News & Analysis as of

Provider Reimbursement Review Board

D.C. District Court Upholds CMS’s Predicate Fact Three-Year Reopening Limitation

by King & Spalding on

On March 10, 2017, Judge John Bates of the U.S. District Court for the District of Columbia upheld CMS’s three-year cost report reopening limitation, as applied to “predicate fact” determinations. The regulation at issue is...more

It Ain't Over 'Till It's Over – First Circuit Rejects Settlement Agreements Between Providers and Intermediary and Upholds Cost...

by Baker Ober Health Law on

On October 27, 2016, a three-judge panel for the United States Court of Appeals for the First Circuit issued an opinion concluding that a Medicare fiscal intermediary (Intermediary) does not have the authority to enter into a...more

D.C. District Court Bucks the Trend and Rules for Hospital in Provider Tax Case

by Baker Ober Health Law on

Many states assess taxes against hospitals and other providers as a means of funding their Medicaid and other healthcare-related programs. The revenue generated by the taxes is used, with CMS’s approval, to fund Medicaid...more

Court Rules in Favor of Hospitals in Bad Debt Collection Effort

by Baker Ober Health Law on

On July 25, 2016, the United States District Court for the District of Columbia issued an opinion favoring provider flexibility in the reasonable collection of Medicare bad debt. Winder HMA, LLC, et al. v. Sylvia Burwell. The...more

D.C. District Ct Applies Prohibition on Administrative and Judicial Review to IRF PPS Rates

by Baker Ober Health Law on

On July 25, 2016, Judge John D. Bates of the United States District Court for the District of Columbia issued a memorandum opinion broadly construing 42 U.S.C. § 1395ww(j) to prohibit administrative or judicial review of a...more

D.C. District Court Invalidates CMS’s “Protest” Requirement

by King & Spalding on

On August 19, 2016, the United States District Court for the District of Columbia granted a group of hospitals’ motion for summary judgment against HHS in a challenge of the Provider Reimbursement Review Board’s (PRRB) denial...more

The Bad Debt Moratorium Requires a Flexible Approach to Evaluating "Reasonable Collection Efforts"

by Baker Ober Health Law on

On September 10, 2015, District Judge Randolph D. Moss of the U.S. District Court for the District of Columbia issued an opinion in Mountain States Health Alliance v. Burwell (Mountain States) involving Section 310 of the...more

D.C. District Court Holds that CMS’s Rigid Application of the “Similar Collection Efforts” Requirement Violates the Bad Debt...

by King & Spalding on

In a case of first impression in the U.S. District Court for the District of Columbia, brought by King & Spalding on behalf of Mountain States Health Alliance, the court held that CMS’s disallowance of certain Medicare bad...more

Ministry Motivation Costs Hospital $59 Million

by Faegre Baker Daniels on

Sometimes doing the right thing for the right reason can be costly. Last week it cost nonprofit Via Christi Regional Medical Center $59 million....more

Provider Reimbursement Review Board Imposes New Requirements for Providers with Pending Medicaid Eligible Days Appeals

by King & Spalding on

On May 23, 2014, the CMS Office of Hearings released Alert 10, notifying providers with pending appeals before the Provider Reimbursement Review Board (PRRB) of a new sixty-day submission requirement for the Medicaid eligible...more

Supreme Court: Providers' Appeal Period Not Extended by Doctrine of Equitable Tolling

by Baker Donelson on

Under the Medicare statute and implementing regulation, providers have 180 days from the issuance of a Notice of Program Reimbursement (NPR) in which to file an appeal to the Provider Reimbursement Review Board (PRRB). This...more

Supreme Court Rules Equitable Tolling Cannot Be Used To Extend Deadline For Filing Medicare Part A Reimbursement Appeals

by Foley & Lardner LLP on

On January 21, 2103, the U.S. Supreme Court unanimously held in Sebelius v. Auburn Regional Medical Center that the Medicare statute does not permit the time period for filing an appeal with the Provider Reimbursement Review...more

Supreme Court Upholds Regulatory Time Limitations on PRRB Appeals

by Ropes & Gray LLP on

On January 22, 2013, the United States Supreme Court unanimously upheld the Secretary of HHS’s regulation establishing an absolute three-year limit for taking an appeal from a Notice of Provider Reimbursement (“NPR”). In...more

Bolstered By Favorable District Court Decision, King & Spalding Now Forming Group Appeals Contesting Inclusion of Part C Days in...

by King & Spalding on

In a recent decision for which King & Spalding organized the appealing group of hospitals and was co-counsel, the D.C. district court ruled that CMS’s regulation requiring the inclusion of Medicare Part C patient days in the...more

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