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 |
|---|---|---|---|
15-2868
|
14-0150
|
Whether the Medicare Contractor ("Medicare Contractor") determined the Medicare reimbursement of the operating and capital outliers, and the corresponding time value of money ("TVM"), through the outlier reconciliation process properly. This issue relate...
|
|
19-1917
|
18-4012
|
Whether the Elizabethtown Core Based Statistical Area ("CBSA") 21060 Wage Index was correctly established for Medicare payments made to the Provider during its fiscal year ending April 30, 2017.
|
|
21-0412
|
05-0254
|
Whether the Centers for Medicare & Medicaid Services ("CMS") properly determined that the federal fiscal year ("FFY") 2021 payment update to the inpatient prospective payment system ("IPPS") for the hospital should be reduced by one fourth because the hos...
|
|
17-1027
|
17-1358
|
Whether the Medicare Contractor properly disallowed the allocated related party costs claimed by Lindsborg Community Hospital ("Provider" or "Lindsborg") for fiscal year ("FY") 2015.
|
|
21-0266GC
|
49-4010; 49-4021
|
Whether the Medicare Contractor's decision to disallow all professional costs for the Providers' fiscal years ("FYs") 2016 and 2017 was proper, given the Providers are teaching hospitals.
|
|
16-2591
|
15-0011
|
Whether the Medicare Contractor properly calculated the volume decrease adjustment ("VDA") owed to Marion General Hospital ("Marion General" of the "Provider") for the significant decrease in inpatient discharges that occurred in its cost reporting period...
|
|
22-0953
|
15-3045
|
Whether the Community Stroke and Rehabilitation Center ("Community Stroke" or "Provider") should be subject to a two (2) percentage point reduction to its federal fiscal year 2022 inpatient rehabilitation facility annual payment update ("APU") for failure...
|
|
19-0263
|
24-0166
|
Whether the Medicare Contractor properly calculated the volume decrease adjustment ("VDA") owed to Mayo Clinic Health System - Fairmont ("Mayo Clinic Fairmont" or "Provider") for the significant decrease in inpatient discharges that occurred in its cost r...
|
|
18-0120
|
18-0038
|
Whether the Medicare Contractor properly calculated the volume decrease adjustment ("VDA") owed to Owensboro Health Regional Hospital ("Owensboro Health" or the "Provider") for the significant decrease in inpatient discharges that occurred during its fisc...
|
|
17-1846
|
49-0069
|
1. Whether the Provider is entitled to receive reimbursement for its Medicare Managed Care ("Medicare Part C") costs incurred through its nursing and allied health ("NAH") program, based on the requirements in 42 C.F.R. § 413.87, when the Provider submit...
|
|
19-2081, 21-1783
|
36-0041
|
Did the Medicare Contractor properly determine the Provider's Per Resident Amount ("PRA") for fiscal year ending December 31, 2016 ("FY 2016")?
|
|
14-2534
|
43-0012
|
Whether the Medicare Contractor appropriately made adjustments, which eliminated pass-through reimbursement of Avera Sacred Heart Hospital's ("Avera" or "the Provider") Nursing Education costs for fiscal year ("FY") 2010, pursuant to 42 C.F.R. § 413.85(g...
|
|
21-1676
|
45-2061
|
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 two percentage po...
|
|
19-0124
|
05-0435
|
Whether Fallbrook District Hospital (the "Provider") is entitled to a volume decrease adjustment ("VDA") for the significant decrease in inpatient discharges that occurred in its cost reporting period ending June 30, 2015 ("FY 2015").
|
|
17-1313
|
05-0435
|
Whether Fallbrook District Hospital (the "Provider") is entitled to a volume decrease adjustment ("VDA") for the significant decrease in inpatient discharges that occurred in its cost reporting period ending June 30, 2014 ("FY 2014").
|
|
17-1243
|
33-0250
|
Whether the Medicare Contractor properly calculated the volume decrease adjustment ("VDA") owed to Champlain Valley Physicians Hospital ("Champlain Valley" or the "Provider") for the significant decrease in inpatient discharges that occurred during its fi...
|
|
17-1252
|
33-0250
|
Whether the Medicare Contractor properly calculated the volume decrease adjustment ("VDA") owed to Champlain Valley Physicians Hospital ("Champlain Valley" or the "Provider") for the significant decrease in inpatient discharges that occurred during its fi...
|
|
17-1312
|
39-0084
|
Whether the Medicare Administrative Contractor, Wisconsin Physicians Service ("WPS"), properly calculated the volume decrease adjustment owed to Sunbury Community Hospital ("Sunbury" or "Provider") for the significant decrease in inpatient discharges that...
|
|
18-0547
|
33-0276
|
Whether the Medicare Contractor properly calculated the volume decrease adjustment ("VDA") owed to Nathan Littauer Hospital ("Nathan Littauer" or the "Provider") for the significant decrease in inpatient discharges that occurred during its cost reporting ...
|
|
17-0004
|
33-0276
|
Whether the Medicare Contractor properly calculated the volume decrease adjustment ("VDA") owed to Nathan Littauer Hospital ("Nathan Littauer" or the "Provider") for the significant decrease in inpatient discharges that occurred during its cost reporting ...
|
|
16-2145
|
33-0276
|
Whether the Medicare Contractor properly calculated the volume decrease adjustment ("VDA") owed to Nathan Littauer Hospital ("Nathan Littauer" or the "Provider") for the significant decrease in inpatient discharges that occurred during its cost reporting ...
|
|
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 ...
|
|
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...
|
|
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.
|
|
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").
|
|
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...
|
|
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...
|
|
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...
|
|
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.
|
|
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 ...
|
|
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...
|
|
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.
|
|
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...
|
|
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...
|
|
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.
|
|
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...
|
|
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...
|
|
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.
|
|
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...
|
|
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...
|
|
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.
|
|
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.
|
|
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.
|
|
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.
|
|
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.
|
|
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...
|
|
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").
|
|
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 ("...
|
|
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").
|
|
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.
|
|
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 ...
|
|
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").
|
|
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...
|
|
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...
|
|
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").
|
|
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...
|
|
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?
|
|
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...
|
|
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...
|
|
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...
|
|
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...
|
|
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...
|
|
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...
|
|
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...
|
|
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").
|
|
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").
|
|
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.
|
|
14-0643
|
32-0006
|
Whether the Provider is entitled to a volume decrease adjustment ("VDA") payment for a sole community hospital ("SCH").
|
|
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...
|
|
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...
|
|
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.
|
|
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...
|
|
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...
|
|
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...
|
|
16-2233
|
15-0030
|
Whether the Provider is entitled to receive a volume decrease adjustment ("VDA") for a Medicare dependent hospital ("MDH").
|
|
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...
|
|
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...
|
|
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").
|
|
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").
|
|
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.
|
|
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...
|
|
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...
|
|
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...
|
|
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").
|
|
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...
|
|
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...
|
|
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...
|
|
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.
|
|
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...
|
|
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...
|
|
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...
|
|
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...
|
|
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?
|
|
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").
|
|
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").
|
|
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").
|
|
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 (...
|
|
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.
|
|
17-1612
|
37-0030
|
Whether the Provider is entitled to a Volume Decrease Adjustment ("VDA") for Fiscal Year End ("FYE") 03/31/2012.
|
|
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...
|
|
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...
|
|
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...
|
|
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").
|
|
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 ...
|
|
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...
|
|
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...
|
|
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 ...
|
|
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...
|
|
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...
|
|
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...
|
|
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...
|
|
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...
|
|
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...
|
|
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 ...
|
|
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...
|
|
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...
|
|
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...
|
|
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...
|
|
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").
|
|
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").
|
|
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").
|
|
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.
|
|
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...
|
|
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...
|
|
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...
|
|
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.
|
|
19-2078
|
14-1694
|
Whether the Medicare Contractor used the correct number of Medicare beneficiaries in calculating the Cap Year 2018 Hospice Cap.
|
|
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...
|
|
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").
|
|
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").
|
|
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.
|
|
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.
|
|
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.
|
|
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.
|
|
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...
|
|
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.
|
|
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").
|
|
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").
|
|
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").
|
|
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").
|
|
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").
|
|
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").
|
|
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").
|
|
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.
|
|
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.
|
|
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...
|
|
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...
|
|
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).
|
|
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.
|
|
13-0394
|
19-2037
|
Whether the Medicare Contractor's adjustment to the outlier reconciliation adjustment determination was proper.
|
|
16-1155
|
38-0002
|
Whether the contractor was correct in calculating the Provider's Sole Community Hospital Volume Decrease Adjustment.
|
|
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.
|
|
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.
|
|
08-2236GC, 09-1414GC, 10-1019GC, 11-0106GC
|
Various
|
Whether the Providers' Medicare bad debts pending at outside collection agencies are allowable.
|
|
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, ...
|
|
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.
|
|
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.
|
|
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...
|
|
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.
|
|
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...
|
|
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...
|
|
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.
|
|
16-2515
|
50-0072
|
Whether the Medicare Contractor was correct in calculating the Provider's Sole Community Hospital ("SCH") Volume Decrease Adjustment ("VDA").
|
|
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...
|
|
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...
|
|
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?
|
|
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.
|
|
14-4128
|
37-0002
|
The sole disputed issue in this appeal is the methodology used to calculate the Volume Decrease Adjustment ("VDA") payment.
|
|
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...
|
|
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...
|
|
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.
|
|
17-1827
|
34-0151
|
The sole disputed issue in this appeal is the methodology used to calculate the Volume Decrease Adjustment (“VDA”) payment.
|
|
17-1826
|
34-0151
|
The sole disputed issue in this appeal is the methodology used to calculate the Volume Decrease Adjustment (“VDA”) payment.
|
|
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...
|
|
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 (...
|
|
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...
|
|
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.
|
|
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....
|
|
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 ...
|
|
17-1878
|
11-0032
|
The sole issue in this appeal is the methodology used to calculate the Volume Decrease Adjustment ("VDA") payment.
|
|
17-1879
|
11-0032
|
The sole disputed issue in this appeal is the methodology used to calculate the Volume Decrease Adjustment ("VDA") payment.
|
|
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.
|
|
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.
|
|
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.
|
|
17-1392
|
23-0092
|
Did the Medicare Contractor properly calculate the per-resident amount ("PRA") for Medicare payment of direct graduate medical education ("DGME")?
|
|
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...
|
|
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.
|
|
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 ...
|
|
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...
|
|
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.
|
|
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...
|
|
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.
|
|
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.
|
|
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.
|
|
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...
|
|
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...
|
|
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...
|
|
18-0508
|
36-0245
|
Whether the fiscal year ("FY") 2018 penalty imposed under the hospital inpatient quality reporting ("IQR") program was proper.
|
|
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.
|
|
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...
|
|
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...
|
|
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.
|
|
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.
|
|
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...
|
|
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.
|
|
18-0460
|
45-0152
|
Whether the payment penalty under the Hospital Inpatient Quality Reporting Program was properly applied to the Provider.
|
|
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...
|
|
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.
|
|
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 (...
|
|
13-1053
|
45-0044
|
Whether the Medicare Contractor's audit adjustments to remove Medicare Usable Organs (Heart & Kidney) were fair and proper.
|
|
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.
|
|
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...
|
|
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...
|
|
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.
|
|
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...
|
|
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?
|
|
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.
|
|
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?
|
|
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 ...
|
|
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?
|
|
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...
|
|
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...
|
|
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...
|
|
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.
|
|
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...
|
|
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?
|
|
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...
|
|
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...
|
|
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.
|
|
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?
|
|
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?
|
|
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.
|
|
17-1253
|
23-3026
|
Whether the Provider is entitled to the full market basket update for Fiscal Year (“FY”) 2017.
|
|
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.
|
|
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.
|
|
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”...
|
|
17-0564
|
16-0001
|
Whether the Provider is entitled to the full Market Basket Update for the fiscal year (?FY?) 2017.
|
|
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?
|
|
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...
|
|
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?
|
|
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...
|
|
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.
|
|
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.
|
|
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...
|
|
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.
|
|
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?
|
|
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?
|
|
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?) ...
|
|
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...
|
|
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 ...
|
|
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 ...
|
|
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...
|
|
11-0142
|
19-4653
|
Was the Medicare Contractor’s adjustment to the Provider’s bad debts claimed proper?
|
|
09-0233
|
19-4653
|
Was the Medicare Contractor’s adjustment to the Provider’s bad debts claimed proper?
|
|
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?
|
|
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...
|
|
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.
|
|
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.
|
|
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.
|
|
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 ...
|
|
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.
|
|
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...
|
|
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...
|
|
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...
|
|
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...
|
|
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 ...
|
|
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 ...
|
|
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.
|
|
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?
|
|
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...
|
|
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...
|
|
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).
|
|
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...
|
|
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...
|
|
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...
|
|
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...
|
|
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...
|
|
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...
|
|
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.
|
|
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...
|
|
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 ...
|
|
10-1018GC
|
Various
|
Whether the Providers can claim Medicare and Medicaid crossover bad debts for reimbursement without billing the appropriate state agency.
|
|
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...
|
|
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...
|
|
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...
|
|
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?
|
|
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).
|
|
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.
|
|
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.
|
|
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.
|
|
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...
|
|
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?
|
|
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?
|
|
13-1012
|
16-0016
|
Whether Trinity Regional Medical Center (?Trinity? or ?Provider?) was entitled to a Volume Decrease Adjustment (?VDA?)?
|
|
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?
|
|
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?
|
|
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.
|
|
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.
|
|
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.
|
|
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.
|
|
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.
|
|
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.
|
|
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...
|
|
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.
|
|
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")...
|
|
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...
|
|
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)?
|
|
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 (...
|
|
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...
|
|
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.
|
|
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...
|
|
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.
|
|
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?
|
|
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...
|
|
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.
|
|
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?
|
|
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")?
|
|
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.
|
|
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...
|
|
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...
|
|
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 ("...
|
|
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")?
|
|
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")?
|
|
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")?
|
|
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...
|
|
08-0143 and 09-0403
|
33-0044
|
Whether the Medicare Contractor's adjustment to Faxton - St. Luke's Medicare bad debts was proper?
|
|
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 ...
|
|
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...
|
|
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?
|
|
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 ...
|
|
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...
|
|
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.
|
|
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.
|
|
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?
|
|
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...
|
|
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...
|
|
09-1754
|
15-0017
|
Whether the Medicare Contractor's adjustment to remove time for off-site rotations was proper?
|
|
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?
|
|
09-1704
|
02-0012
|
Whether the Medicare Contractor's calculation of the Provider's low volume adjustment amount was determined correctly.
|
|
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?
|
|
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?
|
|
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...
|
|
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...
|
|
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.
|
|
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?
|
|
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")...
|
|
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...
|
|
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?
|
|
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 ...
|
|
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.
|
|
08-0050
|
27-1335
|
Whether the Medicare Administrative Contractor's disallowance of the Provider's certified registered nurse anesthetist on-call costs was proper.
|
|
08-1929GC; 09-0510GC; 11-0568GC
|
Various
|
Whether the Intermediary properly applied the weighted discharge cap to the Providers' ancillary costs.
|
|
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...
|
|
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...
|
|
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.
|
|
08-0496
|
19-4650
|
Was the Intermediary's adjustment to the allocation of the Provider's cost proper?
|
|
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 ...
|
|
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...
|
|
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.
|
|
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...
|
|
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.
|
|
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.
|
|
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...
|
|
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...
|
|
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?
|
|
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?
|
|
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?
|
|
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?
|
|
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...
|
|
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?
|
|
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?
|
|
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...
|
|
12-0144
|
31-0031
|
Whether CMS improperly denied the Provider's request to be reclassified as a rural hospital.
|
|
07-2006GC
|
39-5680, 39-5047 and 39-5409
|
Whether the Intermediary's exclusion of unbilled crossover bad debts was proper.
|
|
07-2069
|
39-5110
|
Whether the Intermediary's adjustment to disallow Medicare Bad Debts on the Medicare Cost Report was proper.
|
|
11-0010
|
25-1627
|
Notice of Effect of Inpatient Day Limitation and Hospice Cap Amount
|
|
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.
|
|
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...
|
|
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 § ...
|
|
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...
|
|
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?
|
|
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.
|
|
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?
|
|
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...
|
|
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.
|
|
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...
|
|
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?
|
|
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...
|
|
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?
|
|
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?
|
|
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.
|
|
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.
|
|
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?
|
|
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?
|
|
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.
|
|
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?
|
|
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?
|
|
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)(...
|
|
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.
|
|
02-1305
|
39-0097
|
Whether the Intermediary's adjustment disallowing therapy services claims pursuant to a comprehensive medical review was proper?
|
|
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)(...
|
|
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.
|
|
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?
|
|
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.
|
|
09-0234
|
23-2553
|
Whether CMS' denial of the Provider's request for an exception to the ESRD composite rate was proper?
|
|
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...
|
|
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.
|
|
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...
|
|
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 ...
|
|
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.
|
|
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.
|
|
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).
|
|
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.
|
|
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.
|
|
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...
|
|
08-0105GC
|
44-0176; 44-0063
|
Whether the Intermediary's adjustments to remove Medicare bad debts from the Providers' cost reports were proper?
|
|
11-0570
|
20-0050
|
Was Maine Coast Memorial Hospital's request to be designated as a Sole Community Hospital properly denied?
|
|
11-0160
|
10-4993
|
Whether the Intermediary properly removed total costs and total payments.
|
|
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.
|
|
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...
|
|
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 ...
|
|
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.
|
|
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.
|
|
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)...
|
|
08-1580; 10-0178; 10-0179
|
22-2006
|
Whether the allocation of the physician costs between Part A and Part B was proper.
|
|
97-2425R
|
05-0455
|
Whether the Secretary's failure to reclassify costs in the peer group construction was arbitrary, capricious or plainly erroneous?
|
|
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.
|
|
02-0387GC
|
Various
|
Whether the Intermediary's adjustments to the Laundry and Linen and the Central Service and Supply statistics were proper.
|
|
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...
|
|
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...
|
|
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?
|
|
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.
|
|
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.
|
|
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 ...
|
|
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.
|
|
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.
|
|
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.
...
|
|
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...
|
|
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...
|
|
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?
|
|
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 ...
|
|
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...
|
|
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.
|
|
09-0957
|
23-0021
|
Whether the Intermediary's disallowance of Medicare bad debts that had been referred to an outside collection agency was proper.
|
|
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...
|
|
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...
|
|
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.
|
|
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...
|
|
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.
|
|
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.
|
|
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.
|
|
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?
|
|
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.
|
|
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 ...
|
|
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 ...
|
|
07-0522
|
50-1312
|
Whether the Intermediary's adjustment to the Provider's ambulance service rates was proper.
|
|
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) ...
|
|
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...
|
|
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.
|
|
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...
|
|
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.
|
|
06-2319
|
06-0009
|
Whether the Intermediary properly disallowed the Provider's entire Medicare disproportionate share hospital (DSH) payment.
|
|
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.
|
|
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.
|
|
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...
|
|
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?
|
|
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...
|
|
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.
|
|
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.
|
|
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.
|
|
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.
|
|
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.
|
|
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.
|
|
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...
|
|
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...
|
|
05-1032; 06-1173
|
09-0001
|
Whether the Intermediary properly extrapolated the sample error rate to the population in adjusting Medicaid eligible days.
|
|
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.
|
|
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?
|
|
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.
|
|
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...
|
|
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.
|
|
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.
|
|
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.
|
|
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...
|
|
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.
|
|
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...
|
|
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.
|
|
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.
|
|
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.
|
|
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.
|
|
08-0298G
|
Various
|
Whether the Intermediary's adjustments to the Providers' Medicare bad debts were proper.
|
|
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...
|
|
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...
|
|
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...
|
|
Various
|
Various
|
Whether Medicare Choice (M C) days should be included in the Medicaid fraction used to calculate the disproportionate share hospital (DSH) adjustment.
|
|
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...
|
|
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...
|
|
10-0056
|
37-1635
|
Whether the amount in controversy requirement under 42 C.F.R. Section 405.1835 is satisfied.
|
|
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...
|
|
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).
|
|
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.
|
|
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...
|
|
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.
|
|
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'...
|
|
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 ...
|
|
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...
|
|
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...
|
|
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...
|
|
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...
|
|
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...
|
|
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...
|
|
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.
|
|
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...
|
|
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.
|
|
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?
|
|
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 ...
|
|
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...
|
|
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?
|
|
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.
|
|
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...
|
|
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...
|
|
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.
|
|
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...
|
|
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.
|
|
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.
|
|
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?
|
|
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.
|
|
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...
|
|
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...
|
|
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...
|
|
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...
|
|
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?
|
|
05-0828
|
10-0061
|
Whether the provider has a right to hearing on correction of its cost report to reclassify certain nurse expenses.
|
|
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?
|
|
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.
|
|
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...
|
|
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.
|
|
00-3325
|
05-0146; 05-7037
|
Whether the Provider timely filed its Tax Equity and Fiscal Responsibility Act (TEFRA) exception request.
|
|
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...
|
|
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 ...
|
|
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.
|
|
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.
|
|
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.
|
|
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?
|
|
06-1078G; 06-1079G
|
Various
|
Whether the Intermediary's adjustments to the Provider's reimbursable capital costs after denying "new hospital" status was proper.
|
|
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.
|
|
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.
|
|
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.
|
|
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.
|
|
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...
|
|
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...
|
|
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.
|
|
06-1080G; 06-1081G
|
Various
|
Whether the Intermediary"s adjustments to the Provider's reimbursable capital cost after denying "new hospital" status was proper.
|
|
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 ...
|
|
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...
|
|
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.
|
|
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)...
|
|
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.
|
|
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.
|
|
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.
|
|
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.
|
|
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).
|
|
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.
|
|
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...
|
|
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.
|
|
99-0584R (on Remand)
|
39-0080
|
Whether the Jeanes Hospital merger was a bona fide sale.
|
|
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.
|
|
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.
|
|
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...
|
|
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.
|
|
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 ...
|
|
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?
|
|
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...
|
|
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.
|
|
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...
|
|
02-0488; 03-1001
|
05-4144
|
Whether the Intermediary's determination of the Provider's direct graduate medical education (DGME) payment was proper.
|
|
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...
|
|
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...
|
|
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,...
|
|
07-1153
|
27-1325
|
Whether the Intermediary's disallowance of the Provider's certified registered nurse anesthetist (CRNA) on-call costs was proper.
|
|
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.
|
|
05-1420G
|
Various
|
Whether the Intermediary's adjustment to utilization review costs was proper.
|
|
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.
|
|
06-1300; 06-1301; 06-1307
|
03-0103
|
Whether the Intermediary used proper cost to charge ratios in calculating the Provider's outlier payments.
|
|
04-1915
|
03-0023
|
Whether the Intermediary properly calculated and applied the Provider's ambulance cost per trip limit.
|
|
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)(...
|
|
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...
|
|
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.
|
|
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.
|
|
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.
|
|
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?
|
|
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...
|
|
06-0614
|
23-0097
|
Whether the Intermediary correctly limited the Provider's ambulance reimbursement to its charges.
|
|
06-0987
|
27-1328
|
Whether the Intermediary's adjustment to Certified Registered Nurse Anesthetist (CRNA) cost was proper.
|
|
00-1456
|
39-0098
|
Whether the Intermediary's adjustments disallowing the loss on disposal of depreciable assets through consolidation were proper.
|
|
00-1454
|
39-0067
|
Whether the Intermediary's adjustments disallowing the loss on disposal of depreciable assets through consolidation were proper.
|
|
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...
|
|
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.
|
|
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...
|
|
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...
|
|
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...
|
|
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...
|
|
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.
|
|
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...
|
|
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...
|
|
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.
|
|
05-1219
|
17-1302
|
Was the Intermediary's adjustment to the provider's claimed owner's compensation proper?
|
|
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.
|
|
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.
|
|
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.
|
|
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...
|
|
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...
|
|
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...
|
|
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.
|
|
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.
|
|
01-0801
|
14-0174
|
Whether the Intermediary's adjustment disallowing the loss on disposal of depreciable assets through consolidation was proper.
|
|
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.
|
|
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 ...
|
|
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?
|
|
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?
|
|
00-1904G
|
Various
|
Whether the Intermediary's calculation of the disproportionate share hospital (DSH) payment was proper.
|
|
04-1491; 04-1495; 04-1496
|
18-0080
|
Whether the Intermediary properly adjusted Medicare bad debts accounts considered indigent by the Provider.
|
|
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...
|
|
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.
|
|
03-0811
|
04-0091
|
Whether the Provider's Disproportionate Share Hospital (DSH) adjustment was correctly calculated.
|
|
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...
|
|
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...
|
|
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.
|
|
06-1478
|
31-5381
|
Whether the Intermediary properly adjusted Medicare bad debts.
|
|
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.
|
|
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...
|
|
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...
|
|
05-0686
|
15-0011
|
Whether the recission of the hospital's approved request for Sole Community Hospital (SCH) status was proper.
|
|
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 ...
|
|
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...
|
|
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...
|
|
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...
|
|
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...
|
|
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...
|
|
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...
|
|
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...
|
|
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...
|
|
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...
|
|
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...
|
|
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).
|
|
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...
|
|
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...
|
|
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...
|
|
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?
|
|
96-2468
|
05-0279
|
Whether the Intermediary's determination of non-allowable physician office and vacant space costs was proper.
|
|
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...
|
|
04-1341; 04-1369
|
65-0001
|
Whether the Intermediary's adjustment disallowing the Provider's claimed withholding tax expense was proper.
|
|
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.
|
|
03/0759
|
22-0089
|
Whether the Provider's Notice of Program Reimbursement (NPR) dated September 24, 2002 was an original or a revised NPR.
|
|
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.
|
|
04-0823
|
35-0070
|
Whether the Provider is entitled to Transitional Outpatient Payments (TOPs).
|
|
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...
|
|
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).
|
|
00-1081
|
08-0003
|
Whether the Intermediary's application of the reasonable compensation equivalent (RCE) limits was proper.
|
|
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...
|
|
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)
|
|
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.
|
|
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 ...
|
|
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).
|
|
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 ...
|
|
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.
|
|
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.
|
|
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).
|
|
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...
|
|
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.
|
|
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.
|
|
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.
|
|
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.
|
|
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.
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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.
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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...
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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.
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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...
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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).
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00-2803
|
52-0174
|
Whether the Intermediary's determining disallow post-retirement health benefits costs for a terminated provider was proper.
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01-3521G
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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.
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|
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...
|
|
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...
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03-0513; 04-0456
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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...
|
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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...
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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.
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06-0110G; 06-0111G
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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?
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|
03-1199G
|
Various
|
Whether the Intermediary should include all MediKan patient days, primary and secondary, in the Providers' disproportionate share hospital (DSH) calculation.
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|
01-2214
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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.
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|
01-0654; 02-0235
|
01-7009
|
Whether the relevant claims were timely filed by Alacare under 42 C.F.R. Section 424.44.
|
|
03-0268; 03-0269
|
05-0045
|
Whether the Intermediary's adjustments disallowing the Provider's regular Medicare bad debts were proper.
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|
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 ...
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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.
|
|
02-2080
|
45-0688
|
Whether the Intermediary's determination of allowable Medicare bad debts based upon collection effort was proper.
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|
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.
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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.
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|
00-1836
|
21-7134
|
Whether the Intermediary's adjustment to disallow the cost of accrued compensatory time was proper.
|
|
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 ...
|
|
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...
|
|
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 ...
|
|
97-2446
|
05-0597
|
Whether the Intermediary's determination of reimbursable Medicare bad debts for beneficiaries without Medicaid eligibility (non-crossover beneficiaries) was proper.
|
|
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.
|
|
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.
|
|
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...
|
|
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...
|
|
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...
|
|
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.
|
|
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.
|
|
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.
|
|
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...
|
|
97-0174
|
16-0024
|
Was the Intermediary's disallowance of the loss on disposal of assets resulting from a merger proper?
|
|
03-0895
|
34-0168
|
Whether the Intermediary's disallowance of Medicare bad debts claimed by the Provider was justified.
|
|
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.
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|
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.
|
|
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...
|
|
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.
|
|
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.
|
|
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.
|
|
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...
|
|
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.
|
|
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.
|
|
98-2103; 99-1746; 00-2563; 03-0127; 03-048 |