Various provisions governing Medicare Part A provider reimbursement determinations, appeals before the intermediary hearing officers and the Provider Reimbursement Review Board (PRRB), and CMS Administrator review of PRRB decisions will become effective August 21, 2008, under a Final rule published by CMS on May 23, 2008.
Cost reporting. Under amendments to 42 C.F.R. §§405.1811(a)(1) and 405.1835(a)(1), effective for cost reporting periods ending on or after December 31, 2008, providers will have more time to evaluate whether they wish to file a cost report item under protest and eliminate the transitional administrative burden for intermediaries. Providers filing cost report items under protest will be required to explain their dissatisfaction with the amount of Medicare payment for the specific items at issue by stating why Medicare payment is incorrect for each disputed item. The regulatory amendments allow a provider to explain why it is unable to determine whether payment is correct as a result of not having access to underlying information.
Common ownership or control. A new §405.1835(b)(4) has been added to require a provider under common ownership or control to furnish the name and address of its parent corporation and submit a statement that, to the best of the provider's knowledge, no other provider to which it is related by common ownership or control has pending a request for a PRRB hearing on any of the same issues contained in the provider's hearing request. If a pending appeal exists, the provider must submit the provider name and provider number, as well as the case number for the appeal.
Appeal period. The method for determining the beginning and end of a specific appeal period has been clarified by amended definitions for the “date of receipt” for any documents received by a reviewing entity, party, or interested nonparty. At this time, the Office of Hearings is not able to implement an electronic docket, but such a system may be implemented in the future.
Providers of services. Hospitals, critical access hospitals, skilled nursing facilities, comprehensive outpatient rehabilitation facilities, home health agencies, and hospice programs will be recognized as “providers of services” for Medicare Part A reimbursement determinations and appeals under the amended 45 C.F.R. §405.1801(b)(1). Rural health clinics and federally qualified health centers will be recognized as Medicare providers under §1878(j) of the Social Security Act, and end stage renal disease facilities will be recognized as providers under §1881(b)(2)(D). Any other entity recognized as a provider under the Act also will be recognized as a provider for purposes of reimbursement determinations and appeals.
Other changes. The Final rule also addresses changes to group appeals, expedited judicial review, administrator review, the Children's Health Graduate Medical Education Program, and information collection.
Final rule, 73 FR 30190, May 23, 2008, Health Care Compliance Reporter ¶700,067.
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