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 1247 entries
| Decision # | Case # | Provider # | Issue |
|---|---|---|---|
| 2022D21 | 17-1626 | 32-0063 | Whether the Medicare Contractor properly calculated the volume decrease adjustment ("VDA") owed to Carlsbad Regional Medical Center ("Carlsbad" or "Provider") for its cost reporting period ending August 31, 2014 ("FY 2014"). |
| 2022D20 | 17-0981 | 33-0085 | Whether the Medicare Contractor properly calculated the Revised Volume Decrease Adjustment ("VDA") owed to the Provider for the significant decrease in inpatient discharges that occurred in its cost reporting period ending December 31, 2012 ("FY 2012"), and whether the Medicare Contractor properly reopened the Original VDA approval. |
| 2022D19 | 15-3335 | 16-0032 | Whether the Medicare Contractor properly calculated the volume decrease adjustment ("VDA") owed to Skiff Medical Center ("Skiff" or the "Provider") for the significant decrease in inpatient discharges that occurred in its cost reporting period ending June 30, 2011 ("FY 2011"). |
| 2022D18 | 15-1708, 15-1709, 15-1688 | 20-0041, 20-0050, 20-0037 | Whether the Medicare Contractor's adjustment for fiscal year ("FY") 2012, which reduced the Providers' allowable Medicare reasonable costs by offsetting a portion of the Providers' Medicaid payments against the Providers' Maine Hospital Tax expense, was proper. |
| 2022D17 | 15-3405 | 39-1544 | Whether the Medicare Contractor used the correct data and methodology in calculating and applying a hospice cap on Tender Loving Care for the 2013 Cap Year. |
| 2022D16 | 17-0848 | 33-0177 | Whether the Medicare Contractor properly calculated the Revised Volume Decrease Adjustment ("VDA") owed to the Provider for the significant decrease in inpatient discharges that occurred in its cost reporting period ending December 31, 2011 ("FY 2011"), and whether the Medicare Contractor properly reopened the original VDA determination. |
| 2022D15 | 12-0630 | 16-0032 | Whether the Medicare Contractor properly calculated the volume decrease adjustment ("VDA") owed to Skiff Medical Center ("Skiff" or the "Provider") for the significant decrease in inpatient discharges that occurred in its cost reporting period ending June 30, 2009 ("FY 2009"). |
| 2022D14 | 11-0501 | 16-0032 | Whether the Medicare Contractor properly calculated the volume decrease adjustment ("VDA") owed to Skiff Medical Center ("Skiff" or the "Provider") for the significant decrease in inpatient discharges that occurred in its cost reporting period ending June 30, 2008 ("FY 2008"). |
| 2022D13 | 17-0933 | 33-0033 | Whether the Medicare Contractor properly calculated the volume decrease adjustment ("VDA") owed to Chenango Memorial Hospital ("Chenango" or the "Provider") for the significant decrease in inpatient discharges that occurred in its cost reporting period ending December 31, 2012 ("FY 2012"), and whether the Medicare Contractor properly reopened the Original VDA approval. |
| 2022D12 | 14-0032 | 36-0079 | Did the Medicare Contractor err when it made an adjustment for fiscal year ("FY") 2009 to remove the Provider's protested item for the addition of Allied Health Program revenue to the accumulated cost allocation statistic, Audit Adjustment No. 26? |