM