Provider Reimbursement Review Board

News & Analysis as of

PRRB Releases New Reinstatement Rules

Effective July 1, 2015, the Provider Reimbursement Review Board (PRRB or Board) has promulgated new rules regarding the reinstatement and withdrawal of appeals before the Board. The most significant change is a new rule...more

CMS Issues DSH Ruling 1498-R2

CMS recently issued Ruling 1498-R2 (Ruling), dated April 22, 2015, amending its 2010 Ruling 1498-R. The new Ruling addresses the calculation of the Medicare fraction of the disproportionate share hospital (DSH) adjustment for...more

Court Enjoins CMS From Enforcing Dissatisfaction Requirement When a Provider’s Appeal Stems from the MAC’s Failure to Issue a...

On August 6, 2014, the United States District Court for the District of Columbia enjoined CMS, its Medicare Administrative Contractors (MACs), and the Provider Reimbursement Review Board (PRRB) from applying the...more

D.C. Circuit Says CMS Doesn’t Know What’s New

On Tuesday of last week the D.C. Circuit Court ruled that the Provider Review Reimbursement Board doesn’t know what’s new. It reversed the PRRB’s decision, along with the District Court’s decision that upheld it. In doing...more

Provider Reimbursement Review Board Issues 60 Day Deadline to Supplement Record in All DSH Medicaid Eligible Days Appeals

On May 23, 2014, the CMS Office of Hearings released Alert 10, notifying providers of an important new 60 day deadline concerning certain appeals before the Provider Reimbursement Review Board (PRRB or Board). By the end of...more

PRRB Issues Alert Requiring Supplementation of Record in DSH Cases

Recently, on May 23, the Provider Reimbursement Review Board (PRRB) issued its latest alert, Alert 10 (Alert), in an email blast. As of the writing of this article, the Alert had not been posted on the PRRB’s website....more

Government Reopens with Affordable Care Act in Place

On October 17, President Obama signed the bill titled the “Continuing Appropriations Act, 2014” (the “Act”) ending the 16-day government shutdown and lifting the nation’s debt limit. The Senate voted 81-18 in favor of the...more

Government Shutdown Continues

Medicare claims processing activities continue during the shutdown. PRRB appeal deadlines, although temporarily suspended, will become due immediately on the day the government reopens. Federal court deadlines remain in...more

PRRB Upholds Liquidation Requirement for Pension Expenses in Wage Index Calculation

The Provider Reimbursement Review Board (PRRB) has issued a decision upholding CMS’s policy of not recognizing pension expenses for purposes of calculating the wage index unless such expenses are liquidated within one year. ...more

Provider Reimbursement Review Board Issues Alert 9 and Revised Rules

On March 1, 2013, the Provider Reimbursement Review Board (PRRB or the Board) issued Alert 9, which notified interested parties that the PRRB has made revisions to its Rules and updated its Model Forms. Medicare providers...more

PRRB Amends its Rules and Requires More Thorough Documentation

On March 1, 2013, the Provider Reimbursement Review Board (PRRB) amended its rules for the first time since July 1, 2009. The changes are effective immediately and will “apply to appeals pending as of, or filed on or after,...more

Recent PRRB and CMS Administrator Decisions: A Summary for Providers

In recently released decisions, the PRRB and the CMS Administrator addressed a number of issues of interest to many providers. Short summaries of those decisions are provided below. The PRRB and CMS Administrator post their...more

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