List of PRRB Decisions

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 Admistrator within 60 days of notification to the provider of that decision.

 

Decision # Case # Provider # Issue
2024D07
18-1014
23-0130
This case involves the following three issues for the fiscal year ending December 31, 2013 ("FY 2013"): 1. Whether the Medicare Contractor should have adjusted William Beaumont Hospital - Royal Oak's (hereinafter "Provider" or "Beaumont") nursing school ...
2024D06
17-2113
34-0106
Whether the Medicare Contractor properly calculated the volume decrease adjustment ("VDA") owed to Sandhills Regional Medical Center ("Sandhills" or the "Provider") for the significant decrease in inpatient discharges that occurred in its cost reporting p...
2024D05
21-0760
14-1694
Whether the Medicare Contractor used the correct time-period and calculations for determining the Provider's hospice cap amount for the cap year ending on September 30, 2019.
2024D04
21-0661
16-1544
Whether the Centers for Medicare & Medicaid Services ("CMS") properly imposed a two percentage point reduction to the fiscal year ("FY") 2021 Medicare annual payment update ("APU") for Hospice of Washington County (the "Provider").
2024D03
20-1792
03-0111
Whether the Centers for Medicare & Medicaid Services ("CMS") properly imposed a two percentage point reduction to the Provider's Federal Fiscal Year ("FFY") 2020 Annual Payment Update ("APU") under the Inpatient Psychiatric Facility Quality Reporting ("IP...
2024D02
14-0786GC
32-0002; 45-0046; 45-0034
Whether the disproportionate share hospital ("DSH") payments for the fiscal year ending June 30, 2009 ("FY 2009") of each of the Christus Health Providers should be revised to include additional Medicaid labor and delivery room ("LDR") patient days that w...
2024D01
14-2200
39-0197
Whether the Medicare Contractor's determination of the Provider's disproportionate share hospital ("DSH") payment for fiscal year ("FY") 2010 should be revised to include additional Medicaid patient days that were excluded from the numerator of the Medica...
2023D36
13-0583GC, 13-1710GC, 14-0584GC, 14-3382GC, 14-3963GC & 15-1816GC
Various
Whether the Medicare Contractor's disallowance of Medicare Bad Debts claimed by the Providers for the fiscal years at issue, on the grounds that they had not been returned from a collection agency, was proper.
2023D35
20-0218
10-2026
Whether the payment penalty that the Centers for Medicare & Medicaid Services ("CMS") imposed under the Long-Term Care Hospital Quality Reporting Program ("LTCH-QRP") which reduced the Provider's payment update for Federal Fiscal Year ("FFY") 2020 by two ...
2023D34
21-0114
45-0876
Whether, in connection with the hospital Inpatient Quality Reporting ("IQR") program, the Centers for Medicare & Medicaid Services' ("CMS") decision to reduce the Annual Percentage Update ("APU") to the Federal Fiscal Year ("FFY") 2021 Inpatient Prospecti...
2023D33
14-1468
01-0055
Whether the Medicare Contractor improperly calculated the Provider's Disproportionate Share Hospital ("DSH") reimbursement due to sampling errors in review of the Medicaid-eligible patient days.
2023D32
15-2971, 15-3228, 16-2290 & 17-0907
49-0069
Whether the Provider is entitled to receive reimbursement for its Medicare Part C Managed Care costs incurred through its nursing and allied health ("NAH") program, based on the requirements in 42 C.F.R. § 413.87, when the Provider submitted no-pay bills...
2023D31
14-1112
26-0141
Whether the Centers for Medicare & Medicaid Services ("CMS") correctly refused to exclude the Missouri Psychiatric Center unit ("MUPC") of the University of Missouri Health Care's ("UMHC" or "Provider") from the inpatient prospective payment system ("IPPS...
2023D30
14-3959, 15-3440, 16-1866, 18-1647, 19-0371 & 22-0536
33-0153
Whether the Medicare Contractor properly determined the Provider's unweighted direct graduate medical education ("GME") and indirect medical education ("IME") full time equivalent ("FTE") resident caps for the fiscal years ("FYs") 2010 and 2012-2016.
2023D29
15-0359, 15-0909 & 16-1527
22-0110
Whether Brigham and Women's Hospital ("Brigham and Women's" or "Provider") timely claimed the $316,565 at issue in the initial fiscal year ("FY") 1989 cost report and, if timely claimed, whether those expenses included Ultrasound and Nuclear Medicine Clin...
2023D28
19-0405
31-0058
Whether the Medicare Contractor properly excluded a lump sum payment of $4,991,315 from the interim payments included on the Provider's notice of program reimbursement ("NPR") for fiscal year ("FY") 2014 and, if so, whether the Provider is entitled to hav...
2023D27
15-2265 & 16-0058
19-0046
Whether the Medicare Contractor's adjustments to remove Full Time Equivalents ("FTEs") from the Graduate Medical Education ("GME") Cap for fiscal years ("FYs") 2010 and 2011 are proper.
2023D26
20-0230
45-0072
Whether the Provider complied with the Affordable Care Act ("ACA") Inpatient Rehabilitation Facility ("IRF") Quality Reporting Program ("QRP") requirements for submission of quality data for the period at issue and, therefore, is not subject to a 2 percen...
2023D25
21-0416
29-2008
Whether the Centers for Medicare & Medicaid Services ("CMS") properly imposed the penalty, under the Long Term Care Hospital Quality Reporting Program ("LTCH QRP"), to reduce the Provider's Federal fiscal year 2021 ("FFY 2021") Medicare annual payment upd...
2023D24
15-3002
05-0057
Whether the Provider is entitled to reasonable cost reimbursement for its graduate medical education ("GME") start-up costs for the fiscal year ending ("FYE") June 30, 2013.
2023D23
15-3264
04-0016
Whether the Provider's disproportionate share hospital ("DSH") payment for the fiscal year ending June 30, 2012 ("FY 2012") should be revised to include additional Medicaid patient days that were excluded from the numerator of the Medicaid faction.
2023D22
15-2944
04-0016
Whether the Provider's disproportionate share hospital ("DSH") payment for the fiscal year ending June 30, 2011 ("FY 2011") should be revised to include additional Medicaid patient days that were excluded from the numerator of the Medicaid fraction.
2023D21
20-1381
36-1702
Whether the imposition of a two percentage point reduction to the fiscal year ("FY") 2020 Medicare annual percentage update ("APU") for Comfortbrook Hospice d/b/a Grace Hospital ("Grace Hospice" or "Provider") (Provider No. 36-1702) was proper.
2023D20
20-1380
36-1703
Whether the imposition of a two percentage point reduction to the fiscal year ("FY") 2020 Medicare annual percentage update ("APU") for Comfortbrook Hospice d/b/a Grace Hospice (Provider No. 36-1703) ("Grace Hospice" or "Provider") was proper.
2023D19
16-1961
38-0027
Whether the Medicare Contractor properly calculated and denied the volume decrease adjustment ("VDA") owed to Mercy Medical Center ("Mercy" or "Provider") for the significant decrease in inpatient discharges that occurred for its cost report period ending...
2023D18
16-0304, 16-1222 & 16-1429
50-1330
Whether the Provider is entitled to certain emergency room availability costs including costs for mid-level providers ("MLPs") for the fiscal years ending December 31, 2011, December 31, 2012 and December 31, 2013 ("FYs 2011, 2012, and 2013").
2023D17
15-1665, 16-2122, 18-1200, 19-0260 & 20-0452
10-0080
Whether the Medicare Contractor correctly determined the Graduate Medical Education ("GME") and Indirect Medical Education ("IME") full-time equivalent ("FTE") resident caps for the new Internal Medicine residents training program at JFK Medical Center ("...
2023D16
15-1092
32-0014
Whether the Medicare Contractor properly determined the sole community hospital ("SCH") volume decrease adjustment ("VDA") granted for the fiscal year ending March 31, 2010 ("FY 2010").
2023D15
14-0443
10-0118
Whether the Medicare Contractor's determination to classify the Provider as a Medicare-dependent hospital ("MDH") effective June 6, 2013, as opposed to October 1, 2012, was proper.
2023D14
17-2189
06-0023
Whether the Medicare Contractor properly calculated and denied the the Volume Decrease Adjustment ("VDA") owed to St. Mary's Hospital & Medical Center (" St. Mary's" or "Provider") as a sole community hospital ("SCH") for its cost reporting period ending ...
2023D13
17-1542
53-0014
Whether the Medicare Contractor properly calculated the sole community hospital ("SCH") volume decrease adjustment ("VDA") owed to Cheyenne Regional Medical Center ("Cheyenne" or "Provider") for its cost reporting period ending June 30, 2014 ("FY 2014").
2023D12
20-1306
25-2006
Whether the payment penalty that the Centers for Medicare & Medicaid Services ("CMS") imposed under the Long Term Care Hospital Quality Reporting Program ("LTCH-QRP") to reduce the Provider's payment update for Federal Fiscal Year ("FFY") 2020 by two perc...
2023D11
17-0927
47-0012
Whether the Medicare Contractor properly reopened the Original Volume Decrease Adjustment ("VDA") approval and whether the Medicare Contractor properly calculated the Revised VDA owed to the Provider for the significant decrease in inpatient discharges t...
2023D10
21-0061
27-0017
Whether the Provider has proven that it is entitled to a Sole Community Hospital Volume Decrease Adjustment ("VDA") for the fiscal year ending December 31, 2015 ("FY 2015").
2023D09
17-1611
14-0040
Whether the Medicare Contractor properly calculated the volume decrease adjustment ("VDA") owed to Galesburg Cottage Hospital ("Galesburg" or the "Provider") for the significant decrease in inpatient discharges that occurred in its cost reporting period e...
2023D08
06-1843, 07-1701, 08-1543, 10-0786, 10-1178, 11-0530
15-1301
Was the Medicare Contractor's disallowance of the interest expense proper for St. Vincent Randolph Hospital ("St. Vincent Randolph" or "Provider") for the fiscal years ("FYs") 2004 through 2009?
2023D07
17-0072
23-0095
Whether the Medicare Contractor properly calculated the volume decrease adjustment owed to West Branch Regional Medical Center ("West Branch" or "Provider") for the significant decrease in inpatient discharges that occurred in its cost reporting period en...
2023D06
15-3152
23-0095
Whether the Medicare Contractor properly calculated the volume decrease adjustment owed to West Branch Regional Medical Center ("West Branch" or "Provider") for the significant decrease in inpatient discharges that occurred in its cost reporting period e...
2023D05
15-3079GC
Various
Whether to include Medicaid days of children and adolescents for the hospital's inpatient behavioral health departments in the Medicaid fraction of the Medicare disproportionate share hospital ("DSH") calculation for fiscal year ("FY") 2007 for each of th...
2023D04
17-0931
20-0031
Whether the Medicare Contractor properly calculated the volume decrease adjustment ("VDA") owed to Cary Medical Center ("Cary" or the "Provider") for the significant decrease in inpatient discharges that occurred in its cost reporting period ending Decemb...
2023D03
17-0930
20-0031
Whether the Medicare Contractor properly calculated the volume decrease adjustment ("VDA") owed to Cary Medical Center ("Cary" or the "Provider") for the significant decrease in inpatient discharges that occurred in its cost reporting period ending Decemb...
2023D02
20-0420
14-0040
Whether the Medicare Contractor properly calculated the volume decrease adjustment ("VDA") owed to Galesburg Cottage Hospital ("Galesburg" or the "Provider") for the significant decrease in inpatient discharges that occurred in its cost reporting period e...
2023D01
18-1206
14-0040
Whether the Medicare Contractor properly calculated the volume decrease adjustment ("VDA") owed to Galesburg Cottage Hospital ("Galesburg" or the "Provider") for the significant decrease in inpatient discharges that occurred in its cost reporting period e...
2022D40
17-1544
49-0037
Whether the Medicare Contractor properly calculated and denied the Volume Decrease Adjustment ("VDA") owed to Riverside Shore Memorial Hospital ("Riverside" or "Provider") for its cost reporting period ending December 31, 2013 ("FY 2013").
2022D39
17-1541
49-0037
Whether the Medicare Contractor properly calculated and denied the Volume Decrease Adjustment ("VDA") owed to Riverside Shore Memorial Hospital ("Riverside" or "Provider") for its cost reporting period ending December 31, 2010 ("FY 2010").
2022D38
15-3066
37-0089
Whether the Provider has proven that it is entitled to the Volume Decrease Adjustment ("VDA") that it seeks for fiscal year ("FY") 2011.
2022D37
14-0643
32-0006
Whether the Provider is entitled to a volume decrease adjustment ("VDA") payment for a sole community hospital ("SCH").
2022D36
17-0182
45-0165
Whether the Medicare Contractor properly calculated the volume decrease adjustment ("VDA") owed to Methodist Hospital South, formerly known as South Texas Regional Medical Center, ("Methodist Hospital" or the "Provider") for the significant decrease in in...
2022D35
14-4410G
34-0091, 50-0044
Whether the Centers for Medicare & Medicaid Services ("CMS") was arbitrary and capricious in establishing a 10 percent threshold in 2003 and whether CMS was arbitrary and capricious in using the same 10 percent threshold in 2006 to determine whether the P...
2022D34
18-0890, 18-0896, 18-0897, 18-0898, 20-0275G, 20-0621G
Various
Whether it is appropriate to offset the tuition revenue for Nursing and Allied Health ("NAH") programs on Worksheet A-8 or whether it is appropriate to offset the tuition revenue only after the stepdown process.
2022D33
17-0526
14-0040
Whether the Medicare Contractor properly calculated the volume decrease adjustment ("VDA") owed to Galesburg Cottage Hospital ("Galesburg" or the "Provider") for the significant decrease in inpatient discharges that occurred in its cost reporting period e...
2022D32
14-1466
14-0040
Whether the Medicare Contractor properly calculated the volume decrease adjustment ("VDA") owed to Galesburg Cottage Hospital ("Galesburg" or the "Provider") for the greater than five percent decrease in inpatient discharges that occurred in its cost repo...
2022D31
16-0187GC, 16-1462GC
Various
Whether the sequestration amount reported on the Provider Statistical and Reimbursement ("PS&R") report for each hospice should be added to the net reimbursement amount in the Aggregate Cap Limitation Calculation to determine payments in excess of the hos...
2022D30
16-2233
15-0030
Whether the Provider is entitled to receive a volume decrease adjustment ("VDA") for a Medicare dependent hospital ("MDH").
2022D29
14-2968
37-0037
Should Medicaid days attributed to child and adolescent patients who received services in three of the Provider's inpatient behavioral health units licensed as psychiatric residential treatment facilities ("PRTFs"), namely ACCENTS (Unit 1929), Human Resto...
2022D28
16-2292
05-0625
Whether the reasonable compensation equivalent ("RCE") limits should have been applied at all to pre-transplant time spent by physicians working for the Provider on organ acquisition-related activities and, if the RCE does apply, whether the Medicare Cont...
2022D27
16-1817
05-0448
Whether the Medicare Contractor properly determined the sole community hospital ("SCH") volume decrease adjustment ("VDA") granted for the short fiscal year ending August 7, 2012 ("Short Period 2012").
2022D26
16-0008
05-0448
Whether the Medicare Contractor properly determined the sole community hospital ("SCH") volume decrease adjustment ("VDA") granted for the fiscal year ending January 31, 2012 ("FY 2012").
2022D25
15-2439
36-0123
Whether the Medicare Contractor erred in disallowing Medicare managed care payments associated with the Provider's operation of its pastoral care allied health education program.
2022D24
14-4177
31-0039
Whether the Medicare Contractor's determination of the Provider's disproportionate share hospital ("DSH") payment [was accurate] and whether that calculation should be revised to include additional Medicaid patient days that were excluded from the numerat...
2022D23
20-0468
19-2022
Whether the payment penalty that the Centers for Medicare & Medicaid Services ("CMS") imposed under the Long Term Care Hospital Quality Reporting Program ("LTCH-QRP") to reduce the Provider's payment update for federal fiscal year ("FFY") 2020 by two perc...
2022D22
15-3430
15-0030
Whether the Medicare Contractor properly calculated the volume decrease adjustment ("VDA") owed to Henry County Memorial Hospital ("Henry County" or the "Provider") for the significant decrease in inpatient discharges that occurred in its cost reporting p...
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"), a...
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...
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 p...
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"), a...
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...
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...
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 en...
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?
2022D11
14-2776
23-0095
Whether the West Branch Regional Medical Center ("West Branch" or "Provider") is entitled to a volume decrease adjustment ("VDA") payment for a sole community hospital ("SCH") for the fiscal year ending March 31, 2010 ("FY 2010").
2022D10
13-3788
23-0095
Whether the West Branch Regional Medical Center ("West Branch" or "Provider") is entitled to a volume decrease adjustment ("VDA") payment for a sole community hospital ("SCH") for the fiscal year ending March 31, 2009 ("FY 2009").
2022D09
17-0272
45-0489
Whether Medical Arts Hospital ("Medical Arts" or the "Provider") is entitled to a volume decrease adjustment ("VDA") for the fiscal year ending March 31, 2012 ("FY 2012").
2022D08
18-1559, 19-2776
23-0055
Whether the Medicare Contractor erred in its determination that the Provider did not qualify for the exception to the per-visit upper payment limit ("UPL") for rural health clinics ("RHCs") for fiscal years ending December 31, 2015 and December 31, 2016 (...
2022D07
20-1892
34-0040
Whether the Provider's disproportionate share hospital ("DSH") payment for fiscal year ending September 30, 2009 ("FY 2009") should be revised to include additional patient days that were excluded from the numerator of the Medicaid fraction.
2022D06
17-1612
37-0030
Whether the Provider is entitled to a Volume Decrease Adjustment ("VDA") for Fiscal Year End ("FYE") 03/31/2012.
2022D05
17-1631
14-0294
Whether the Medicare Contractor properly calculated the volume decrease adjustment ("VDA") owed to Crossroads Community Hospital ("Crossroads" or the "Provider") for the significant decrease in inpatient discharges that occurred in its cost reporting peri...
2022D04
16-1924
14-0184
Whether the Medicare Contractor properly calculated the volume decrease adjustment ("VDA") owed to Marion Memorial Hospital ("Marion" or the "Provider") for the significant decrease in inpatient discharges that occurred in its cost reporting period ending...
2022D03
19-1449
22-2007
Whether the payment penalty that the Centers for Medicare & Medicaid Services ("CMS") imposed under the Long Term Care Hospital Quality Reporting Program ("LTCH-QRP") which reduced the Provider's payment update for Fiscal Year ("FY") 2019 by two percent w...
2022D02
17-0274
45-0073
Whether D.M. Cogdell Memorial Hospital ("Cogdell" or the "Provider") is entitled to a Volume Decrease Adjustment ("VDA") from the Medicare Contractor for the fiscal year ending December 31, 2010 ("FY 2010").
2022D01
17-0788
45-0073
Whether the Medicare Contractor properly calculated the volume decrease adjustment owed to D.M. Cogdell Memorial Hospital ("Cogdell" or the "Provider") for the significant decrease in inpatient discharges that occurred in its cost reporting period ending ...
2021D44
18-0031
45-0370
Whether the Medicare Contractor properly calculated the volume decrease adjustment ("VDA") owed to Columbus Community Hospital ("Columbus" or the "Provider") for the significant decrease in inpatient discharges that occurred in its cost reporting period e...
2021D43
17-0592
27-0003
Whether the Medicare Contractor properly calculated the volume decrease adjustment owed to St. Peter's Hospital ("St. Peter's" or the "Provider") for the significant decrease in inpatient discharges that occurred in its cost reporting period ending May 31...
2021D42
14-0406
37-0059
Whether the Medicare Administrative Contractor, Novitas Solutions, Inc. ("Medicare Contractor"), properly calculated the volume decrease adjustment ("VDA") owed to Stillwater Medical Center ("Stillwater" or the "Provider") for the significant decrease in ...
2021D41
17-0980
33-0223
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, 2013 ("FY 2013"), a...
2021D40
17-0979
33-0223
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"), a...
2021D39
17-0978
33-0223
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, 2009 ("FY 2009"), a...
2021D38
15-3450
45-0615
Whether the Medicare Contractor properly calculated the volume decrease adjustment ("VDA") owed to Atlanta Memorial Hospital ("Atlanta Memorial" or the "Provider") for the significant decrease in inpatient discharges that occurred in its cost reporting pe...
2021D37
15-3448
45-0615
Whether the Medicare Contractor properly calculated the volume decrease adjustment ("VDA") owed to Atlanta Memorial Hospital ("Atlanta Memorial" or the "Provider") for the significant decrease in inpatient discharges that occurred in its cost reporting pe...
2021D36
15-3436
45-0615
Whether the Medicare Contractor properly calculated the volume decrease adjustment ("VDA") owed to Atlanta Memorial Hospital ("Atlanta Memorial" or the "Provider") for the significant decrease in inpatient discharges that occurred in its cost reporting pe...
2021D35
17-0648
26-0186
Whether the Medicare Contractor properly calculated the volume decrease adjustment owed to Lake Regional Health System ("Lake" or the "Provider") for the significant decrease in inpatient discharges that occurred in its cost reporting period ending April ...
2021D34
16-1950
26-0186
Whether the Medicare Contractor properly calculated the volume decrease adjusted owed to Lake Regional Health System ("Lake" or the "Provider") for the significant decrease in inpatient discharges that occurred in its cost reporting period ending April 30...
2021D33
18-1799
28-0077
Whether the Medicare Contractor properly calculated the volume decrease adjustment ("VDA") owed to Fremont Area Medical Center ("Fremont" or the "Provider") for the significant decrease in inpatient discharges that occurred in its cost reporting period en...
2021D32
16-2144
28-0077
Whether the Medicare Contractor properly calculated the volume decrease adjustment ("VDA") owed to Fremont Area Medical Center ("Fremont" or the "Provider") for the significant decrease in inpatient discharges that occurred in its cost reporting period en...
2021D31
14-1615
28-0077
Whether the Medicare Contractor properly calculated the volume decrease adjustment ("VDA") owed to Fremont Area Medical Center ("Fremont" or the "Provider") for the significant decrease in inpatient discharges that occurred in its cost reporting period en...
2021D30
18-0250
45-0653
Whether the Medicare Contractor properly calculated the volume decrease adjustment ("VDA") payment for Scenic Mountain Medical Center for the cost reporting period ending December 31, 2014 ("FY 2014").
2021D29
17-1311
45-0653
Whether the Medicare Contractor properly calculated the volume decrease adjustment ("VDA") payment for Scenic Mountain Medical Center for the cost reporting period ending December 31, 2013 ("FY 2013").
2021D28
16-1919
45-0653
Whether the Medicare Contractor properly calculated the volume decrease adjustment ("VDA") payment for Scenic Mountain Medical Center for the cost reporting period ending December 31, 2012 ("FY 2012").
2021D27
19-1472
34-5522
Whether the payment penalty imposed by the Centers for Medicare & Medicaid Services ("CMS") to reduce Universal Health Care's ("Provider" or "Universal") Fiscal Year ("FY") 2019 Medicare payment by two percent was proper.
2021D26
17-0849
33-0218
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"), a...
2021D25
17-1021
33-0263
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"), a...
2021D24
17-1016
33-0263
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"), a...
2021D23
16-2143GC
Various
Whether the Medicare Contractor's inclusion of sequestered payments in the determination of the Providers' cap on overall Medicare reimbursement was proper.
2021D22
19-2078
14-1694
Whether the Medicare Contractor used the correct number of Medicare beneficiaries in calculating the Cap Year 2018 Hospice Cap.
2021D21
17-0850
33-0215
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"), a...
2021D20
15-1617
32-0003
Whether the Medicare Contractor properly calculated the volume decrease adjustment ("VDA") owed to the Provider for the significant decrease in inpatient discharges that occurred in its cost reporting period ending August 31, 2010 ("FY 2010").
2021D19
14-0442
32-0003
Whether the Medicare Contractor properly calculated the volume decrease adjustment ("VDA") owed to the Provider for the significant decrease in inpatient discharges that occurred in its cost reporting period ending August 31, 2008 ("FY 2008").
2021D18
17-2259
45-0055
Whether Rolling Plains Memorial Hospital ("Rolling Plains" or "Provider") is entitled to a Volume Decrease Adjustment ("VDA") for Fiscal Year End September 30, 2012 ("FY 2021"), greater than the amount determined by the Medicare Contractor.
2021D17
17-1984
45-0055
Whether Rolling Plains Memorial Hospital ("Rolling Plains" or "Provider") is entitled to a Volume Decrease Adjustment ("VDA") for Fiscal Year End September 30, 2010.
2021D16
19-1988
22-7515
Whether the payment penalty imposed on the Provider's home health prospective payment system Annual Payment Update ("APU") for calendar year ("CY") 2019 was proper.
2021D15
17-1947
45-0698
Whether the Provider is entitled to a Volume Decrease Adjustment ("VDA") for Fiscal Year End September 30, 2012 ("FY 2012") greater than the amount determined by the Medicare Contractor.
2021D14
18-1545, 18-1669, 18-1802
18-0029
1. For Case No. 18-1454, whether CMS' decision to reduce the Provider's Fiscal Year ("FY") 2018 Inpatient Psychiatric Facility Prospective Payment System annual payment update ("APU") by 2 percentage points proper? 2. For Case No. 18-1669, whether CMS' d...
2021D13
19-0070
92-1588
Whether the two-percentage point reduction to the Annual Percentage Update ("APU") of ProHealth Home Care, Inc. ("ProHealth" or "Provider") for Fiscal Year ("FY") 2019 was proper.
2021D12
20-0536
45-0587
Whether the Medicare Contractor properly calculated the volume decrease adjustment ("VDA") owed to the Provider for the significant decrease in inpatient discharges that occurred in its cost reporting period ending September 30, 2016 ("FY 2016").
2021D11
19-2624
45-0587
Whether the Medicare Contractor properly calculated the volume decrease adjustment ("VDA") owed to the Provider for the significant decrease in inpatient discharges that occurred in its cost reporting period ending September 30, 2015 ("FY 2015").
2021D10
18-1202
45-0587
Whether the Medicare Contractor properly calculated the volume decrease adjustment ("VDA") owed to the Provider for the significant decrease in inpatient discharges that occurred in its cost reporting period ending September 30, 2014 ("FY 2014").
2021D09
17-1625
45-0587
Whether the Medicare Contractor properly calculated the volume decrease adjustment ("VDA") owed to the Provider for the significant decrease in inpatient discharges that occurred in its cost reporting period ending September 30, 2013 ("FY 2013").
2021D08
16-1508
45-0587
Whether the Medicare Contractor properly calculated the volume decrease adjustment ("VDA") owed to the Provider for the significant decrease in inpatient discharges that occurred in its cost reporting period ending September 30, 2012 ("FY 2012").
2021D07
12-0564
45-0587
Whether the Medicare Contractor properly calculated the volume decrease adjustment ("VDA") owed to the Provider for the significant decrease in inpatient discharges that occurred in its cost reporting period ending September 30, 2007 ("FY 2007").
2021D06
19-0114
39-0072
Whether the Medicare Contractor properly calculated the volume decrease adjustment ("VDA") owed to the Provider for the significant decrease in inpatient discharges that occurred in its cost reporting period ending June 30, 2015 ("FY 2015").
2021D05
17-2258
45-0565
Whether Palo Pinto General Hospital ("Palo Pinto" or "Provider") is entitled to a Volume Decrease Adjustment ("VDA") for the Fiscal Year Ended September 30, 2012 ("FY 2012"), greater than the amount determined by the Medicare Contractor.
2021D04
16-0927, 16-1860, 16-2470
16-1356
Whether the Medicare Contractor improperly disallowed certain related party costs claimed by Henry County Health Center ("Henry Center" or "Provider") based on its determination that Henry Center had not incurred the claimed costs.
2021D03
17-1316
39-0072
Whether the Medicare Contractor properly calculated the volume decrease adjustment ("VDA") owed to Berwick Hospital Center ("Berwick" or the "Provider") for the significant decrease in inpatient discharges that occurred in its cost reporting period ending...
2021D02
17-0003
39-0072
Whether the Medicare Contractor properly calculated the volume decrease adjustment ("VDA") owed to Berwick Hospital Center ("Berwick" or the "Provider") for the significant decrease in inpatient discharges that occurred in its cost reporting period ending...
2021D01
16-2000GC, 16-2002
11-1719, 11-1728
Whether the Medicare Contractor used the correct data and methodology in calculating and applying the "hospice cap" for Cap Years 2013 (Provider No. 11-1719) and 2014 (Provider Nos. 11-1719 and 11-1728).
2020D25
16-2381
16-1362
Whether the Medicare Contractor improperly disallowed certain related party costs claimed by Cherokee Regional Medical Center ("Cherokee" or "Provider") based on its determination that Cherokee Regional Medical Center had not incurred the claimed costs.
2020D24
13-0394
19-2037
Whether the Medicare Contractor's adjustment to the outlier reconciliation adjustment determination was proper.
2020D23
16-1155
38-0002
Whether the contractor was correct in calculating the Provider's Sole Community Hospital Volume Decrease Adjustment.
2020D22
18-0556
42-0027
Whether the denial of the Provider's request for sole community hospital ("SCH") designation by the Centers for Medicare & Medicaid Services ("CMS") and the Medicare Contractor was proper.
2020D21
18-1331
03-7450
Whether the Medicare Contractor's reduction to the Provider's home health prospective payment system (" HHA PPS") payments for calendar year ("CY") 2018 by two percent was proper.
2020D20
08-2236GC, 09-1414GC, 10-1019GC, 11-0106GC
Various
Whether the Providers' Medicare bad debts pending at outside collection agencies are allowable.
2020D19
10-0520, 12-0427
14-0276
Whether the Medicare Contractor should adjust the direct graduate medical education ("GME") cap for Loyola University Medical Center ("Loyola" or "Provider") on Worksheet E-3, Part VI of the Provider's cost reports for fiscal years ("FYs") 2006 and 2007, ...
2020D18
16-1507
26-1595
Whether the Medicare Contractor's amended hospice cap calculation properly calculated the Provider's hospice aggregate cap overpayment when it included in "the amount of payment made" certain funds that were sequestered and never paid to the Provider.
2020D17
16-0408GC, 16-0409GC, 16-2238GC
Various
Whether the Medicare Administrative Contractor improperly denied Medicare reimbursement for the Providers' Medicare bad debt for indigent patients.
2020D16
15-2435, 15-2436, 15-2437
36-0037
Issue 1 - Whether the Medicare Contractor's adjustments for disallowing pass-through costs and managed care payments associated with the Provider's operation of its pastoral care allied health education program were proper. Issue 2 - Whether the Medicare...
2020D15
12-0269
35-0070
Whether the Medicare Contractor's adjustment to reconcile outlier payments was proper and, since the Contractor waited 5 years after discovering the error before notifying the Provider, whether the law bars recovery of the overpayment.
2020D14
17-0654, 17-0656
04-1331
Issue 1 - Whether the use of total costs, rather than patient days, as a statistic to allocate home office pooled costs was proper. Issue 2 - Whether the use of gross revenues, rather than patient days, as a statistic to functionally allocate business of...
2020D13
15-3312
17-1582
Whether the Medicare Contractor's amended hospice cap calculation issued pursuant to the Notice of Reopening properly calculated the Provider's hospice aggregate cap overpayment when it included in "the amount of payment made" certain funds that were sequ...
2020D12
17-1190
24-0052
Whether the Medicare Contractor's final determination of the Provider's Sole Community Hospital ("SCH") Volume Decrease Adjustment ("VDA") was properly calculated.
2020D11
16-2515
50-0072
Whether the Medicare Contractor was correct in calculating the Provider's Sole Community Hospital ("SCH") Volume Decrease Adjustment ("VDA").
2020D10
17-0184
25-0044
Whether the Medicare Administrative Contractor ("MAC") determination of the Provider's Medicare Dependent Hospital ("MDH") Volume Decrease Adjustment ("VDA") was calculated in accordance with the regulations at 42 C.F.R. § 412.108 (d) and Program Reimbur...
2020D09
17-0187
25-0044
Whether the Medicare Administrative Contractor's ("MAC") determination of the Provider's Medicare Dependent Hospital ("MDH") Volume Decrease Adjustment ("VDA") was calculated in accordance with the regulations at 42 C.F.R. § 412.108(d) and Program Reimbu...
2020D08
15-1656, 15-3267, 17-0608, 18-0376, 18-0374
02-0008
Whether the contributions made by the state of Alaska can be counted as "reasonable cost" by the Bartlett Regional Hospital ("Bartlett" or "Provider") for purposes of reimbursement under the Medicare Rural Demonstration Project?
2020D07
16-2051
37-0002
The dispute in this appeal relates to the methodology and calculations used to determine the Provider's fiscal year ("FY") 2011 Volume Decrease Adjustment ("VDA") payment.
2020D06
14-4128
37-0002
The sole disputed issue in this appeal is the methodology used to calculate the Volume Decrease Adjustment ("VDA") payment.
2020D05
15-0359, 15-0909, 16-1527
22-0110
Issue 1 – Whether the Medicare Contractor improperly disallowed the Provider’s reasonable cost for the Ultrasound Allied Health Clinical Training Program that is not operated by the Provider. Issue 2 – Whether the Medicare Contractor improperly dis...
2020D04
13-1221
26-0022
Whether Northeast Regional Medical Center (“Northeast” or the “Provider”), as a Sole Community hospital (“SCH”), was properly reimbursed for indirect medical education costs for services provided to Medicare Advantage (“MA”) patients for t...
2020D03
19-2424GC
05-1770, 05-1746
Whether the MAC’s inclusion of sequestered payments in the determination of the Providers’ Cap on Overall Medicare Reimbursement was proper.
2020D02
17-1827
34-0151
The sole disputed issue in this appeal is the methodology used to calculate the Volume Decrease Adjustment (“VDA”) payment.
2020D01
17-1826
34-0151
The sole disputed issue in this appeal is the methodology used to calculate the Volume Decrease Adjustment (“VDA”) payment.
2019D38
15-0887
26-0022
Whether Northeast Regional Medical Center ("Northeast" or "Provider"), as a Sole Community Hospital ("SCH"), was properly reimbursed for indirect medical education costs for services provided to Medicare Advantage patients for the fiscal year ending May 3...
2019D37
16-1265
10-1543
Whether the Medicare Contractor incorrectly determined the cap year 2012 aggregate cap amount for Seasons Hospice & Palliative Care of Southern Florida ("Seasons" or "Hospice") when the Medicare Contractor used the patient-by-patient proportional method (...
2019D36
13-0929, 13-3153, 13-3155, 13-3156 and 15-1780
52-0098
Issue 1: Whether the Medicare Contractor's adjustments, decreasing the Provider's direct Graduate Medical Education ("GME") and Indirect Medical Education ("IME") Full Time Equivalent ("FTE") Caps to a level below the Provider's audited and adjusted fisca...
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....
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 ...
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 Nov...
2019D25
17-1221
45-7803
Whether the Centers for Medicare & Medcaid Services properly reduced Abundant Home Health, LLC's home health market basket percentage increase by two percentage points for Calendar Year ("CY") 2017.
2019D24
08-2810, 09-0523, 08-2100
42-0036
Whether the Medicare Contractor properly disallowed all costs and removed all therapy charges relating to the Provider's use of a Therapy and Management Services subcontractor for its Skilled Nursing Facility ("SNF") and Inpatient Rehabilitation Facility ...
2019D23
17-0638
05-0205
Whether the payment penalty imposed by CMS [Centers for Medicare & Medicaid Services] under the Hospital Inpatient Quality Reporting ("IQR") program to reduce the Provider's payment update for federal fiscal year 2017 by one-fourth of the annual market ba...
2019D22
15-3311, 16-2022, 16-2024
10-1313
Whether the Medicare Contractor improperly disallowed costs incurred by the Provider under its service agreements with emergency and anesthesiologist physicians groups for availability, standby, and administrative services furnished to the hospital.
2019D21
18-0421
10-8422
Whether RX Home Health Services, Inc. ("RX" or "Provider") should be subject to a two percentage point reduction to its Calendar Year ("CY") 2018 Annual Payment Update ("APU") for failure to meet Home Health Quality Reporting Program requirements in accor...
2019D20
16-1235GC
Various
Whether National Government Services ("Medicare Contractor" or "NGS") erred in calculating the hospice aggregate cap overpayments when it included, in "the amount of payment made," certain funds that were sequestered and never paid to the Providers.
2019D19
18-1292
17-4020
Whether Cottonwood Springs, LLC ("Cottonwood" or "Provider") is entitled to the full market basket adjustment to its Inpatient Psychiatric Facility Prospective Payment System ("IPF PPS") rate for fiscal year 2018.
2019D18
15-2875GC, 15-3271GC
Various
Whether National Government Services ("Medicare Contractor" or "NGS")erred in calculating the hospice aggregate cap overpayments when it included, in "the amount of payment made," certain funds that were sequestered and never paid to the Providers.
2019D17
17-1223
11-2018
Whether the payment penalty that the Centers for Medicare & Medicaid Services ("CMS") imposed under the Long Term Care Hospital Quality Reporting Program ("LTCH-QRP") to reduce the Provider's payment update for Fiscal Year ("FY") 2017 by 2-percent was pro...
2019D16
17-1255
46-2006
Whether the payment penalty that the Centers for Medicare & Medicaid Services ("CMS") imposed under the Long Term Care Hospital Quality Reporting Program ("LTCH-QRP") to reduce the Provider's payment update for Fiscal Year ("FY") 2017 by 2-percent was pro...
2019D15
13-0820, 13-1873
42-0004
Issue 1: Whether the Medicare Administrative Contractor's decision to reclassify the costs and statistics out of the paramedical pass-through cost center was proper. This issue applies to the fiscal years ending June 30, 2007 ("FY 2007") and June 30, 200...
2019D14
18-0508
36-0245
Whether the fiscal year ("FY") 2018 penalty imposed under the hospital inpatient quality reporting ("IQR") program was proper.
2019D13
17-1238
12-3025
Whether the reduction to the Provider's Market Basket Update for the fiscal year ("FY") 2017 under the Inpatient Rehabilitation Facility ("IRF") Quality Reporting Program ("QRP") was proper.
2019D12
13-0252 & 14-3256
15-1318
Whether the Medicare Contractor appropriately disallowed costs to the Provider claimed for physician compensation for emergency room availibility services (frequently referred to as "standby services"), administrative/management services, and on-call cost...
2019D11
14-3883G, 14-3890G, 14-3894G, 14-3896G, 14-3897G, 14-3899G, 14-0259 & 14-0266
Various
Whether the Medicare Contractor's determination to reduce the Providers' indirect medical education ("IME") and graduate medical education ("GME") full-time equivalent ("FTE") resident counts to exclude certain resident rotations in nonhospital clinics wa...
2019D10
18-1034
24-1582
Whether the Centers for Medicare & Medicaid Services properly reduced Minnesota Hospice, LLC's annual payment update ("APU") for Fiscal Year ("FY") 2018 by 2 percentage points.
2019D09
17-1958
31-4019
Whether Christian Health Care Center (d/b/a Ramapo Ridge Psychiatric Hospital ("Ramapo Ridge" or "Provider")) is entitled to the full market basket adjustment to its rate for fiscal year ("FY") 2017.
2019D08
12-0404G, 12-0450G, 12-0456GC, 12-0457GC, 12-0449GC, 12-0454GC
Various
Whether the Federal Fiscal Year ("FFY") 2012 wage index factor and capital geographic adjustment factor for Core Based Statistical Area ("CBSA") No. 40900 used in the calculation of Medicare inpatient and outpatient prospective payments is properly stated...
2019D07
17-0820
25-T004
Whether the reduction of the Provider's Annual Payment Update ("APU") by 2 percent for fiscal year ("FY") 2017 was proper.
2019D06
18-0460
45-0152
Whether the payment penalty under the Hospital Inpatient Quality Reporting Program was properly applied to the Provider.
2019D05
13-2991, 13-3853
14-0224
Did National Government Services, the Medicare Administrative Contractor, properly determine the count of full-time equivalent residents ("FTEs"), used for the purposes of calculating payments for direct graduate medical education ("DGME"), indirect medic...
2019D04
17-0685
42-8960
Whether the Medicare Administrative Contractor's ("Medicare Contractor") disallowance of the Medicare bad debts claimed by Mackey Family Practice was proper.
2019D03
10-1176, 11-0252, 11-0733, 12-0400
05-1317
Issue 1 - Whether the costs incurred by the Provider for its physician on-call expenses should be allowed for the four cost reporting periods at issue (2005, 2006, 2007 and 2008). Issue 2 - Whether the Provider's costs of meals furnished to outpatients (...
2019D02
13-1053
45-0044
Whether the Medicare Contractor's audit adjustments to remove Medicare Usable Organs (Heart & Kidney) were fair and proper.
2019D01
17-0646
51-0006
Whether the reduction by one-fourth of the Provider's fiscal year ("FY") 2017 Inpatient Prospective Payment System annual payment update for the failure to meet all of the inpatient quality reporting requirements is proper.
2018D52
14-3942
24-0101
Whether the Medicare Administrative Contractor was correct when it calculated the Provider's volume decrease adjustment ("VDA") by prorating the amount of the VDA according to the portion of the year during which the Provider maintained sole community hos...
2018D51
14-3941
24-0088
Whether the Medicare Administrative Contractor was correct when it calculated the Provider's volume decrease adjustment ("VDA") by prorating the amount of the VDA according to the portion of the year during which the Provider maintained sole community hos...
2018D50
13-0430, 13-0628, 13-0680
05-0231
Whether the Medicare Administrative Contractor properly calculated Pomona Valley Hospital Medical Center's disproportionate share hospital reimbursement with respect to the Provider's Supplemental Security Income percentage.
2018D49
13-1460GC, 14-0565GC, 14-0773GC & 14-3216GC
Various
Whether a certain category of Medicaid waiver days should be included in the numerator of the Medicaid fraction used to calculate the Providers' disproportionate share hospital ("DSH") payments. The specific days at issue are attributable to patients who...
2018D48
09-0937GC
Various
Should patient days associated with Medicare Part A and Title XIX eligible patients that were not included in the SSI percentage factor of the Medicare Disproportionate Share formula be included in the Medicaid fraction of the Medicare DSH formula?
2018D47
17-1018
45-2061
Whether the payment penalty that CMS imposed under the Long-Term Care Hospital Quality Reporting Program to reduce the Provider's payment update for the federal fiscal year of 2017 by two percent was proper.
2018D46
13-2321; 13-2323; 13-3154; 15-3191
19-0064
When the Medicare Contractor recalculates the Provider's per-resident amount ("PRA"), whether it is consistent with the law to use 1998 census region hospital data to determine the cap on the Provider's recalculated PRA?
2018D45
13-0489
33-0044
The Provider contends that the disallowance of the bad debts claimed is not in accordance with the Medicare regulations and manual provisions as described in the Centers for Medicare & Medicaid Services' ("CMS") Provider Reimbursement Manual ("PRM"), CMS ...
2018D44
17-0196
23-0244/23-T244
Whether the Provider timely submitted required quality data during the required timeframes, and is entitled to the full Market Basket Update for Fiscal Year ("FY") 2017?
2018D43
08-2598G; 08-2955GC; 13-0016G
Various
Should patient days associated with Medicare Part A, Title XIX eligible patients that were not included in the Supplemental Security Income ("SSI") percentage factor of the Medicare Disproportionate Share Hospital ("DSH") formula be included in the Medica...
2018D42
17-1167
04-3033
Conway Regional Rehabilitation Hospital ("Conway" or the "Provider") challenges the reduction of its Annual Payment Update ("APU") for the federal fiscal year ("FFY") 2017 by the Centers for Medicare & Medicaid Services ("CMS") under the Inpatient Rehabil...
2018D41
13-1588
44-0193
Whether the Medicare Administrative Contractor ("Medicare Contractor") determined Medicare reimbursement for Disproportionate Share Hospital ("DSH") payments in accordance with the Medicare statute, 42 U.S.C. § 1395ww(d)(5)(F)(vi). Specifically, whether...
2018D40
17-1266
49-7591
Whether the imposition of a two percent reduction in the appealing home health agency’s (“HHA’s”) Medicare payments for calendar year (“CY”) 2017 was proper.
2018D39
17-0854
05-9656
Whether Grace Community Home Health, Inc., (“Grace Community” or “Provider”) should be subject to a two percentage point reduction to its calendar year (“CY”) 2017 home health market basket percentage increase1 for failure to meet the Home Hea...
2018D38
17-0866
34-0047/34-T047
Whether a two percentage point reduction in the Provider’s fiscal year (“FY”) 2017 annual increase factor, due to failure to meet Inpatient Rehabilitation Facility Quality Reporting Program (“IRF-QRP”) requirements, was proper?
2018D37
16-0828
33-1542
Hospice Care in Westchester and Putnam, Inc. (“Hospice Care” or the “Provider”) challenges the Centers for Medicare & Medicaid Services’ (“CMS’”) reduction to the Provider’s Annual Payment Update (“APU”) for Fiscal Year (“FY”) 20...
2018D36
13-1575; 13-2481; 13-2518
23-0070
Whether, for purposes of the graduate medical education (“GME”) payment and indirect medical education (“IME”) adjustments for FYE’s 06/30/2007, 06/30/2008 and 06/30/2009, the Provider is entitled to count full time equivalent (“FTE”) reside...
2018D35
15-3416
36-0006
Whether the determination that the Riverside Methodist Hospital (“Riverside” or “Provider”) failed to meet the validation requirements for the Calendar Year (“CY”) 2015 Hospital Outpatient Quality Reporting (“HOQR”) Program was proper.
2018D34
15-3197
46-0047
Whether the Provider is entitled to the full Outpatient Prospective Payment System (“OPPS”) market basket rate for Calendar Year (“CY”) 2015 based on its reported Hospital Outpatient Quality Reporting (“HOQR”) validation data?
2018D33
14-3449; 14-3627 and 15-3186
23-0142
Whether the Provider is entitled to higher Graduate Medical Education (“GME”) and Indirect Medical Education (“IME”) full-time equivalent (“FTE”) resident caps for a new Family Medicine residents training Program?
2018D32
16-0159
05-1763
Whether the imposition of a two percent reduction in Lightbridge Hospice?s (?Lightbridge? or ?Provider?) fiscal year (FY) 2016 Medicare payments was proper.
2018D31
17-1253
23-3026
Whether the Provider is entitled to the full market basket update for Fiscal Year (“FY”) 2017.
2018D30
16-0143
52-1531
Whether the imposition of a two percent reduction in Horizon Home Care & Hospice, Inc.’s (“Horizon” or “Provider”) fiscal year (“FY”) 2016 Medicare payments was proper.
2018D29
04-1447; 05-2052; 06-1034
36-0151
Whether the Medicare Contractor’s adjustments to the Provider’s available beds and bed days and prior-year resident-to-bed ratio for cost reporting periods ending 6/30/2001, 6/30/2002 and 6/30/2003 were proper.
2018D28
08-1553, 09-1533, 09-2222
50-0054
Whether the Medicare Contractor improperly disallowed reimbursement for direct graduate medical education (“GME”) and indirect medical education (“IME”) costs in the non-hospital setting by reducing the Provider’s full-time equivalent (“FTE”...
2018D27
17-0564
16-0001
Whether the Provider is entitled to the full Market Basket Update for the fiscal year (?FY?) 2017.
2018D26
17-0301
25-0099
Whether the reduction of the Provider’s Market Basket Update for federal fiscal year (“FY”) 2017 under the Hospital Inpatient Quality Reporting (“IQR”) Program was proper?
2018D25
13-2696; 14-0033; 14-0031; 15-0072; 15-0827; 15-3347
33-0136
Whether Mary Imogene Bassett Hospital (“Mary Imogene” or “Hospital”), as a Sole Community Hospital (“SCH”), was properly reimbursed for Indirect Medical Education (“IME”) costs for services provided to Medicare Advantage (“MA” or “Pa...
2018D24
15-0414
10-0284
Whether the payment reduction to the market basket update that the Centers for Medicare and Medicaid Services (“CMS”) imposed under the Hospital Inpatient Quality Reporting (“IQR”) program for fiscal year (“FY”) 2015 was proper?
2018D23
13-0043
14-5713
Whether the Medicare Administrative Contractor’s (“Medicare Contractor’s”) adjustment that eliminated $183,879 of claimed Medicare reimbursable bad debts was proper and in accordance with Medicare regulations and the Centers for Medicare and Medic...
2018D22
14-0682G; 14-1124G
Various
Whether the Low-Income Pool Section 1115 waiver days should be included in the Medicaid fraction of the Low Income Patient (?LIP?) calculations.
2018D21
09-0580GC; 13-3376G; 14-0871GC; 14-3832GC;15-0446G; 15-3474GC; 14-0645G
Various
Whether the Low-Income Pool Section 1115 waiver days should be included in the Medicaid fraction of the disproportionate share hospital (?DSH?) calculations.
2018D20
08-1052G
18-0038, 18-0130, 18-0138, 18-0104, 18-0103, 18-0080
Whether the inclusion of surgical technicians, mental health technicians, and heart center recovery technicians in the “All other occupations” category instead of the “Nursing aides, orderlies and attendants” category in the Provider’s occupatio...
2018D19
09-2156GC
Various
Whether the Providers are entitled to reimbursement of their Medicare bad debts for the fiscal years ending December 31, 2001, 2002 and 2003.
2018D18
08-0105GC
44-0176 and 44-0063
Whether the Providers engaged in “reasonable collection efforts” notwithstanding their differential treatment of Medicare and non-Medicare bad debt, in light of the Reed City and St. Francis Board decisions?
2018D17
07-1015
06-0104
Did the Medicare Contractor improperly reduce the Provider’s adjusted indirect medical education (“IME”) full time equivalent (“FTE”) count from 6.48 to zero?
2018D16
16-2080
33-0108
Whether the Provider should be subjected to a reduction of one quarter of the market basket update to the fiscal year (?FY?) 2017 Inpatient Prospective Payment System (?IPPS?) rates for the failure to meet the Hospital Inpatient Quality Reporting (?IQR?) ...
2018D15
07-1589G, 08-1344G and 09-1283G
Various
Whether the Medicare Contractor should have excluded the aberrant wage index data from Brunswick Hospital Center (“Brunswick”) when calculating the Nassau-Suffolk Core-Based Statistical Area (“CBSA”) wage index calculations for fiscal years (“FY...
2018D14
15-1033
33-1990
Whether the Medicare Administrative Contractor (“Medicare Contractor”), Cahaba Safeguard Administrators, LLC (“Cahaba”) improperly reclassified Provider costs related to providing housing free of charge for temporary, on-call and other staff, and ...
2018D13
17-1310
34-0098
Whether the full reduction of the Provider’s annual increase factor by 2 percent for fiscal year (“FY”) 2017 for failing to timely submit one of the six required data under the Inpatient Rehabilitation Facility (“IRF”) Quality Reporting Program ...
2018D12
14-2968
37-0037
Whether the Medicaid days attributable to child and adolescent patients who received services in three of the Provider’s inpatient behavioral health units (namely the ACCENTS Unit, the Human Restoration Unit, and the Positive Outcomes Unit) can be inclu...
2018D11
11-0142
19-4653
Was the Medicare Contractor’s adjustment to the Provider’s bad debts claimed proper?
2018D10
09-0233
19-4653
Was the Medicare Contractor’s adjustment to the Provider’s bad debts claimed proper?
2018D09
16-0395
33-0132
Whether the reduction of the Provider?s Market Basket Update for federal fiscal year (?FY?) 2016 under the Hospital Inpatient Quality Reporting (?IQR?) Program was proper?
2018D08
09-0915G
Various
Whether the Supplemental Security Income (?SSI?) ratio used to calculate the Medicare Low Income Patient (?LIP?) adjustment for inpatient rehabilitation facilities (?IRFs?) accurately reflects the number of patient days corresponding to the IRF cost repor...
2018D07
10-0033
51-1318
Whether the Medicare Contractor improperly calculated and adjusted Montgomery General Hospital’s (“Montgomery” or “Provider”) defined benefit pension plan contribution cost that the Provider claimed on its fiscal year 2007 cost report.
2018D06
10-0991GC; 10-1158GC
Various
Whether the Medicare Contractor’s adjustment to the Clinical Pastoral Education (“CPE”) costs from being reported as an allied health educational activity to an administrative and general expense is correct.
2018D05
08-0585GC; 09-1589GC; 10-0090GC; 11-0028GC; 12-0147GC; 13-2822GC; 14-1622GC; 15-3239GC and 16-1252GC
Various
Whether the Providers may be reimbursed for bad debts incurred by patients who were dually eligible for Medicare and Medicaid.
2018D04
16-1544 and 17-0193
36-0148
Whether the Medicare Contractor’s adjustments to the Provider’s Electronic Health Record (“EHR”) incentive payment based on the exclusion of inpatient days for which the Provider provided covered services to Medicare Advantage (“MA”) patients ...
2018D03
09-0890 and 10-1102
37-2007
Whether the Centers for Medicare and Medicaid (“CMS”) must-bill policy applies to the Provider’s crossover bad debts where the Provider did not participate in the Medicaid Program.
2018D02
17-0865
74-7761
Whether Canine Friendly Coalition, Inc. d/b/a Desert Star Home Health (“Desert Star” or “Provider”) should be subject to a two percent reduction to its calendar year (“CY”) 2017 home health market basket percentage increase for failure to me...
2018D01
14-1248 and 15-1445
16-1325
Whether the Wisconsin Physician Services (“Medicare Contractor”) improperly disallowed certain home office costs claimed by Greene County Medical Center (“Greene” or “Provider”) on the grounds that it was not related to the entity that had fur...
2017D31
13-3331, 14-1269 and 14-3176
16-1305
Whether the Wisconsin Physician Services (“Medicare Contractor”)1 improperly disallowed certain home office costs claimed by Pocahontas Community Hospital (“Pocahontas or Provider”) on the grounds that it was not related to the entity that had fur...
2017D30
13-0633
22-0066
Whether Center for Medicare and Medicaid Services’ (“CMS”) June 27, 2012 determination that Mercy Medical Center (“Mercy” or “Provider”) did not meet the quality reporting program requirements for Fiscal Year (“FY”) 2013 and that its fai...
2017D29
15-2800
10-0106
Whether the payment penalty that the Centers for Medicare & Medicaid Services (?CMS?) imposed under the Hospital Inpatient Quality Reporting (?IQR?) program to reduce the Provider?s payment update for fiscal year (?FY?) 2016 by twenty-five percent of the ...
2017D28
09-0454
29-0021
Whether the Medicare Contractor’s exclusion of Medicare Advantage/HMO charges and days from the calculation of the direct graduate medical education (“DGME”) payment for Valley Hospital Medical Center (“Valley” or “Provider”) for its fiscal ...
2017D27
05-0202 and 06-0933
33-0125
Whether the Provider is entitled to a temporary increase in its resident full time equivalent (“FTE”) count due to the closing of one of the other three hospitals in a medical education training program.
2017D26
13-3169
05-0174
Whether Santa Rosa Memorial Hospital’s (“Santa Rosa” or Provider”) Medicaid eligible days for the low-income patient (“LIP”) adjustment for FY 2008 are correctly stated?
2017D25
13-1196, 13-1198 and 13-0900
10-0007
Whether the Medicare Administrative Contractor properly disallowed a portion of the Hospital’s indigent bad debts claimed for the cost reporting periods for fiscal years (“FYs”) ending December 31, 2006, December 31, 2007 and December 31, 2008, on t...
2017D24
13-0009
18-0070
Whether the decision by the Centers for Medicare and Medicaid Services (“CMS”) to impose a 2 percent reduction to the Market Basket Update for fiscal year (“FY”) 2013 for Twin Lakes Regional Medical Center (“Provider” or “Twin Lakes”) , wh...
2017D23
15-2948
10-9401
Whether Millennium Home Care, LLC (“Provider” or “MHC”) should be subject to a 2 percent reduction in home health prospective payment system payments for calendar year (“CY”) 2015 in accordance with 42 C.F.R. § 484.225(i) (2013).
2017D22
13-2636GC, 13-2637GC,13-2640GC
Various
Whether the Medicare Contractor’s revised determination that the Iowa Critical Access Hospitals (“Iowa CAHs” or “Providers”) are not related to Mercy Medical Center-Des Moines (“Mercy”), and all cost report adjustments stemming from that det...
2017D21
15-1873, 15-1880
45-2060, 49-2009
Whether the payment penalty that the Centers for Medicare and Medicaid Services (“CMS”) imposed under the Long-Term Care Hospital Quality Reporting Program (“LTCH QRP”) to reduce the Provider’s payment update for Fiscal Year (“FY”) 2015 by 2...
2017D20
13-1203
17-0086
Whether the Provider, Stormont-Vail Healthcare, Inc. (“Stormont-Vail”), was the legal operator of Baker University Nursing School pursuant to 42 C.F.R. § 413.85(f)(1) (2008), thus qualifying under the Medicare program for pass-through reimbursement f...
2017D19
14-3177, 14-1331 and 15-0165
16-1348
Whether the Medicare Administrative Contractor (“Medicare Contractor”),1 Wisconsin Physicians Service (“WPS”), improperly disallowed certain home office costs claimed by the Provider, Clarke County Hospital (“Clarke”), on the grounds that it w...
2017D18
15-1879
15-2027
Whether the payment penalty that the Centers for Medicare and Medicaid Services (?CMS?) imposed under the Long-Term Care Hospital Quality Reporting Program (?LTCH QRP?) to reduce the Provider?s payment update for Fiscal Year (?FY?) 2015 by 2 percent was p...
2017D17
13-0196G, 13-3892G,14-1723G and 15-1946G
Various
Was the use of Centers for Medicare and Medicaid Services’ (“CMS”) sequential geography methodology (“SGM”) for setting the Providers’ base year per resident amounts (“PRAs”) for Medicare reimbursement of certain graduate medical education...
2017D16
15-2721
19-0081
Whether the reduction of West Carroll Memorial Hospital’s (“West Carroll” or “Provider”)annual payment update for calendar year (“CY”) 2015 under the hospital outpatient quality reporting (“Hospital OQR”) program was proper.
2017D15
15-0660
15-3043
Whether the Provider satisfied Inpatient Rehabilitation Facility (“IRF”) Quality Reporting Program (“QRP”) requirements applicable to it during its first year of Medicare participation such that it would be entitled to the full market basket1 rate...
2017D14
10-1036
05-4662
Whether Portia Bell Hume Behavioral Health & Training Center (“Hume Center”) can be paid by the Medicare program for certain dual eligible Medicare and Medicaid crossover bad debts without billing and obtaining a remittance advice (“RA”) from the ...
2017D13
10-1018GC
Various
Whether the Providers can claim Medicare and Medicaid crossover bad debts for reimbursement without billing the appropriate state agency.
2017D12
07-0413, 07-2872G, 09-1039GC, 09-1830G, 09-1863GC, 12-0365GC, 12-0373GC, 12-0412, 13-0140GC, 13-0591, 15-0266 and 15-0270
Various
Whether Medicare Disproportionate Share Hospital (“DSH”) reimbursement calculations for the Providers (“Hospitals”) were understated due to the failure of the Centers for Medicare & Medicaid Services (“CMS”) and the relevant Medicare administr...
2017D11
13-1862GC, et al.
Various
Whether the Medicare Disproportionate Share Hospital (“DSH”) reimbursement calculations for the Providers (“Hospitals”) were understated due to the failure of the Centers for Medicare & Medicaid Services (“CMS”) and the relevant Medicare Admin...
2017D10
15-0839
33-1520
The Provider appeals the Centers for Medicare & Medicaid Services’ (“CMS”)determination that the Provider is subject to a reduced Federal Fiscal Year (“FY”) 2015 Annual Payment Update (“APU”) under the Hospice Quality Reporting Program(“H...
2017D09
10-0015
25-1318
Whether the Intermediary’s reduction to the Provider’s fiscal year ending September 30, 2007(“FY 2007”) cost report to disallow Medicare bad debts related to the Provider’s geropsychiatric program was proper?
2017D08
11-0124
19-4069
Whether the Provider is entitled to blended reimbursement for its fiscal year end (“FYE”)December 31, 2008 cost report under 42 C.F.R. § 412.426(a)(3).
2017D07
10-0896
13-0007
Whether the Medicare Contractor’s adjustments disallowing Saint Alphonsus’ claimed reimbursement for GME and IME costs in the non-hospital setting, by reducing its FTE count because Saint Alphonsus shared these costs with another hospital, was proper.
2017D06
06-2131; 10-0547
45-2072
Whether the Medicare Contractor?s adjustment to apply the ?must-bill? policy to bad debts related to dual eligible Medicare and Medicaid beneficiaries was proper.
2017D05
15-0146; 16-0811
45-0389
Whether the Centers for Medicare and Medicaid Services (‘CMS”) have assigned the Provider to the correct Core Based Statistical Area (“CBSA”) for the Federal Fiscal Year (“FFY”) 2015.
2017D04
14-1394GC; 14-1732GC
Various
Whether days attributable to patients who were eligible for, and received, assistance through the Massachusetts Commonwealth Care Health Insurance Program (“CCHIP”), a CMS-approved § 1115 waiver, should be included in the numerator of the Medicaid f...
2017D03
15-1819
19-2031
Whether the payment penalty imposed by the Centers for Medicare and Medicaid Services (?CMS?) to reduce Cornerstone Hospital West Monroe?s Fiscal Year (?FY?) 2015 Medicare payment by 2 percent was proper?
2017D02
03-1599G
15-5443; 15-5246; 15-5280; 15-5233; 15-5202; 15-5217; 15-5304; 15-5483; 15-5409; 15-5238, 45-5947
Whether the Medicare Contractor’s methodology allocating Park Associates pooled home office costs improperly denied reimbursement to the Providers?
2017D01
13-1012
16-0016
Whether Trinity Regional Medical Center (?Trinity? or ?Provider?) was entitled to a Volume Decrease Adjustment (?VDA?)?
2016D27
13-1119; 14-2753
10-0271
Did the Medicare Contractor properly calculate the cancer center's payment-to-cost ratio ("PCR") for both fiscal years ("FYs") under appeal?
2016D26
09-1541G
Various
Did the Medicare Contractor properly reduce the Hospitals' Indirect Medical Education ("IME") Full Time Equivalent ("FTE") resident counts, for time spent by residents in research activities?
2016D25
10-0988; 10-0989; 09-0320; 09-0330GC; 09-2117GC; 12-0057; 11-0569GC; 14-2864; 13-2360GC; 15-2603
Various
Whether the Centers for Medicare & Medicaid Services' ("CMS") must-bill policy applies to the Providers' dual-eligible bad debts when the Providers did not participate in Medicaid.
2016D24
15-1975
45-2116
Whether the payment penalty that the Centers for Medicare & Medicaid Services ("CMS") imposed under the Long-Term Care Hospital Quality Reporting Program to reduce the Provider's update for Fiscal Year ("FY") 2016 by 2 percent was proper.
2016D23
15-2051
46-7213
Whether the Medicare Contractor properly imposed a 2 percent payment reduction upon Valeo Home Health Services, Inc. for calendar year ("CY") 2015 for failure to submit quality data as required by the Deficit Reduction Act of 2005.
2016D22
08-0252GC; 08-1945GC; 09-1473GC; 10-1130GC; 11-0590GC
Various
Whether the Centers for Medicare & Medicaid Services ("CMS") must-bill policy applies to the Providers' dual eligible bad debts when the Providers did not participate in the Medicaid Program.
2016D21
13-3307; 14-1004; 14-1760; 15-1894
44-0048
Whether the Medicare Contractor's disallowance of the costs for the Hospital's Allied Health Care Management Program ("AHCMP") was correct.
2016D20
04-1952; 06-2367; 08-1595; 08-1951; 11-0132
45-0076
Issue 1 - Whether the Provider's request for adjustments to the TEFRA target amount shall be granted. Issue 2 - Whether the Medicare Contractor's adjustment to certain Company P expenses was proper.
2016D19
09-0543
25-0040
Whether, in calculating the Medicaid fraction of the Medicare DSH percentage, the Medicare Contractor improperly excluded the inpatient days related to individuals eligible for either expanded Medicaid eligibility or Uncompensated Care Pool services under...
2016D18
10-1020G
25-0078, 25-0097
Whether the Medicare Contractor properly excluded the Hospitals' patient days attributable to Mississippi's § 1115 Waiver, from the calculation of the Hospitals' disproportionate share hospital ("DSH") percentage.
2016D17
07-0637GC, 08-1019GC, 08-0258GC, 10-0249GC, 13-1238GC, 14-0003GC, 14-2395GC, 14-3725GC, 15-0196GC
Various
Whether patient days which the appealing Providers have identified as "inactive" in the Colorado Medicaid program should be included in the Medicaid proxy that is used in the calculation of the Medicare payment for disproportionate share hospitals ("DSH")...
2016D16
12-0031
16-0005
Whether the Medicare Administrative Contractor (Medicare Contractor) correctly determined the amount of the Sole Community Hospital ("SCH") volume decrease adjustment in accordance with the regulations and Program instructions per 42 C.F.R. § 412.92(e)(3...
2016D15
07-2449G
25-1560; 25-1565
Whether the Medicare Contractor used the proper date to start the running of the 3-year reopening period for the 2003 hospice cap calculation by CMS for the cap tear ending October 31, 2003 (November 1, 2002 through October 31, 2003)?
2016D14
07-1992GC
37-0032, 37-0028
Was the Medicare Contractor's exclusion of all of the family practice interns and residents for each of the Hospitals from their respective full time equivalent ("FTE") counts and Medicare Contractor's denial of the associated indirect medical education (...
2016D13
07-0631
05-0017
Whether the Medicare Contractor properly calculated the amount of the Provider's exception to the routine cost limits ("RCL") for hospital-based skilled nursing facilities ("HB-SNF") by excluding from that calculation those costs that were above the RCL b...
2016D12
10-1377, 10-1375
23-0130
Whether the William Beaumont Hospital, Royal Oak ("Beaumont") submitted sufficient documentation for its non-Provider-operated nurse clinical training program costs to support pass-through reimbursement for fiscal years (FYs") 2005 and 2006.
2016D11
06-0213, 05-2117, 06-0167, 07-0976, 08-0181, 08-1846, 08-2830
18-0141
1. DIDACTIC TIME-Whether the Medicare Contractor's exclusion of didactic time from the FTE counts for indirect medical education ("IME") and direct graduate medical education ("DGME") for fiscal years ("FYs") 2000 to 2006 was appropriate.; 2. DENTAL FOREI...
2016D10
15-1874
22-2043
Whether the payment penalty that the Centers for Medicare & Medicaid Services ("CMS") imposed under the Long-Term Care Hospital Quality Reporting Program to reduce the Provider's payment update for Fiscal Year ("FY") 2015 by two percent was proper?
04-1952, 06-2367, 08-1595, 08-1951
45-0076
1.Whether the Provider's request for adjustments to the TEFRA target amount shall be granted.; 2.Whether the Medicare Contractor's adjustment to certain Company P expenses was proper.
2016D08
15-0199
26-2020
Whether the payment penalty that the Centers for Medicare and Medicaid Services ("CMS") imposed under the Long-Term Care Hospital Quality Reporting Program to reduce the Provider's update for Fiscal Year ("FY") 2015 by two percent was proper?
2016D07
09-0939GC
14-T007, 14-T217
Does the Provider Reimbursement Review Board ("Board") have jurisdiction to review the Medicare Contractor's determination of the low-income patient ("LIP") adjustment for Provena St. Joseph Medical Center and Provena St. Joseph Hospital (collectively "Pr...
2016D06
03-1202G; 07-2262G and 07-2263G
Various
Whether secondary MediKan days should have been included in the Provider's Medicaid fraction for the Disproportionate Share Hospital ("DSH") calculation in the disputed cost reports.
2016D05
15-0204
10-2021
Whether the payment penalty that the Centers for Medicare and Medicaid Services ("CMS") imposed under the Long-Term Care Hospital Quality Reporting Program to reduce the Provider's payment update for Fiscal Year ("FY") 2015 by two percent was proper?
2016D04
09-0101
05-0006
Does the Provider Reimbursement Review Board ("Board") have jurisdiction to review the Medicare Contractor's determination of the low-income patient ("LIP") adjustment pertaining to fiscal year ("FY") 2007 for St. Joseph Hospital of Eureka ("St. Joseph")?
2016D03
11-0625
16-0147
Whether the Medicare Contractor properly denied the request of Grinnell Regional Medical Center ("Grinnell" or "Provider") for a volume decrease payment adjustment.
2016D02
15-2901
05-0009
Does the Provider Reimbursement Review Board ("Board") have jurisdiction to review the Medicare Contractor's determination of the number of Medicaid eligible days included in the numerator of the low-income patient ("LIP") adjustment for Queen of the Vall...
2016D01
05-0543GC, 05-0862GC and 06-0910GC
Various
Whether inpatient days for Medicaid-eligible patients who were enrolled in a Medicare+Choice ("M+C") plan under Medicare Part C were properly excluded from the numerator of the Medicaid fraction that is used to calculate the disproportionate share hospita...
2015D30
11-0121GC
Various
Does the Provider Reimbursement Review Board ("Board") have jurisdiction to review the Medicare Contractor's determination of low-income patient ("LIP") adjustment for Baptist Memorial Hospital-Germantown and Baptist Memorial Hospital North Mississippi ("...
2015D29
09-0861GC and 09-1942GC
Various
Does the Provider Reimbursement Review Board ("Board") have jurisdiction to review the Medicare Contractor's determination of low-income patient ("LIP") adjustments for the 2006 and 2007 HealthSouth SSI Percentage CIRP Groups ("HealthSouth")?
2015D28
08-0943
05-0498
Does the Provider Reimbursement Review Board ("Board") have jurisdiction to review the Medicare Contractor's determination of low-income patient ("LIP") adjustment pertaining to fiscal year ("FY") 2004 for Sutter Auburn Faith Hospital ("Auburn")?
2015D27
08-0933
05-0498
Does the Provider Reimbursement Review Board ("Board") have jurisdiction to review the Medicare Contractor's determination of low-income patient ("LIP") adjustment pertaining to fiscal year ("FY") 2005 for Sutter Auburn Faith Hospital ("Auburn")?
2015D26
11-0160
10-4993
1. Whether a community mental health center ("CMHC") is a "provider of services" entitled to a hearing before the Provider Reimbursement Review Board ("the Board") under 42 U.S.C. Section 1395oo. 2. If a CMHC is a "provider of services," does this find...
2015D25
08-0143 and 09-0403
33-0044
Whether the Medicare Contractor's adjustment to Faxton - St. Luke's Medicare bad debts was proper?
2015D24
08-1441 and 08-2364
45-0209
Whether the current year bed count and the available bed days were properly recorded for fiscal year ("FY") 2005, and whether the current year bed count and available bed days and the available bed days used to calculate the prior year intern to resident ...
2015D23
98-0212G, et al.
See Appendix A
Whether the Providers had to bill the state Medicaid program and submit a state remittance advice to the Medicare Contractor as a precondition for the Medicare program to pay bad debts for unpaid coinsurance and deductiblees for individuals who are eligib...
2015D22
15-0404
19-0204
Whether the reduction of the Provider's market basket update for federal fiscal year ("FY") 2015 under the Hospital Inpatient Quality Reporting ("IQR)" program was proper?
2015D21
08-0028
34-0168
1. Whether the Medicare Contractor's adjustment to the provider-based physician professional component was proper.; 2. Whether the Medicare Contractor's recoupment of payments related to the denial of inpatient admissions was proper.; 3. Whether the ...
2015D20
07-1509
05-0498
Does the Provider Reimbursement Review Board ("Board") have jurisdiction to review the Medicare Contractor's determination of low-income patient ("LIP") adjustment for Sutter Auburn Faith Hospital ("Auburn") for fiscal year ("FY") 2003? Specifically, Aub...
2015D19
01-2872R
05-2250
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.
2015D18
01-2871R
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.
2015D17
15-0203
19-2043
Whether the payment penalty that the Centers for Medicare and Medicaid Services ("CMS") imposed under the Long-Term Care Hospital Quality Reporting Program to reduce the Provider's payment update for Fiscal Year ("FY") 2015 by two percent was proper?
2015D16
08-2387
05-0498
Does the Provider Reimbursement Review Board (“Board”) have jurisdiction to review the Medicare Contractor’s determination of low-income patient (“LIP”) adjustment for Sutter Auburn Faith Hospital (“Auburn”) for fiscal year (“FY”) 2006? ...
05-0543GC; 05-0862GC and 06-0910GC
Various
Whether inpatient days for Medicaid-eligible patients who were enrolled in a Medicare+Choice ("M+C") plan under Medicare Part C were properly excluded from the numerator of the Medicaid fraction that is used to calculate the disproportionate share hospita...
2015D14
08-0362
31-4021
Whether the Medicare Contractor improperly disallowed from the calculation of the Provider's bad debt expense, for the subject fiscal year, bad debts associated with patients whose accounts were not billed to Medicaid prior to the accounts being written o...
2015D13
09-1754
15-0017
Whether the Medicare Contractor's adjustment to remove time for off-site rotations was proper?
2015D12
05-1647
05-0446
Whether the Medicare Contractor's denial of Tehachapi Valley Hospital's ("Tehachapi" or "Provider") request for a low volume adjustment payment under 42 C.F.R. Section 412.92(e) was proper?
2015D11
09-1704
02-0012
Whether the Medicare Contractor's calculation of the Provider's low volume adjustment amount was determined correctly.
2015D10
14-3722
34-7247
Was it proper to impose a 2 percent reduction in the Medicare payments to Liberty Healthcare Group, LLC's home health agency located in Supply, North Carolina for calendar year ("CY") 2014?
2015D09
12-0146
32-0003
Whether the Medicare Contractor's denial of Alta Vista Regional Hospital's ("Alta Vista") request for a sole community hospital volume decrease adjustment payment was proper?
2015D08
08-2169G and 08-2177G
See Appendix A
Whether the exclusion by the Medicare Contractor of days identified as inpatient days attributable to individuals who received medical assistance/general assistance under the Connecticut State Administered General Assistance ("SAGA") Program from the Medi...
2015D07
06-0686; 07-1177; 08-1362
10-0061
Issue 1: Whether the Provider Reimbursement Review Board ("Board") has jurisdiction to review the Medicare Contractor's determination that the days of patients who were both eligible for medical assistance under an approved Medicaid state plan and enroll...
2015D06
04-0492G
Various
Whether the Medicare Contractor and the Centers for Medicare and Medicaid Services ("CMS") properly determined the Santa Cruz, California Metropolitan Statistical Area ("MSA") Wage Index for Federal Fiscal Year ("FFY") 2004.
2015D05
07-0399 and 08-0748
36-0019
For fiscal years ("FYs") 2004 and 2005, does the Provider Reimbursement Review Board (the "Board") have jurisdiction over the Medicaid eligible days issue in the appeals?
2015D04
13-2038; 13-0452; 13-1454G; 11-0518GC; and 11-0497GC
Various (See Appendix A)
Did the Medicare contractor properly offset the Kentucky provider tax assessment ("KP-Tax") for each of the seven hospitals for the fiscal years at issue by the corresponding amount of the Kentucky Medicaid Disproportionate Share Hospital ("Medicaid DSH")...
2015D03
01-0004GE; 04-1492GE; 06-0509GE; 09-2040G
Various (See Appendix I)
This case was remanded to the Board and the parties presented the following issues pursuant to the decision of the U.S. Court of Appeals for the Ninth Circuit ("Ninth Circuit") in Providence Yakima Medical Center v. Sebelius ("Providence Yakima"). The ca...
2015D02
06-1843; 07-1701; 08-1543; 10-0786 and 10-1178
15-1301
Was the Intermediary's disallowance of the interest expense proper for St. Vincent Randolph for the 2004, 2005, 2006, 2007 and 2008 fiscal years?
2015D01
10-0302GC; 06-0662G; 06-2036G; 06-0740G; 07-0271G; 07-0273G; 06-0872G and 06-0873G
Various
Whether the Intermediary's application of the Sixth Circuit Court of Appeals' holding in Clark Regional Medical Center v. United States Department of Health and Human Services, 314 F.3d. 241 (6th Cir. 2002) ("Clark") to the determination of the number of ...
2014D30
07-2227GC; 07-2762GC and 08-1704GC
Various
Whether the Intermediary properly disallowed the Providers' non-indigent debts for fiscal year ends 2004, 2005, and 2006, for not meeting all applicable regulatory requirements.
2014D29
08-0050
27-1335
Whether the Medicare Administrative Contractor's disallowance of the Provider's certified registered nurse anesthetist on-call costs was proper.
2014D28
08-1929GC; 09-0510GC; 11-0568GC
Various
Whether the Intermediary properly applied the weighted discharge cap to the Providers' ancillary costs.
2014D27
05-0553
31-0014
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. Section 1395ww(d)(5...
2014D26
99-1340R
39-0028
Whether pursuant to 42 C.F.R. Section 405.378, or otherwise, and in view of the Intermediary's ten year delay in fully implementing PRRB Decision No. 1998-D26 for PRRB Case No. 91-2673M, interest is due on the underpayments which were otherwise at issue i...
2014D25
09-1897
30-1307
Whether the offset of "investment income" up to the amount of interest expense claimed by the Provider for the fiscal year ending June 30, 2007, was proper.
2014D24
08-0496
19-4650
Was the Intermediary's adjustment to the allocation of the Provider's cost proper?
2014D23
10-0224
16-0030
1. Whether the intermediary and CMS Regional Office for Region VII ("CMS Regional Office") evaluated market share for the provider for the correct geographic area when they denied the provider's request for classification as a sole community hospital on ...
2014D22
06-1304; 07-0199; 08-0025; 08-0231; 08-1852
10-0289
Whether the Intermediary's removal of residents who participated in Colorectal Surgery (fiscal years ("FYs") 2002-2006), Internal Medicient (FYs 2004-2006), and Neurology (FYs 2004-2006) programs (collectively, "Programs") from the Provider's Graduate Med...
2014D21
14-0568
39-1745
Whether the imposition of a two percent reduction in Legacy Hospice and Palliative Care LLC's Medicare payments for calendar year 2014 was proper.
2014D20
07-2549R; 07-2546R; 07-2547R; 07-2548R; 07-2538R; 07-2544R; 07-2532R; 07-2533R and 08-0470R
22-1990; 45-1990; 05-1993 and 05-1991
Whether the training offered by the Providers is necessary to enter the specialty of Christian Science nursing in a Religious, Non-Medical Health Care Institution and therefore, eligible for pass-through reimbursement, or whether the Providers' nurse-trai...
2014D19
09-1065GC and 09-2172G
Various
Whether the Intermediary's disallowance of the Providers' bad debts claims, because the claims had been referred to an outside collection agency, should be reversed because the Intermediary's adjustments violate the Bad Debt Moratorium.
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.
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 cor...
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...
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?
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?
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?
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?
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 affirm...
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?
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?
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 reporti...
2014D07
12-0144
31-0031
Whether CMS improperly denied the Provider's request to be reclassified as a rural hospital.
2014D06
07-2006GC
39-5680, 39-5047 and 39-5409
Whether the Intermediary's exclusion of unbilled crossover bad debts was proper.
2014D05
07-2069
39-5110
Whether the Intermediary's adjustment to disallow Medicare Bad Debts on the Medicare Cost Report was proper.
2014D04
11-0010
25-1627
Notice of Effect of Inpatient Day Limitation and Hospice Cap Amount
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.
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 numb...
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 § ...
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 c...
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?
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.
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?
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 calculatio...
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.
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...
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?
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 accorda...
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?
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?
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.
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.
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?
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?
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.
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?
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?
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)(...
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.
2013D22
02-1305
39-0097
Whether the Intermediary's adjustment disallowing therapy services claims pursuant to a comprehensive medical review 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)(...
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.
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?
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.
2013D17
09-0234
23-2553
Whether CMS' denial of the Provider's request for an exception to the ESRD composite rate was proper?
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 educat...
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.
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 MA...
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 ...
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.
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.
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).
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.
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.
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 Pr...
2013D06
08-0105GC
44-0176; 44-0063
Whether the Intermediary's adjustments to remove Medicare bad debts from the Providers' cost reports were proper?
2013D05
11-0570
20-0050
Was Maine Coast Memorial Hospital's request to be designated as a Sole Community Hospital properly denied?
2013D04
11-0160
10-4993
Whether the Intermediary properly removed total costs and total payments.
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.
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...
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 ...
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.
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.
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)...
2012D22
08-1580; 10-0178; 10-0179
22-2006
Whether the allocation of the physician costs between Part A and Part B 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?
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.
2012D19
02-0387GC
Various
Whether the Intermediary's adjustments to the Laundry and Linen and the Central Service and Supply statistics were proper.
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 sub...
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...
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 th...
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?
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.
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.
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 ...
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.
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.
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. ...
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 h...
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 indir...
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?
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 ...
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 Pr...
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.
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.
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...
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. (3...
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.
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. W...
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.
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.
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.
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?
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.
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 ...
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 ...
2011D38
07-0522
50-1312
Whether the Intermediary's adjustment to the Provider's ambulance service rates was proper.
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) ...
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 fund...
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.
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 9...
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.
2011D32
06-2319
06-0009
Whether the Intermediary properly disallowed the Provider's entire Medicare disproportionate share hospital (DSH) payment.
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.
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.
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...
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?
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 E...
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.
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.
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.
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.
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.
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.
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...
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 s...
2011D18
05-1032; 06-1173
09-0001
Whether the Intermediary properly extrapolated the sample error rate to the population in adjusting Medicaid eligible days.
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.
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?
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.
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, 200...
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.
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.
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.
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...
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.
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...
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.
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.
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.
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.
2011D03
08-0298G
Various
Whether the Intermediary's adjustments to the Providers' Medicare bad debts were proper.
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 fu...
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 variou...
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 reside...
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 t...
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 f...
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 juri...
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.
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 Intermedi...
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.
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'...
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 ...
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 Seco...
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 demonstrat...
2010D39
10-0081
46-0003
Should the Provider Reimbursement Review Board ("Board") grant the Providers' request for expedited judicial review ("EJR") over the validity of the provisions of the Centers for Medicare and Medicaid Services Ruling CMS-1498-R, which if valid, render moo...
2010D38
10-0165G; 10-0162GC; and 10-0169GC
Various
1. Should the Provider Reimbursement Review Board ("Board") grant the Providers' request for expedited judicial review ("EJR") over the question of whether Medicare Part C days should be excluded from the numerator and denominator of the Supplemental Sec...
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...
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 jur...
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.
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 O...
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.
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?
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 ...
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 reque...
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?
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.
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...
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 o...
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.
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 avai...
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.
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.
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?
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.
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/Faciliti...
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/Faciliti...
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/Faciliti...
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/Faciliti...
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?
2010D14
05-0828
10-0061
Whether the provider has a right to hearing on correction of its cost report to reclassify certain nurse expenses.
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?
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.
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 endi...
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.
2010D09
00-3325
05-0146; 05-7037
Whether the Provider timely filed its Tax Equity and Fiscal Responsibility Act (TEFRA) exception request.
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 i...
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 ...
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.
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.
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.
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?
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.
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.
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.
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.
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.
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 Medi...
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 attribut...
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.
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 ...
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 properl...
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)...
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.
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.
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 app...
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.
2009D23
99-0584R (on Remand)
39-0080
Whether the Jeanes Hospital merger was a bona fide sale.
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.
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.
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...
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.
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 ...
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...
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 p...
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...
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 tha...
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,...
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.
2009D04
04-1915
03-0023
Whether the Intermediary properly calculated and applied the Provider's ambulance cost per trip limit.
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)(...
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...
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.
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.
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.
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...
2008D41
06-0614
23-0097
Whether the Intermediary correctly limited the Provider's ambulance reimbursement to its charges.
2008D40
06-0987
27-1328
Whether the Intermediary's adjustment to Certified Registered Nurse Anesthetist (CRNA) cost was proper.
2008D39
00-1456
39-0098
Whether the Intermediary's adjustments disallowing the loss on disposal of depreciable assets through consolidation were proper.
2008D38
00-1454
39-0067
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...
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.
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 in...
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 requi...
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 deni...
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 f...
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.
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. Whethe...
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 wit...
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?
2008D26
02-0326; 03-0730; 04-1130
05-0327
Whether the payment for indirect medical education (IME) and direct graduate medical education (DGME) was understand because not all managed care days and discharges for inpatient services for Medicare beneficiaries were included in the calculation.
2008D25
05-1788
05-0599
Whether the Intermediary can make an adjustment to the Provider's Medicare cost report more than three years after the original Notice of Program Reimbursement date.
2008D24
01-0679; 02-0244
05-0043
Whether the TEFRA base year used by the fiscal intermediary to compute a target amount for the Provider's excluded psychiatric unit for the February 28, 1998 and February 28, 1999 cost years was proper.
2008D23
04-1953; 05-1582
45-0076
1. Whether the Intermediary properly disallowed the Provider's request for an adjustment to the TEFRA rate-of-increase ceiling to account for the cost of new drugs that were not approved in the 1983 base year.; 2. Whether the Intermediary properly calcula...
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 w...
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 P...
2008D20
06-0763; 06-2010
24-0213
Whether the Intermediary's refusal to reimburse the Provider for capital-related costs under the hold harmless methodology was proper.
2008D19
04-1995G
35-0002; 35-0015
Whether the Intermediary properly disallowed reimbursement for direct graduate medical education (DGME) and indirect medical education (IME) costs in the non-hospital setting by reducing the Provider's full-time equivalent (FTE) resident counts.
2008D18
01-0801
14-0174
Whether the Intermediary's adjustment disallowing the loss on disposal of depreciable assets through consolidation was proper.
2008D17
04-0088G
Various
Whether the Providers are entitled to receive additional indirect medical education (IME) and direct graduate medical education (DGME) payments for Medicare managed care enrollees for fiscal years ended December 31, 1998 and 1999.
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 ...
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?
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?
2008D13
00-1904G
Various
Whether the Intermediary's calculation of the disproportionate share hospital (DSH) payment was proper.
2008D12
04-1491; 04-1495; 04-1496
18-0080
Whether the Intermediary properly adjusted Medicare bad debts accounts considered indigent by the Provider.
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 calculat...
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.
2008D09
03-0811
04-0091
Whether the Provider's Disproportionate Share Hospital (DSH) adjustment was correctly calculated.
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 F...
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...
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.
2008D05
06-1478
31-5381
Whether the Intermediary properly adjusted Medicare bad debts.
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.
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 pl...
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 incl...
2008D01
05-0686
15-0011
Whether the recission of the hospital's approved request for Sole Community Hospital (SCH) status was proper.
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 ...
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 th...
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...
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 sal...
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...
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 c...
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 prope...
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 prop...
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 Intermedia...
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 p...
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 Memor...
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).
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 limi...
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 Memor...
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 Pro...
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 limi...
2007D60
04-1341; 04-1369
65-0001
Whether the Intermediary's adjustment disallowing the Provider's claimed withholding tax expense was proper.
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.
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.
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.
2007D56
04-0823
35-0070
Whether the Provider is entitled to Transitional Outpatient Payments (TOPs).
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...
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).
2007D53
00-1081
08-0003
Whether the Intermediary's application of the reasonable compensation equivalent (RCE) limits was proper.
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 for...
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)
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 ...
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 ...
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.
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.
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).
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 hospita...
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.
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.
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.
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.
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.
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.
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 meet...
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.
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, Deliver...
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).
2007D32
00-2803
52-0174
Whether the Intermediary's determining disallow post-retirement health benefits costs for a terminated provider was proper.
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.
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)E...
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 Disproportio...
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 c...
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...
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.
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?
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 ...
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.
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 ...
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 su...
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 ...
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.
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...
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 paymen...
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...
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.
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.
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.
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...
2007D01
97-0174
16-0024
Was the Intermediary's disallowance of the loss on disposal of assets resulting from a merger proper?
2006D58
03-0895
34-0168
Whether the Intermediary's disallowance of Medicare bad debts claimed by the Provider was justified.
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.
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.
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 o...
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.
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.
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.
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 disapprove...
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.
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.
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.
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.
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.
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?
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.
2006D43
04-0025
17-0032
Whether the Provider was improperly denied a Medicare low-volume adjustment.
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 adjustm...
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.
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.
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.
2006D38
98-1822
07-0028
Whether the Intermediary's adjustment to disallow the Connecticut Sales Tax was proper.
2006D37
02-0140
07-0007
Whether the Intermediary's adjustment to disallow the Connecticut Sales Tax 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 ...
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 ...
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.
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.
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...
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.
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?
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...
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.
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...
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.
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 Inter...
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.
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.
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.
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.
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)percenta...
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.
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?
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?
2006D16
04-0426
05-0122
Whether the Intermediary's disallowance of the Provider's inpatient and outpatient Medicare bad debts was proper?
2006D15
02-1526
19-7060
Whether the Intermediary's disallowance of medical director fees was proper.
2006D14
03-0176
07-5407
Whether the Intermediary properly denied the Provider's new provider exemption request.
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.
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.
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.
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.
2006D08
03-0009G
Various
Whether the Intermediary's adjustments reallocating key employee and owners' bonuses were proper.
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 t...
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...
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 nu...
2006D04
99-1295
15-5478
Was the Intermediary's adjustment to owners' compensation proper?
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.
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 disproport...
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?
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.
2005D71
02-0399, 02-1946
15-0029
Were the Intermediary's adjustments to the count of full-time equivalent interns and residents 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. W...
2005D69
01-3317
39-7086
Whether the Intermediary's adjustment of accounting fees was 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 Ro...
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 P...
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.
2005D65
00-3600
45-7661
Whether the Intermediary properly disallowed interest expense incurred in connection with the Provider's deferred compensation plan.
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.
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 pr...
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.
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.
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.
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.
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.
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.
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.
2005D55
00-3322
39-0263
Whether the Intermediary's adjustment disallowing the Provider's loss on sale of assets is proper?
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?
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)?
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.
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.
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 d...
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.
2005D48
95-0777
33-0225
Whether the Intermediary's application of the reasonable compensation equivalent limits was proper.
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...
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)?
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?
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.
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)?
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.
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.
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 prop...
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.
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.
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?
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 r...
2005D35
99-1345
55-7729
Whether the liabilities claimed by the Provider are reimbursable under the Medicare principles.
2005D34
98-1658
45-0124
Whether the Intermediary properly applied the "Pickle Amendment" in calculating the Provider's Disproportionate Share Hospital (DSH) adjustment.
2005D33
03-0055
05-8034
Was the Intermediary's adjustment to start-up costs proper?
2005D32
94-3299, 96-0845, 98-2163
31-0111
Whether the Intermediary failed to properly classify certain projects as old capital.
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.
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.)
2005D29
95-0468
05-0076
Was the Intermediary's partial denial of the Provider's End Stage Renal Disease (ESRD) exception request proper?
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?
2005D27
02-1008
25-0019
Was the Intermediary's disallowance of Medicare bad debts 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 r...
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...
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 ...
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 ...
2005D22
01-0700
15-5228
Whether the Intermediary's adjustment to disallow a portion of the owner's compensation was proper?
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?
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 "pri...
2005D19
01-0261
19-7558
Was the Intermediary's adjustment to disallow accrued salaries 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 adj...
2005D17
02-0013, 02-0319
04-3816
Was the Intermediary's adjustment to physician/owners compensation 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?
2005D15
02-0020
05-6092
Whether the Intermediary's denial of the Provider's Routine Cost Limit (RCL) exception request 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?
2005D13
02-0078
19-7585
Whether the Intermediary denial of the Provider's request for exception to its per-visit cost limits was proper?
2005D12
99-0452G
Various
Whether the Intermediary properly processed the Providers' TEFRA exception request?
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?
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 supp...
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?
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?
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?
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?
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?
2005D04
01-1458
20-0033
Was CMS' denial of the Provider's end stage renal disease (ESRD) composite rate exception request correct?
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?
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 p...
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?
2004D46
01-1540; 01-2860; 02-1247
23-7251
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 w...
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 b...
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?
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?
2004D41
98-3477G
Various
Was the Intermediary's determination of the disproportionate share hospital (DSH) computation relating to state-only General Assistance Days Proper?
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 ...
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?
2004D38
02-1971
31-0067
Was the intermediary's determination of loss on consolidation 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")?
2004D36
00-0386
39-0088
Was the Intermediary's denial of the Provider's loss on disposal of assets proper?
2004D35
96-0059; 96-0060
15-5383
Was the Provider entitled to an exemption from the routine cost limit as a "new" provider?
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?
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?
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?
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?
2004D30
01-0937
23-7252
Was the Intermediary's adjustment to the single business tax proper?
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?
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?
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?
2004D26
01-0883
20-0018
Was CMS' denial of end stage renal disease composite rate exception request correct based on applicable Medicare law?
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?
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?
2004D23
97-2439
19-0160
Was the Provider's routine cost limit determined in accordance with Medicare law, regulations, and program instructions?
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?
2004D21
99-1424
04-0048
Was the Intermediary's determination of the loss on disposal of assets proper?
2004D20
98-1344; 99-1718; 00-2691
51-0001
Was the Intermediary's adjustment to bond interest proper?
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?
2004D17
00-2285
32-7125
Was the Intermediary's adjustment to the Provider's cost limits 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?
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?
2004D14
98-1861
34-0115
Was the Intermediary's determination disallowing the loss incurred on change of ownership proper?
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...
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?
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?
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?
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?
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?
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?
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?
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?
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 adju...
2004D02
99-3609; 00-3050; 01-2972
22-4022
Were the Intermediary's adjustments to physician stand-by costs in the routine area correct?
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?
2003D66
99-4073
49-5280
Was the Intermediary's adjustment disallowing Medicare Part A and Part B bad debts 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?
2003D64
98-2851
17-0087
Was the Intermediary's determination of loss on consolidation 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 renta...
2003D62
99-0584
39-0080
Was the Intermediary's determination of loss on sale of assets 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?
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?
2003D59
00-1344
40-0079
Was the Intermediary's adjustment to the disproportionate share, (DSH) computation proper?
2003D58
95-0590
40-0016
Was the Center for Medicare & Medicaid Services' denial of the Provider's exception request proper?
2003D57
99-3821
40-0098
Was the Intermediary's adjustment to bad debts 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?
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?
2003D54
01-2453
05-6323
Was the Intermediary's adjustment reclassifying Medical Director cost proper?
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?
2003D52
01-2455
Were the Intermediary's adjustments reclassifying the Medical Director cost proper?
2003D51
01-3608G
Various
Was the Intermediary's adjustment to restorative nurses aides proper?
2003D50
00-0961G
Various
Was the Intermediary's adjustment to restorative nurses aides 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?
2003D48
99-2780, 99-2781, 01-1334, 01-1335; 02-0450
39-7015
Was the Intermediary's adjustment to home office costs proper?
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?
2003D46
00-1172
55-7008
Whether the Provider is entitled to an exception to the visit cost limits in accordance with Medicare regulations?
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?
2003D44
02-0901G
Various
Was the Intermediary's disallowance of liabilities not liquidated timely on the Medicare cost report proper?
2003D43
97-3008
10-0055
Was the Intermediary's determination of obligated capital proper?
2003D42
02-1198
41-7001
Was the Intermediary's disallowance of the Provider's Spanish and Portuguese interpreter expenses 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?
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...
2003D39
97-2608
55-5405
Was the Intermediary's denial of the Provider's SNF routine service cost limit exception request proper?
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?
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?
2003D36
98-1973
12-0006
Were the Intermediary's adjustment disproportionate share hospital payments 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?
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?
2003D33
01-1779; 02-0270
18-3026
Was the all inclusive rate allocation Methodology proper?
2003D32
98-1282
67-7181
Was the Intermediary's Audit Adjustment #2 which disallowed $108,875 of Administrative and General Costs 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 dieticia...
2003D30
01-1525
31-7060
Was the Intermediary's adjustment to the Per Beneficiary Limit (PBL) calculation proper?
2003D29
01-1866
23-0205
Was the Intermediary's adjustment to DRG (Diagnostic Related Group) payments proper?
2003D28
00-3416
14-7614
Was the Intermediary's adjustment to disallow accrued bonuses for employees proper?
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 ...
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 base...
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?
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?
2003D23
99-0160
45-0119
Was the Intermediary's determination of available beds for purposes of the disproportionate share payment calculation proper?
2003D22
96-1531, 97-1417; 98-1063
20-0024
Is the Provider entitled to a TEFRA exception?
2003D21
01-0153
06-7201
Was the Intermediary's adjustment to owner's compensation proper?
2003D20
99-4064
52-0089
Was the Intermediary's determination of the TEFRA exception request proper?
2003D19
99-0646
03-5145
Whether the Intermediary properly calculated the Provider's Medicare bad debts?
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.]
2003D12
97-1686
39-7006
Was the Intermediary's adjustment to rent paid by the Provider to a related party proper?
2003D11
00-2451
39-7279
Were the Intermediary's adjustments to physical therapy costs 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?
2003D09
00-3979
17-5185
Was the Intermediary's adjustment disallowing the allocation of general service costs to the ancillary cost centers proper?
2003D08
00-3980
49-5281
Was the Intermediary's adjustment disallowing the allocation of general service costs to the ancillary cost centers proper?
2003D07
00-3976
17-5218
Was the Intermediary's adjustment disallowing the allocation of general service costs to the ancillary cost centers 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 tw...
2003D05
00-3145
05-8017
Was the Intermediary's adjustment of start-up costs proper?
2003D04
01-0320
28-5149
Whether the provider's appeal of bad debts was derived from an intermediary determination or adverse finding?
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 o...
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?
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?
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 Li...
2002D49
98-0489
22-0036
Was the Intermediary's adjustment (denial) of the transitional care unit new provider exemption 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...
2002D47
00-3139; 01-2861
23-0115
Was the Intermediary's denial of the Provider's request for additional payment for decreased discharges proper?
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' refus...
2002D45
97-2659
21-5302
Did the Provider meet the regulatory requirements for approval of the new provider exemption?
2002D44
97-3201
20-0009
Was it proper for the Intermediary to deny the Provider's TEFRA exception request for untimely filing?
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?
2002D42
99-0417
37-5262
Was the Intermediary's methodology used in settling a low utilization cost report proper?
2002D41
99-0286R
31-7062
Was the interest paid on working capital loans from the Friend Center Fund and commercial banks necessary and allowable?
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?
2002D39
97-0403
39-5066
Was the Intermediary's adjustment to Medicare patient days proper?
2002D38
98-1171
06-7239
Was the Intermediary's determination of legal fees 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' physicia...
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 Intermedi...
2002D35
00-3147; 00-3150
23-6554
Did the Intermediary properly adjust the provider's bad debt expense?
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...
2002D33
91-0550G
Various
Was the Intermediary's adjustment to Indirect Medical Education costs proper?
2002D32
00-3418G
Various
Was the Intermediary's adjustment to the non-qualified deferred compensation plan proper?
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?
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?
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 admi...
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 Intermedi...
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 wit...
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...
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...
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?
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...
2002D21
96-1820
44-7442
Was the Intermediary's adjustment to the Provider's cost report to remove legal fees proper?
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?
2002D19
99-0233
13-0024
Was the Intermediary's adjustment to emergency room ("ER") physicians' availability costs proper?
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 ...
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?
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 f...
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-e...
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.
2002D12
00-0479
15-7425
Was the Intermediary's adjustment reclassifying a portion of the Hospice Director's salary proper?
2002D11
98-1968
33-5521
Was the Intermediary's adjustment to unpaid interest expense proper?
2002D10
97-3094
06-7199
Was the Intermediary's adjustment disallowing yellow page advertisement expense 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?
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 whi...
2002D07
98-0490
49-0009
Was the Intermediary's computation of the Provider's graduate medical education cost 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?
2002D04
95-0620
36-0163
Was the Intermediary's adjustment with respect to parking garage revenues 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?
2002D02
97-1280G
Various
Did the Intermediary properly reimburse the Provider for drugs and medical supplies purchased from a related party?
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?
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"...
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 wh...
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...
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?
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 calculati...
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?
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?
2001D47
96-0225
14-7525
Was the compensation paid to HCC's owner reasonable?
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?
2001D44
97-1917
37-7093
Was the Intermediary' adjustment to physical therapy labor costs proper?
2001D43
89-1522R
05-0327
Was the Provider's computation of the self-disallowance amount of investment income offset against interest expense proper?
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?
2001D41
96-0102
17-0001
Did HCFA properly determine that the SNF routine cost limits exception request was not timely filed?
2001D40
97-0843
01-0079
Was the Intermediary's disallowance of the Provider's Medicare Part B bad debts for deductibles and coinsurance proper?
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?
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...
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?
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?
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 reve...
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 o...
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?
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)?
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 use...
2001D30
97-0160
10-4549
Was the Intermediary's adjustments to the Provider's therapy costs proper?
2001D29
97-0159
10-4549
Was the Intermediary's adjustments to the Provider's therapy costs 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 recl...
2001D27
99-0095
26-7262
Was the Intermediary's adjustment to remove excess key employee compensation proper?
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?
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 reclassifica...
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?
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?
2001D22
98-0229
14-7483
Was the Intermediary's adjustment to skilled nursing and HHA visits proper?
2001D21
97-1287
37-0161
Were the Intermediary's adjustments reducing the loss on asset disposal 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?
2001D19
91-1844
05-0457
Did the Intermediary properly adjust outpatient surgery, anesthesia and supply charges?
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?
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 c...
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)
2001D15
94-0463
24-0053
Were the Intermediary's adjustments to SNF routine cost limits 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?
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?
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 withdra...
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?
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 iss...
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?
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?
2001D06
97-0139R
39-5095
Was the Intermediary's reclassification of employment taxes proper?
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?
2001D03
92-1220; 93-0473
05-0025
Was the Intermediary's adjustment to the number of available beds for indirect medical education ad
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
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?
2000D90
97-2601
20-0016
Was the Intermediary's denial of the Provider's request for a sole community hospital decreased volume adjustment proper?
2000D89
97-2390
52-0109
Were the Intermediary's adjustments offsetting investment income related to the sale of HMO stock 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?
2000D87
95-0634
05-0017
Was HCFA's denial of the Provider's routine cost limit (RCL) exception request 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. Wa...
2000D85
96-2085
05-0090
Was the Intermediary's calculation of the Skilled Nursing Facility (SNF) Routine Cost Limits (RCL) 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?
2000D83
Various
Various
Was the Intermediary's inclusion of maintenance treatments in the Provider's cost aportionment statistics for Medicare reimbursement proper?
2000D82
96-2052
52-5504
Was the Intermediary's recalculation of the Provider's gross-up method proper?
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?
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?
2000D79
98-1396G
Various
Was the Intermediary's adjustment to worker's compensation expense proper?
2000D78
98-2068G
05-7470; 55-7643; 55-7625
Was the Intermediary's disallowance of interst expense proper?
2000D77
97-2085
05-7470
Was the Intermediary's disallowance of interest expense proper?
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 revers...
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?
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?
2000D73
94-1477; 94-1520
45-0023
Were the Intermediary's initial, amended and reopening adjustments to interest expense and bond related cost 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?
2000D71
95-1279; 95-1280
13-0037
Were the Intermediary's adjustments disallowing costs associated with the Certified Nurse Anesthetist proper?
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)?
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?
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?
2000D67
94-0654
45-0358
Was the Intermediary's adjustment reclassifying costs related to equipment which was part of a aupply purchase agreement 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?
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?
2000D64
96-0847
24-0106
Was the Intermediary's adjustment offsetting the Provider-paid surcharge (tax) to the Minnesota Medicaid Program 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?
2000D62
92-0668R
34-0113
Did the Intermediary properly reopen the Provider's cost report and recoup an overpayment made to the Provider?
2000D61
96-2534
23-0132
Was the denial of the TEFRA exception request proper?
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 o...
2000D59
96-2619
03-5104
Was the Intermediary's adjustment disallowing indigent Part B bad debts 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'...
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?
2000D55
97-1810
10-7123
Was the Intermediary's adjustment to the Provider's visit statistic 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?
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?
2000D52
96-2570
16-0059
Was the Intermediary's adjustment disallowing the Provider's loss on the sale of its assets proper?
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?
2000D50
96-0918
51-0001
Was the Intermediary's adjustment reclassifying the depreciable assets as "new" capital proper?
2000D49
96-0804
24-0003
Was the Intermediary's adjustment to disallow the Minnesota Care Tax proper?
2000D48
96-0861
24-2004
Was the Intermediary's adjustment to disallow the Minnesota Care Tax 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, whet...
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 adj...
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?
2000D33
97-2391
33-0158
Were the Intermediary's adjustments to the reasonable compensation equivalent ("RCE") limits proper?
2000D32
98-0448
24-0053
Was the Intermediary's disallowance of the physician Part A compensation due to inadequate physician time studies proper?
2000D31
96-2587
34-7021
Was the Intermediary's adjustment disallowing the Provider's employee recruitment expense proper?
2000D30
95-0459
05-0684
Was the Intermediary's elimination of square footage statistics for the fourth floor storage area correct?
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?
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?
2000D27
96-0036
36-0085
Was the Intermediary's adjustment to the outlier payments proper?
2000D26
95-1566
31-0075
Was the Intermediary's failure to apply updated reasonable compensation equivalents limits proper?
2000D25
95-0326
50-0057
Were HCFA's determinations of the Provider's ESRD exception requests proper?
2000D24
94-0302G; 94-0304G
Various
Were the Intermediary's adjustments to the Providers' home office cost statementsproper?
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 be...
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?
2000D21
95-0897
31-0002
Was the Intermediary's failure to apply updated reasonable compensation equivalent limits proper?
2000D20
94-2879
33-3028
Was HCFA's partial denial of the Provider's request for a TEFRA target rate adjustment proper?
2000D19
95-0072
38-0007
Was the Intermediary's or HCFA's determination regarding the Provider's TEFRA exception request proper?
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?
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?
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 adjust...
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?
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?
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 NIC...
2000D12
95-0068
38-0024
Was the Intermediary's or HCFA's determination regarding the Provider's TEFRA exception request 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?
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 an...
2000D09
98-1081
06-7201
Were the Intermediary's adjustments to owners' compensation 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?
2000D07
94-2649
45-0037
1. Was the HHA cafeteria allocation statistic proper?; 2. Were the HHA administrative costs proper?
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?
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?
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?
2000D03
97-2434
05-0109
Did the Intermediary properly implement PRRB Decision No. 96-D35?
2000D02
96-1218
44-0008
Was the Intermediary's reclassification of home health agency costs proper?
2000D01
97-0602
07-7133
Was the Intermediary's adjustment to disallow franchise fees correct?
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 ?
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?
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?
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?
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 ask...
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?
1999D66
98-0211GE
Various
Did the Intermediary properly determine that the Providers had less than 100 "beds" for the fiscal years in question?
1999D65
94-3026
19-7317
Was the Intermediary's adjustment to Worksheet A-8-3 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?
1999D63
94-3180
36-0085
Was the Intermediary's adjustment to the outlier payments proper?
1999D62
96-0122
38-5161
Was the Intermediary's adjustment limiting contracted occupational therapy and speech therapy costs to $104 per hour 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,...
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?
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?
1999D58
95-0308R
05-0235; 55-5046
Was the Intermediary's denial of the Provider's Routine Cost Limit exception proper?
1999D57
95-1188R
050235; 55-5046
Was the Intermediary's denial of the Provider's Routine Cost Limits exception 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?
1999D55
94-2504
04-0022
Were the Intermediary's adjustments disallowing the pass-through of nursing education costs 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?
1999D53
94-1156
39-4023
Was the Intermediary's application of the 1984 Reasonable Compensation Equivalent (RCE) limits 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?
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?
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?
1999D49
93-1505
22-0077
Was the Intermediary's disallowance of Medicare bad debts 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?
1999D47
95-0931
01-0139
Was the Provider's request for an exception to its TEFRA target rate 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?
1999D45
98-0105
23-6616
Was the Intermediary's adjustment to owner's compensation Proper?
1999D44
96-0529
52-5394
Were the Intermediary's adjustments to ancillary cost centers 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?
1999D42
92-0215; 94-0239
05-0226
Was the Intermediary's adjustment to offset investment income earned from a related organization proper?
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 extensio...
1999D40
88-0373
06-0098
Was the DRG amount, other than outlier payments, calculated correctly under Medicare law and PPS regulations?
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?
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"?
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...
1999D36
91-1440
05-0194
Was the Intermediary's adjustment modifying the disproportionate share adjustment amount proper?
1999D35
89-1782R
33-0041
Were the Intermediary's adjustments reclassifying the lease rental costs reported as capital costs 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?
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?
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)
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?
1999D30
93-1376G
Various
Was the Intermediary's classification of the Louisianna franchise tax as an operating cost rather than a capital cost proper?
1999D29
92-0668
34-0113
Did the Intermediary properly reopen the Provider's cost report and recoup an overpayment made to the Provider?
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?
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?
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?
1999D25
94-2452
11-3027
Were the sale and lease of the Provider Transactions between related organations?
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-reimbu...
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?
1999D22
93-1886
05-5837
Is the Provider entitled to the full exception request to the , which is sought from HCFA?
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 b...
1999D20
91-1734
50-0025
Was the Intermediary's adjustment to bad debts proper?
1999D19
95-1242+, 95-1242C
39-0118
Was the Intermediary's determination regarding the Provider's prospective payment system capital rate proper?
1999D18
94-2471
39-0142
Was the Intermediary's methodology for determining physicians'Part A costs (reasonable compensation equivalents) proper?
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?
1999D16
92-1962G
Various
Should the revised Dallas-Fort Worth wage indexes be effective October 1, 1991?
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?
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), insofa...
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...
1999D12
93-0451, 93-1941
44-7425
Was the Intermediary's adjustment of management fees proper?
1999D11
97-0831
40-7014
Was the Intermediary's audit adjustment to durable medidcal equipment ("DME") bad debts 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?
1999D09
94-2203
11-6571
Was the Intermediary's adjustment to bad debt proper?
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 nur...
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?
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?
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?
1999D04
95-0907
31-0073
Was the Intermediary's calculation of the Provider's disproportionate share hospital adjustment proper?
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...
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?
1999D01
93-0824+
18-0124
Was the Intermediary's adjustment toMedicare bad debts proper?
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?
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?
1998D095
97-2589
10-0237
Did the Intermediary improperly reopen the Provider's fiscal year ended ("FYE") september 30, 1001 cost report? adjustment to
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?
1998D093
92-0591
16-0083
Was the Intermediary's allowcation of the Provider's physician billing costs proper?
1998D092
95-0303
05-4078
Was the Intermediary's adjustment to the property tax expense proper?
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?
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 ...
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 aver...
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...
1998D087
97-0682G
Various
Were the Intermediary's adjustments to occupational and speech therapy costs 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?
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?
1998D084
96-0066G
Various
Was the Intermediary's inclusion of neonatal intensive care unit ("NICU") beds in the indirect medical education ("IME") calculation 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?
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?
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?
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?
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?
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?
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?
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?
1998D075
88-1339
10-0060
Did the Intermediary correctly apply the lower of cost or charge limit?
1998D074
93-0513
11-0198
Was the Intermediary's elimination of space rental 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?
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 installatio...
1998D071
95-2007
05-0457
Was the Intermediary's refusal to reopen the Provider's cost report an abuse of discretion?
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?
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?
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...
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?
1998D066
94-0070
36-0054
Does the Provider meet the criteria for receiving disproportionate share payments based on application of undisputed facts?
1998D065
96-1352; 96-1353
14-7472
Were the Intermediary's adjustments to disallow legal fees deemed not related to patient care proper?
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?
1998D063
96-0535
18-0127
Were the Intermediary's adjustments to Medicare bad debts proper?
1998D062
94-3278
23-0132
Was the denial of the TEFRA exception request 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 ...
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?
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?
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?
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?
1998D056
93-0509
05-0381
Was the Intermediary's refusal to reopen the Provider's cost reports an abuse of discretion?
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 depr...
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?
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 ...
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...
1998D048
97-0050G
Various
Did the Intermediary properly adjust the Provider's occupational and speech therapy costs?
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?
1998D046
92-1582
39-6563
Was the Intermediary's adjustment to the Provider's reasonable costs proper?
1998D045
92-0507
05-0457
Did the Intermediary properly adjust outpatient surgery, anesthesia and supply charges?
1998D044
96-0320
14-7273
Was the Intermediary's adjustment reducing allowable owner's compensation correct?
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?
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?
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)?
1998D039
97-0111G; 97-0112G
Various
Were the Intermediary's adjustments to occupational therapy and speech therapy costs 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?
1998D037
93-0145
52-0091
Was the Intermediary's denial of sole community status under 42 C.F.R. Section 412.92 proper?
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?
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?
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 Intermedia...
1998D033
95-2125
53-7025
Did the Intermediary properly disallow a portion of the owner's compensation?
1998D032
95-0495
39-0181
Was the Intermediary's adjustment disallowing the Provider's claimed loss on disposal proper?
1998D031
91-2986M
33-0153
Were the Intermediary's adjustments made foe graduate medical education (GME) settlement purposes proper?
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?
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 M...
1998D025
95-0308
05-0235
Was the Intermediary's denial of the Provider's Routine Cost Limit exception proper?
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?
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?
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?
1998D021
89-2023
05-0179
Was the Intermediary's adjustment to the amortization of the loss on the sale of Turlock Community Hospital 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?
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?
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?
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?
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?
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?
1998D014
92-0430
10-5201
Was the Health Care Financing Administration's (HCFA) denial of the Provider's exception request proper?
1998D013
96-2058
10-5883
Is the Provider exempt from the skilled nursing facility ("SNF") routine cost limits as a "new provider"?
1998D012
86-0429
05-0289
Was the Intermediary's denial of the full TEFRA incentive payment to the Provider proper?
1998D011
95-0380
52-6514
Was the Intermediary's modification of cost reporting form 2088-79 for the calculation of reimbursable cost 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?
1998D009
92-1679
39-0142
Was the Intermediary's application of the 1984 Reasonable Compensation Equivalent (RCE) limits proper?
1998D008
91-2866M
33-0214
Were the Intermediary's adjustments to the graduate medical education ("GME") base year costs proper?
1998D007
94-3386
33-7243
Was the Intermediary's adjustment reversing the direct assignment of the New York sub-unit costs proper?
1998D006
93-0228
24-0053
Did the Intermediary properly disallow the physician's Part A compensation?
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?
1998D004
91-1441
06-0015
Was the Intermediary's adjustment reclassifying air ambulance lease rental payments from capital costs to operating expenses 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?
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?
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 medica...
Page Last Modified:
09/06/2023 04:57 PM