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 of its fiscal intermediary or the Centers for Medicaid & Medicare Services (CMS). A decision of the Board may be affirmed, modified, reversed or vacated and remanded by the CMS Administrator within 60 days of notification to the provider of that decision.
Decision # | Case # | Provider # | Issue |
---|---|---|---|
2004D11 | 99-3324 | 42-7025 | 1. Was the intermediary's adjustment to Board of Directors fees proper?; 2. Was the intermediary's adjustment to routine and non-routine supply costs proper? |
2004D14 | 98-1861 | 34-0115 | Was the Intermediary's determination disallowing the loss incurred on change of ownership proper? |
2004D15 | 97-2025 | 05-0373 | Whether the Provider's budgeted beds are the most appropriate measure of available beds for proposes of computing the indirect medical education (IME) payment? |
2004D17 | 00-2285 | 32-7125 | Was the Intermediary's adjustment to the Provider's cost limits proper? |
2005D20 | 02-1342 | 15-0021 | 1. Whether for purposes of evaluating the Routine Cost Limit (RCL) exception request, the base year per diem amounts should be adjusted to reflect reclassifications made by the Provider.; 2. Whether the Intermediary properly offset the costs for the "private room differential" from the direct cost centers only. |
2005D21 | 02-0028 | 18-5175 | Whether the Intermediary's adjustment removing the Skilled Nursing Facility (SNF) for purposes of evaluating the Routine Cost Limit (RCL) exception amount was appropriate? |
2005D23 | 01-3385 | 53-7025 | 1. Whether the Intermediary's disallowance of a portion of the fiscal year 1998 accrued compensation for the Provider's Administrator and Assistant Administrator was proper?; 2. Whether the Intermediary's disallowance of a portion of the fiscal year 1998 payroll taxes and other withholdings required by the government was proper?; 3. Whether the Intermediary's adjustment removing a portion of claimed consulting, accounting and legal fees was proper? |
2005D26 | 97-2174 | 38-0018 | 1. Does the Board have jurisdiction over a new provider exemption appeal filed within 180 days of exemption determination?; 2. Does the Board have jurisdiction over multiple fiscal years in a new provider exemption or must the Provider file an exemption request for each cost reporting period?; 3. Was the Health Care Financing Administration's (HCFA's)denial of the Provider's request for exemption as a new provider proper? |
2005D30 | 03-0901 | 19-4056 | Whether the Intermediary erred when it adjusted the method of reimbursing the Provider's skilled nursing facility (SNF) from cost-based reimbursement to the prospective payment system (PPS.) |
2004D31 | 99-3760 | 39-7628 | Was the Intermediary's adjustment applying Medicare's Physical Therapy Compensation Guidelines to the Provider's employee physical therapists proper? |
2004D32 | 98-2100 | 24-0063 | 1. Was the Intermediary's adjustment to the provider's disproportionate share (DSH) payment proper? ; 2. Was the Intermediary's adjustment to the provider's capital DSH payment proper? |
2004D33 | 99-3663G; 00-2170G | Various | Should the provider's Federal Insurance Contributions Act (FICA) payroll costs be classified to the administrative and general cost center? |
2004D35 | 96-0059; 96-0060 | 15-5383 | Was the Provider entitled to an exemption from the routine cost limit as a "new" provider? |
2004D36 | 00-0386 | 39-0088 | Was the Intermediary's denial of the Provider's loss on disposal of assets proper? |
2004D37 | 96-0720 | 18-0092 | Whether non-acute care swing-bed days should be included in the Medicare proxy for the disproportionate share calculation ("DSH")? |
2004D38 | 02-1971 | 31-0067 | Was the intermediary's determination of loss on consolidation proper? |
2004D39 | 96-0591; 97-2042 | 05-7252 | Should denied Medicare visits be included in the "total visits" count for purposes of apportioning costs to the Medicare program? |
2004D40 | 02-0431; 02-0364 | 23-0075; 23-0004 | 1. Was the Intermediary's adjustment to the Provider's TEFRA rate Proper?; 2. Did the Intermediary properly conclude that the Provider failed to make reasonable collection efforts and document such efforts with respect to certain bad debts claimed by the Provider? |
2004D41 | 98-3477G | Various | Was the Intermediary's determination of the disproportionate share hospital (DSH) computation relating to state-only General Assistance Days Proper? |
2004D42 | 01-2416 | 05-4012 | Did the Intermediary properly eliminate the Provider's Medicare bad debts due to the Provider allowing discounts to only non-Medicare patients? |
2004D43 | 00-3936; 00-3937 | 19-2531; 19-2509 | Whether the Intermediary correctly disallowed Medicare bad debts related to amounts not included in the End-Stage Renal Dialysis (ESRD) Composite rate? |
2004D44 | 94-2187 | 23-0098 | Whether the cost of terminating Provider's retirement benefits and retirees' health and life insurance benefits, which were allowed and approved by the Intermediary, should be allocated to prior cost reporting periods and reimbursed to the Provider as a below-the-line adjustment in its final cost report? |
2004D46 | 01-1540; 01-2860; 02-1247 | 23-7251 | Was the Intermediary's adjustment to start-up costs proper? |
2003D01 | 99-0299; 99-3610 | 26-0094 | Were the Intermediary's adjustments reclassifying home health agency (HHA) building rent to the HHA cost center and the elimination of corresponding square footage allocation statistics proper? |
2003D02 | 99-3300 | 45-0272 | Whether the Intermediary's disallowance of disproportionate share (DSH) payments to the Provider on the grounds that it did not have 100 or more available beds was proper? |
2003D03 | 01-0710G | Various | 1. Were the Intermediary's adjustments to the Providers' cost reports for FYE 12/31/97 to eliminate the Providers' claimed losses on disposition of assets proper?; 2. Did the Intermediary err in determining that the Providers disposed of their assets on or after December 1, 1997?; 3. Alternatively, is the regulation that eliminates recognition of gain or loss on asset sales on or after December 1, 1997 invalid, so that the Providers are entitled to losses on disposition of their assets regardless of the date on which that disposition occurred? |
2003D04 | 01-0320 | 28-5149 | Whether the provider's appeal of bad debts was derived from an intermediary determination or adverse finding? |
2004D19 | 99-0729; 01-0036 | 39-5432 | Was it proper for the Intermediary to make an adjustment to remove the hours in the ancillary areas used to allocate nursing administration on Worksheet B-1 of the Medicare cost report? |
2004D18 | 01-1017 | 10-5930 | Whether the Intermediary's adjustment reducing the adjusted hourly salary equivalency amount allowed for services of Physical Therapy Aides was proper? |
2004D22 | 03-0063; 03-0064 | 39-0026 | Were the Intermediary's adjustments disallowing direct graduate medical education (GME) and indirect medical education (IME) costs of the interns and residents full-time equivalent counts proper? |
2004D24 | 98-0815 | 15-7046 | Was the Intermediary's decision to deny the Provider's request for an exception to Medicare's salary equivalency guidelines for physical therapy services furnished under arrangement proper? |
2004D25 | 96-1496; 98-0237 | 14-7135 | Was the Intermediary's adjustment disallowing Medicare reimbursement for a portion of the Provider's physical therapy costs due to its application of physical therapy compensation guidelines proper? |
2004D27 | 95-2033R; 96-1979R; 97-1498R; 98-2049R | 04-0036 | 1. Does the Provider meet the criteria set forth at Section 4004(b) of Omnibus Budget Reconciliation Act (OBRA) 1990?; 2. Do the costs at issue meet the definition of clinical training costs? |
2004D29 | 96-2359; 01-0124 | 22-5681 | Was the Intermediary's denial of the Provider's request for an exemption from Medicare's service cost limits proper? |
2003D19 | 99-0646 | 03-5145 | Whether the Intermediary properly calculated the Provider's Medicare bad debts? |
2003D21 | 01-0153 | 06-7201 | Was the Intermediary's adjustment to owner's compensation proper? |
2003D22 | 96-1531, 97-1417; 98-1063 | 20-0024 | Is the Provider entitled to a TEFRA exception? |
2003D23 | 99-0160 | 45-0119 | Was the Intermediary's determination of available beds for purposes of the disproportionate share payment calculation proper? |
2003D06 | 97-0061 & 97-0062 | 22-0156; 22-0111 | Was there a recognizable loss upon the transfer of assets to Good Samaritan Medical Center ("Good Samaritan") from Goddard Memorial Hospital ("Goddard") and Cardinal Cushing Hospital ("Cushing") that occurred in connection with the consolidation of the two hospitals and the resulting creation of Good Samaritan Medical Center? |
2003D08 | 00-3980 | 49-5281 | Was the Intermediary's adjustment disallowing the allocation of general service costs to the ancillary cost centers proper? |
2003D09 | 00-3979 | 17-5185 | Was the Intermediary's adjustment disallowing the allocation of general service costs to the ancillary cost centers proper? |
2003D10 | 00-3413 | 39-5460 | 1. Was the Intermediary's reclassification of Staff Development Coordinator salaries proper?; 2. Was the Intermediary's reclassification of Social Services salaries proper? |
2003D12 | 97-1686 | 39-7006 | Was the Intermediary's adjustment to rent paid by the Provider to a related party proper? |
2003D18 | 99-0321 | 06-3027 | Did the Intermediary incorrectly determine that the Provider was not entitled to a new provider exemption from the application of the skilled nursing facility for its provider-based skilled nursing facility? |
2003D17 | 00-0544 | 05-0248 | Was the Intermediary's adjustment to the residents count and Graduate Medical Education payments proper? |
2003D16 | 02-0721G | 50-0023, 44-0131; 45-0059 | Were the Intermediaries adjustments to exclude observation bed days from the providers' bed count in determining disproportionate share hospital ("DSH") eligibility and payments proper? |
2003D15 | 96-1651 | 33-5758 | Is it proper for the Intermediary to apply the lower of cost or charges (LCC) principle in calculating the Provider's reimbursement on the Medicare cost report Worksheet E, Part I? |
2003D14 | 96-1951 | 23-0167 | Whether the Board has jurisdiction over the calculation of the disproportionate share adjustment where the issue is added to the appeal of an original Notice of Program Reimbursement? |
2003D13 | 96-0618G, 96-0619G; 96-0620G | Various | Whether the intermediary's refusal to accept the Provider's amended cost reports constituted a final determination appealable to the Board? [This Decision was Vacated.] |
2003D11 | 00-2451 | 39-7279 | Were the Intermediary's adjustments to physical therapy costs proper? |
2003D25 | 99-3866; 01-0764 | 39-5742 | 1. Was the Intermediary's reclassification of Staff Development/ Quality Assurance Coordinator salaries proper?; 2. Was the Intermediary's adjustment allocating social service costs proper? |
2003D26 | 94-3266 | 05-0373 | Did the Intermediary correctly reduce the number of full-time equivalent interns and residents in approved training programs for the purpose of calculating the Provider's graduate medical education adjustment? (Whether the Intermediary may change the bases for excluding residents from the count more than three years after the issuance of the revised Notice of Program Reimbursement.) |
2003D27 | 00-2949 | 49-7259 | 1. Whether the Intermediary's adjustment to disallow advertising cost was proper.; 2. Whether the Intermediary's adjustment to include Heaven Sent Nursing Services as a non-reimbursable cost center was proper.; 3. Whether the Intermediary's adjustment to reclassify the Community Education Coordinator's salary to a non-reimbursable cost center was proper.; 4. Whether the Intermediary's adjustment to remove the Administrator's excess compensation was proper. |
2003D41 | 00-0346; 01-0210 | 39-5789 | Was the Intermediary's adjustment to remove nursing administration statistics from the ancillary cost centers on worksheet B-1 proper? |
2003D24 | 98-0362G, 99-2356; 01-0053 | Various | Was the Intermediary's adjustment to deny the allocation of social service costs based on departmental gross charges proper? |
2003D42 | 02-1198 | 41-7001 | Was the Intermediary's disallowance of the Provider's Spanish and Portuguese interpreter expenses proper? |
2003D43 | 97-3008 | 10-0055 | Was the Intermediary's determination of obligated capital proper? |
2003D44 | 02-0901G | Various | Was the Intermediary's disallowance of liabilities not liquidated timely on the Medicare cost report proper? |
2003D45 | 99-0722 | 05-7252 | Whether the Intermediary's adjustment of Medicare visits to agree with Medicare's Provider Statistical and Reimbursement (PS&R)report were proper? |
2003D28 | 00-3416 | 14-7614 | Was the Intermediary's adjustment to disallow accrued bonuses for employees proper? |
2003D29 | 01-1866 | 23-0205 | Was the Intermediary's adjustment to DRG (Diagnostic Related Group) payments proper? |
2003D30 | 01-1525 | 31-7060 | Was the Intermediary's adjustment to the Per Beneficiary Limit (PBL) calculation proper? |
2003D31 | 98-0507, 99-2398; 00-0946 | 36-0003 | 1. Was the Intermediary's reclassification of certain administrative costs from ambulatory serices area to the Administrative and General Cost Center proper? (Fiscal years 1994, 1995 and 1996); 2. Was the Intermediary's reclassification of clinic dieticians' salary costs to the Dietary Cost Center proper? (Fiscal years 1994 and 1995) |
2003D32 | 98-1282 | 67-7181 | Was the Intermediary's Audit Adjustment #2 which disallowed $108,875 of Administrative and General Costs proper? |
2003D33 | 01-1779; 02-0270 | 18-3026 | Was the all inclusive rate allocation Methodology proper? |
2003D34 | 99-2427G | Various | Were the Intermediary's adjustment disallowing the Providers' claimed losses on disposal of assets due to a change of ownership proper? |
2003D35 | 99-2241G | Various | Were the Intermediary's adjustment disallowing the Providers' claimed losses on disposal of assets due to a change of ownership proper? |
2003D36 | 98-1973 | 12-0006 | Were the Intermediary's adjustment disproportionate share hospital payments proper? |
2003D37 | 94-2728 | 34-0141; 34-S141 | Whether the Intermediary and HCFA properly determined that the Provider's request for an adjustment to the TEFRA limits was untimely? |
2003D38 | 01-1637 | 15-0102 | Was the Intermediary's adjustment to limit reimbursement to the lower of cost or charges for the Provider's distinct part psychiatric unit proper? |
2003D40 | 01-2787 | 10-5858 | Did the Centers for Medicare and Medicaid Services ("CMS") properly deny the Provider's request for an exemption from the Medicare skilled nursing facility routine service cost limits ("SNF RCLs") as a new provider under 42 C.F.R. Section 413.30(e) based on CMS' determination that the exemption request was not timely filed for cost reporting periods ended May 31, 1996, 1997 and 1998? |
2003D39 | 97-2608 | 55-5405 | Was the Intermediary's denial of the Provider's SNF routine service cost limit exception request proper? |
2003D46 | 00-1172 | 55-7008 | Whether the Provider is entitled to an exception to the visit cost limits in accordance with Medicare regulations? |
2003D47 | 98-2105, 98-2106;98-2107 | 33-0261 | Was the Intermediary's treatment of the Provider's increase in bed size of its exempt rehabilitation unit proper? |
2003D48 | 99-2780, 99-2781, 01-1334, 01-1335; 02-0450 | 39-7015 | Was the Intermediary's adjustment to home office costs proper? |
2003D49 | 02-1970 | 14-0167 | Is the Provider entitled to status as a Medicare Dependent hospital ("MDH") for the period of October 1, 2001 through January 14, 2002? |
2003D50 | 00-0961G | Various | Was the Intermediary's adjustment to restorative nurses aides proper? |
2003D51 | 01-3608G | Various | Was the Intermediary's adjustment to restorative nurses aides proper? |
2003D52 | 01-2455 | N/A | Were the Intermediary's adjustments reclassifying the Medical Director cost proper? |
2003D54 | 01-2453 | 05-6323 | Was the Intermediary's adjustment reclassifying Medical Director cost proper? |
2003D55 | 01-2262 | 55-5336 | 1. Was the Intermediary's adjustment to advertising costs proper?; 2. Was the Intermediary's adjustments reclassifying Medical Director cost proper? |
2003D56 | 99-3820 | 40-0098 | 1. Was the Intermediary's adjustment to interest expense proper?; 2. Was the Intermediary's adjustment to deferred organizational cost proper? |
2003D57 | 99-3821 | 40-0098 | Was the Intermediary's adjustment to bad debts proper? |
2003D58 | 95-0590 | 40-0016 | Was the Center for Medicare & Medicaid Services' denial of the Provider's exception request proper? |
2003D59 | 00-1344 | 40-0079 | Was the Intermediary's adjustment to the disproportionate share, (DSH) computation proper? |
2003D60 | 00-0064 | 46-7051 | 1. Was the Intermediary's adjustment to home office costs proper?; 2. Was the Intermediary's adjustment disallowing a portion of the auto allowance proper?; 3. Was the Intermediary's adjustment to travel and lodging costs proper? |
2003D61 | 01-0627 | 23-3519 | Was HCFA's (the Center for Medicare & Medicaid Services') determination concerning the exception request under the prospective payment system proper? |
2003D62 | 99-0584 | 39-0080 | Was the Intermediary's determination of loss on sale of assets proper? |
2003D63 | 99-2054, 99-2307G; 01-0337 | Various | Case No. 99-2054- 1. Was the Intermediary's adjustment disallowing capital related expenditures proper?; 2. Was the Intermediary's adjustment disallowing interest expense proper?; Case No. 99-2307G- 1. Was the Intermediary's adjustment disallowing rental expense proper?; Case No. 01-0337- 1.Was the Intermediary's adjustment disallowing rent expense proper?; 2. Was the Intermediary's adjustment disallowing capital related expenditures proper?; 3. Was the Intermediary's adjustment disallowing interest expense proper? |
2003D64 | 98-2851 | 17-0087 | Was the Intermediary's determination of loss on consolidation proper? |
2003D65 | 95-2104G, 95-1244G; 96-2516G | Various | Whether the Intermediary correctly applied the Medicare lower of cost or charges limit in determining payments to the Providers? |
2003D66 | 99-4073 | 49-5280 | Was the Intermediary's adjustment disallowing Medicare Part A and Part B bad debts proper? |
2005D18 | 98-2318 | 15-5400 | 1. Was the Intermediary's adjustment to National Premier Financial Services, Inc., and NPF VI, Inc. Costs/Program Fees was proper?; 2. Was the Intermediary's failure to allow $18,215 of related party depreciation was proper?; 3. Was the Intermediary's adjustment to decrease total respiratory therapy hours worked, unduplicated days, the cost of respiratory therapy services from outside providers, and $5,661 of related respiratory therapy expense was proper? |
2004D02 | 99-3609; 00-3050; 01-2972 | 22-4022 | Were the Intermediary's adjustments to physician stand-by costs in the routine area correct? |
2004D03 | 99-3323 | 42-7010 | 1. Was the Intermediary's adjustment to Board of Directors fees proper?; 2. Was the Intermediary's adjustment to legal and professional fees proper?; 3. Was the Intermediary's adjustment to key employee compensation proper?; 4. Was the Intermediary's adjustment to routine and non-routine supply costs proper? |
2004D04 | 00-2255; 01-2782 | 17-8012 | Whether the Intermediary's adjustment to include private duty nursing costs on the Medicare cost report was correct? |
2002D18 | 96-1254; 96-1443 | 06-7032 | 1. Was the Intermediary's disallowance of administrative salaries proper? (For Cost Reporting Period Ended September 30, 1993 - Case No. 96-1254); 2. Was the Intermediary's disallowance of legal fees proper? (For Cost Reporting Period Ended May 9, 1994 - Case No. 96-1443) |
2002D19 | 99-0233 | 13-0024 | Was the Intermediary's adjustment to emergency room ("ER") physicians' availability costs proper? |
2002D30 | 95-1515, 95-2428, 99-3520, 99-3125 | 05-0366 | Was the Intermediary's reopening in accordance with Medicare regulations, and did the Intermediary use the proper hospital-specific rate in determining the Provider's reimbursement? |
2002D31 | 97-0135 | 01-5426 | Was the Centers for Medicare & Medicaid Services' (Formerly the Health Care Financing Administration) denial of a new provider exemption proper? |
2002D32 | 00-3418G | Various | Was the Intermediary's adjustment to the non-qualified deferred compensation plan proper? |
2002D33 | 91-0550G | Various | Was the Intermediary's adjustment to Indirect Medical Education costs proper? |
2002D34 | 89-1181R | 05-0230 | 1. Did CMS invalidly apply pre-composite rate ESRD Screens to limit the Provider's reimbursement for the reasonable costs it incurred for the treatment of ESRD patients?; 2. Whether and to what extent the Provider is entitled to an exception from the $138 per treatment ESRD screens for fiscal years 2/28/81, 2/28/82, and 2/28/83. |
2002D35 | 00-3147; 00-3150 | 23-6554 | Did the Intermediary properly adjust the provider's bad debt expense? |
2002D36 | 97-1761 | 14-7525 | 1. Were the Intermediary's adjustments to disallow patient advocate/community relations costs proper?; 2. Was the Intermediary's elimination of accrued expenses proper?; 3. Was the Intermediary's disallowance of pension costs proper?; 4. Was the Intermediary's treatment of executive compensation reasonable? |
2002D38 | 98-1171 | 06-7239 | Was the Intermediary's determination of legal fees proper? |
2002D39 | 97-0403 | 39-5066 | Was the Intermediary's adjustment to Medicare patient days proper? |
2002D40 | 96-2090R | 39-5863 | Whether the Provider is entitled to reimbursement as ancillary services, certain nursing service costs for monitoring the functional operation of air-fluidized beds (AFBs) for the care of Medicare patients with stage IV pressure ulcers/decubitus ulcers? |
2002D41 | 99-0286R | 31-7062 | Was the interest paid on working capital loans from the Friend Center Fund and commercial banks necessary and allowable? |
2002D42 | 99-0417 | 37-5262 | Was the Intermediary's methodology used in settling a low utilization cost report proper? |
2002D43 | 98-2295; 99-2144 | 15-2009 | 1. Was the Intermediary's determination of the provider's Medicare TEFRA base year proper?; 2. Was the Intermediary's determination of the Provider's TEFRA target rate limitation proper? |
2002D44 | 97-3201 | 20-0009 | Was it proper for the Intermediary to deny the Provider's TEFRA exception request for untimely filing? |
2002D45 | 97-2659 | 21-5302 | Did the Provider meet the regulatory requirements for approval of the new provider exemption? |
2002D46 | 98-0460 | 05-0211 | 1.(A) - Did the Intermediary properly apply the low occupancy adjustment in Centers for Medicare and Medicaid Services ("CMS" formerly called the Health Care Financing Administration ("HCFA")) Transmittal No. 378, Section 2534.5.A?; 1.(B) - Was CMS' refusal to grant an exception for that portion of the Provider's per diem costs which do not exceed 112 percent of the total peer group mean cost proper? - on the record; 2. - Was the Intermediary's adjustment eliminating the community education director's salary proper? - on the record. |
2002D47 | 00-3139; 01-2861 | 23-0115 | Was the Intermediary's denial of the Provider's request for additional payment for decreased discharges proper? |
2002D48 | 96-2035, 96-2036, 96-2037; 96-2038 | 22-5673 | Did the Centers for Medicare and Medicaid Services ("CMS") properly deny Milton Hospital Transitional Care Unit's request for an exemption from the Medicare skilled nursing facility routine service cost limits ("SNF RCLs") as a new provider under 42 C.F.R. Section 413.30(e)? |
2002D49 | 98-0489 | 22-0036 | Was the Intermediary's adjustment (denial) of the transitional care unit new provider exemption proper? |
2002D50 | 96-1033 | 50-5025 | Was the decision of the Health Care Financing Administration ("HCFA"), pursuant to its Provider Reimbursement Manual ("PRM") Section 2534.5, to refuse to grant an exception for that portion of the Provider's per diem costs which exceed the Routine Cost Limit, but which do not exceed 112% of the total peer group mean cost, arbitrary, capricious, an abuse of discretion or not in accordance with law? |
2001D12 | 97-0744; 99-0318 | 10-7281 | FY 1994 - 1. Was the Intermediary's adjustment to administrative and general for the intake coordinator's salaries proper?; 2. Was the Intermediary's adjustment to administrative and general staff expenses proper?; 3. Administratively resolved and withdrawn at hearing.; FY 1995 - 1. Same as No. 1 for FY 1994.; 2. Issue administratively resolved and withdrawn at hearing.; 3. Was the Intermediary's adjustment removing expenses from the cost report that were not actually incurred proper? (Parties relied upon materials in the record.) |
2001D55 | 91-2902M & 95-1677 | 39-0156 | 1. Was the Intermediary's failure to recognize and reclassify certain operating costs as graduate medical education ("GME") proper?; 2. Was the Intermediary's failure to add misclassified operating costs to the Provider's Prospective Payment System ("PPS") hospital specific rate ("HSR") and TEFRA target amount ("TA") proper? |
2000D02 | 96-1218 | 44-0008 | Was the Intermediary's reclassification of home health agency costs proper? |
2000D15 | 94-1517 | 10-0129 | Does the recapture of depreciation due to the gain on the sale of depreciable assets have any effect on the Provider's equity capital for prior years? |
2000D16 | 97-0080 | 05-7299 | 1. Was the Intermediary's adjustment to reclassify supplies' salaries to the administrative and general cost center proper?; 2. Was the Intermediary's adjustment to disallow costs paid to a related organization proper?; 3. Was the Intermediary's adjustment to allocate cost shared with the related company using the pooled cost method proper? |
2000D17 | 92-1549 | 26-0104 | Was the computation and allocation of the cashiering, accounts receivable, and collections cost center done correctly and done in accordance with the regulations? |
2000D18 | 94-1750 | 45-0698 | Did the Intermediary properly disallow the Provider's claim of an allowable loss on the sale of assets through a transaction that transferred ownership of all hospital assets and liabilities from Lamb County Hospital Authority to Lamb County, Texas? |
2000D19 | 95-0072 | 38-0007 | Was the Intermediary's or HCFA's determination regarding the Provider's TEFRA exception request proper? |
2000D20 | 94-2879 | 33-3028 | Was HCFA's partial denial of the Provider's request for a TEFRA target rate adjustment proper? |
2000D21 | 95-0897 | 31-0002 | Was the Intermediary's failure to apply updated reasonable compensation equivalent limits proper? |
2005D02 | 96-2577G | Various | Were the Intermediary's adjustments disallowing bad debts claimed by the Provider on uncollectable deductable and coinsurance amounts pertaining to items and services reimbursed outside of Medicare's composite rate for End Stage Renal Disease facilities proper? |
2005D03 | 96-0211, 97-1061R, 98-2080R | 26-0015 | Was the Provider entitled to an exemption from the skilled nursing facility routine cost limits for the years ended December 31, 1992, December 31, 1993, and December 31, 1994? |
2005D04 | 01-1458 | 20-0033 | Was CMS' denial of the Provider's end stage renal disease (ESRD) composite rate exception request correct? |
2005D05 | 94-3085 | 05-0295 | Was the Center For Medicare and Medicaid Services (CMS)' parial denial of the Provider's End Stage Renal Disease (ESRD) atypical service exception request proper? |
2005D06 | 97-0592, 98-1495 | 23-0077 | For purposes of allocation of Administrative & General ("A&G") costs, should Part B physicians' compensation and related fringe benefits be included in total expenses of private physician practices? |
2005D07 | 00-0374 | 52-5478 | Was the Intermediary correct in determining that Provider's request for an exception to the Skilled Nursing Facility (SNF) Routine Cost Limit was untimely filed? |
2005D08 | 00-1542, 01-1278, 03-0040 | 10-0070 | Were the Intermediary's adjustments to interest expense relating to the acquisition of medical records and an assembled work force proper? |
2005D09 | 99-1467 | 05-0420 | Is a loss required to be recognized by Medicare as a result of the May 30, 1996 merger of the former corporate owner of the Provider into a new corporate owner? |
2005D10 | 02-0355 | 19-7210 | 1. Whether the Intermediary's disallowance of owner's accrued salary expense for untimely liquidation was proper?; 2. Whether the Intermediary's adjustment to the related party portion of the office supplies and revision of the related party medical supply expense was proper? |
2005D11 | 00-3166, 00-3167, 00-3119 | 03-0023, 03-7047 | Whether the Intermediary's denial of a request for exception to the Home Health Agency (HHA) per visit cost limits was proper? |
2005D12 | 99-0452G | Various | Whether the Intermediary properly processed the Providers' TEFRA exception request? |
2005D13 | 02-0078 | 19-7585 | Whether the Intermediary denial of the Provider's request for exception to its per-visit cost limits was proper? |
2005D14 | 00-0945 | 15-5258 | 1. Whether the Intermediary adjustment to disallow a portion of the owners' compensation was proper?; 2. Whether the Intermediary adjustment to disallow bad debts was proper? |
2005D15 | 02-0020 | 05-6092 | Whether the Intermediary's denial of the Provider's Routine Cost Limit (RCL) exception request was proper? |
2005D16 | Various | Various | What relief is available through appeal to thre Provider Reimbursement Review Board (Board) for failure of the Intermediaries to timely settle the Provider's cost reports, especially where prejudice will result from the failure to settle such cost report? |
2005D17 | 02-0013, 02-0319 | 04-3816 | Was the Intermediary's adjustment to physician/owners compensation proper? |
2004D05 | 01-0741 | 23-2557 | Did the Centers for Medicare and Medicaid Services ("CMS") correctly deny Chippewa Dialysis Services' request for an exception to the end stage renal disease ("ESRD") composite rate? |
2004D06 | 01-0742 | 23-2553 | Did the Centers for Medicare and Medicaid Services ("CMS") correctly deny Alpena Dialysis Services' request for an exception to the end stage renal disease ("ESRD") composite rate? |
2004D08 | 03-0666 | 37-5109 | Does the Board have jurisdiction over the recoupment of overpayments appealed from a letter from the Centers for Medicare and Medicaid Services? |
2004D07 | 01-0743 | 23-2315 | Did the Centers for Medicare and Medicaid Services ("CMS") correctly deny Northern Michigan Hospital's request for an exception to the end stage renal disease ("ESRD") composite rate? |
2004D09 | 03-0665 | 37-5109 | Does the Board have jurisdiction over the recoupment of overpayments appealed from a letter from the Centers for Medicare and Medicaid Services, and the reimbursement effect is less than $10,000? |
2005D29 | 95-0468 | 05-0076 | Was the Intermediary's partial denial of the Provider's End Stage Renal Disease (ESRD) exception request proper? |
2004D01 | 01-1470; 01-1534G; 01-1539G | Various | Whether the Board has jurisdiction to determine which entity is the proper payee under the terms of a settlement agreement between the Providers and the Intermediary? |
2003D07 | 00-3976 | 17-5218 | Was the Intermediary's adjustment disallowing the allocation of general service costs to the ancillary cost centers proper? |
2005D31 | 01-1679 | 48-0001 | Whether CMS' determination to deny a request for an exception to the end stage renal disease(ESRD) composite rate based on a lack of documentation supporting the criteria of the isolated essential facility (IEF) was proper. |
2005D32 | 94-3299, 96-0845, 98-2163 | 31-0111 | Whether the Intermediary failed to properly classify certain projects as old capital. |
2005D01 | 02-0212, 02-0213,02-0214 et al | 40-7019;40-7013;40-7017;et al | Whether the Providers' receivable financing was a loan or a sale of assets? |
2004D13 | 01-0881GE | Various | This case arises from Hunterdon Medical Center's and Somerset Medical Center's (Providers') dissatisfaction with having a closed hospital's wage data included in the Providers' Metropolitan Statistical Area (MSA) wage index and the exclusion from the wage index data of providers that have been reclassified by the Medicare Geographic Classification Review Board (MGCRB). The question addressed by the decision is whether expedited judicial review (EJR) is appropriate because the Board cannot grant the remedy sought by the Providers: a change to the Secretary's policies used to calculate wage indices. |
2003D05 | 00-3145 | 05-8017 | Was the Intermediary's adjustment of start-up costs proper? |
2003D20 | 99-4064 | 52-0089 | Was the Intermediary's determination of the TEFRA exception request proper? |
2004D16 | 00-0411; 00-2594 | 45-0061 | Was the Intermediary's adjustment excluding observation bed days from the determination of the Provider's disproportionate share hospital adjustment proper? |
2004D30 | 01-0937 | 23-7252 | Was the Intermediary's adjustment to the single business tax proper? |
2004D26 | 01-0883 | 20-0018 | Was CMS' denial of end stage renal disease composite rate exception request correct based on applicable Medicare law? |
2004D21 | 99-1424 | 04-0048 | Was the Intermediary's determination of the loss on disposal of assets proper? |
2004D10 | 00-2699; 00-2700 | 15-7193; 15-7318 | The case involves the propriety of reimbrusing home health agencies (HHA) under the Medicare program for expenses that the HHA incurs to provide pastoral care to its patients? |
2004D28 | 04-1640; 04-1641 | 50-3300 | Were the Intermediary's adjustments to the provider's intern and resident full-time equivalents ("FTEs") counts used for calculating chidren's hospital graduate medical education ("CHGME") payments proper? |
2005D22 | 01-0700 | 15-5228 | Whether the Intermediary's adjustment to disallow a portion of the owner's compensation was proper? |
2004D23 | 97-2439 | 19-0160 | Was the Provider's routine cost limit determined in accordance with Medicare law, regulations, and program instructions? |
2005D27 | 02-1008 | 25-0019 | Was the Intermediary's disallowance of Medicare bad debts proper? |
2005D19 | 01-0261 | 19-7558 | Was the Intermediary's adjustment to disallow accrued salaries proper? |
2004D20 | 98-1344; 99-1718; 00-2691 | 51-0001 | Was the Intermediary's adjustment to bond interest proper? |
2005D25 | 99-1213 | 67-7455 | 1. Whether the Intermediary's adjustment to remove accrued salaries for owners due to payment not being properly liquidated within 75 days after the close of the cost reporting period was correct?; 2. Whether it was proper for the Intermediary to disallow the portion of the accrued owner's compensation expenses attributable to the employees' share of Federal and State withholding taxes? |
2005D24 | 02-0183 | 19-7545 | 1. Whether the Intermediary's adjustment to remove accrued salaries for owners due to payment not being properly liquidated within 75 days after the close of the cost reporting period was proper?; 2. Whether it was proper for the Intermediary to disallow the portion of the accrued owner's compensation expenses attributable to the employees' share of Federal and State withholding taxes? |
2005D28 | 97-1566 | 04-0062 | Was the Centers for Medicare and Medicaid Service's denial of the Provider's request for new provider exemption proper? |
2005D34 | 98-1658 | 45-0124 | Whether the Intermediary properly applied the "Pickle Amendment" in calculating the Provider's Disproportionate Share Hospital (DSH) adjustment. |
2005D35 | 99-1345 | 55-7729 | Whether the liabilities claimed by the Provider are reimbursable under the Medicare principles. |
2005D36 | 02-0216; 02-0217 | 03-0064 | 1. Were the Intermediary's adjustments reducing the Provider's Indirect Medical Education (IME) full-time equivalent (FTE) resident count for time spent by residents in research proper?; 2. Were the Intermediary's adjustments reducing the Provider's FTE resident count for IME and Direct Graduate Medical Education (GME) for time spent by residents on vacation proper? |
2005D37 | 01-2620 | 14-7112 | Were the Intermediary adjustments applying Medicare's salary equivalency guidelines to services performed by Provider's employee physical and occupational therapists proper? |
2005D38 | 02-2031 | 45-2049 | Whether the Intermediary erred in denying the Provider a continuous improvement bonus ("CIB") for fiscal year ending August 31, 1999. |
2003D53 | 99-2359 | 05-5039 | 1. Was the Intermediary's adjustment to advertising costs proper?; 2. Was the Intermediary's adjustment to tax penalties proper? |
2005D40 | 00-2981 | 41-5122 | Whether the Centers for Medicare & Medicaid Services' (CMS) denial of St. Joseph's Health Services of Rhode Island Transitional Care Center's request for exemption from the skilled nursing facility (SNF) routine cost limit (RCL) as a new provider was proper |
2005D41 | 99-4038 | 36-0066 | Whether for purposes of the Provider's disproportionate share (DSH) calculation, the Provider is entitled to an increased number of days of care rendered to eligible Medicaid beneficiaries. |
2005D42 | 01-3257 | 33-0215 | Whether for purposes of the Provider's disproportionate share calculation, the Provider is entitled to an increased number of days of care rendered to eligible Medicaid beneficiaries. |
2005D43 | 00-0909G | Various | Should the Intermediary reclassify the Provider's Federal Insurance Contributions Act (FICA) tax expense from the Employee Benefits cost center to the Administrative and General cost center (A&G)? |
2005D44 | 99-4061 | 50-5504 | Whether CMS' denial of the Provider's request for an exemption to the routine cost limits for skilled nursing facilities as a new provider was proper. |
2005D45 | 02-1213 | 22-0163 | Was the Centers for Medicare and Medicaid Services' (CMS) denial of the Provider's request for an exemption to the end stage renal disease (ESRD) composite rate proper? |
2005D46 | 98-2583 | 50-0124; 50-5492 | Was the Provider entitled to a "new provider" exemption from Medicare's routime cost limits for its hospital-based skilled nursing facility (SNF)? |
2005D47 | 02-2129; 04-1734 | 05-0281 | Whether the Provider is entitled to include in the Medicaid proxy of the DSH payment calculation patient days associated with patients who otherwise were entitled to benefits under both Medicare & Medicaid who were treated in the Provider's sub-acute unit on days when those patients were not entitled to Medicare Part A skilled nursing facility (SNF) benefits. |
2005D48 | 95-0777 | 33-0225 | Whether the Intermediary's application of the reasonable compensation equivalent limits was proper. |
2005D49 | Various | 36-0125; 36-0187; 36-0027; 36-0009; 36-0068 | Whether the Intermediary improperly excluded patient days related to Ohio's Hospital Care Assurance Program (HCAP) in the providers' disproportionate share calculations. |
2005D50 | 89-1584 | 45-0101 | 1.Whether capitalized interest that may have been amortized in future years can be expensed in the current year when future cost reports are no longer subject to reopening.; 2. Whether the Intermediary's determination of allowable interest expense which deducted Hillcrest Medical Tower [HMT] interest from allowable versus total expense is proper. |
2005D51 | 98-2210 | 10-5319A | Whether the Intermediary properly reclassified the Provider's square footage costs for its common areas from the Administrative and General cost center to the Plant Operations, Maintenance and Repair cost center. |
2005D52 | 99-1511G | Various | Whether the Intermediary properly reclassified the Providers' square footage costs for its common areas from the Administrative and General cost center to the Plant Operations, Maintenance and Repair cost center. |
2005D39 | 99-2779; 02-1243 | 36-0242 | Whether the Intermediary's adjustment to disallow the interest paid to the Ohio State University Hospitals was proper. |
2005D53 | 97-1198; 99-0246; 99-0247 | 05-0357 | Did the Provider supply sufficient information to enable the Centers for Medicare and Medicaid Services to make a decision regarding the Provider's request for an exemption to Medicare's routine service cost limits for skilled nursing facilities (SNF)? |
2005D54 | 03-0045; 03-0046 | 45-0130 | Whether the Intermediary's classification of the Provider's home health agency (HHA) as a 'new provider' for purposes of determining the per-beneficiary limits was proper? |
2005D55 | 00-3322 | 39-0263 | Whether the Intermediary's adjustment disallowing the Provider's loss on sale of assets is proper? |
2005D56 | 99-3095 | 45-0272 | Whether observation days and swing bed days should reduce the number of available beds for the purpose of calculating the Provider's eligibility for disproportionate share (DSH) payments. |
2005D57 | 99-3096 | 45-0272 | Whether observation days and swing bed days should reduce the number of available beds for the purpose of calculating the Provider's eligibility for disproportionate share (DSH) payments. |
2005D58 | 99-0832 | 45-0272 | Whether observation days and swing bed days should reduce the number of available beds for the purpose of calculating the Provider's eligibility for disproportionate share (DSH) payments. |
2005D59 | 01-0728 | 45-0272 | Whether observation days and swing bed days should reduce the number of available beds for the purpose of calculating the Provider's eligibility for disproportionate share (DSH) payments. |
2005D60 | 02-1126 | 33-3531 | Whether the denial of the Provider's request for an exception to the renal dialysis composite rate by the Centers for Medicare and Medicaid Services (CMS) was proper. |
2005D61 | 99-1543; 00-1001 | 39-7573 | Whether the Intermediary's adjustments applying the physical therapy salary guidelines to fee-for-service employee compensation was proper. |
2005D62 | 01-0077 | 25-5234 | Whether the Intermediary's adjustment removing the Provider's 'grossing up' of costs and charges for drugs charged to patients was proper. |
2005D63 | 98-1913 | 06-7188 | Whether the Intermediary's adjustment applying the Adjusted Hourly Salary Equivalency Amount, (commonly referred to as the Salary Equivalency Guidelines (SEGs) or 'physical therapy compensation guidelines') to fee-for-service employees compensation was proper. |
2005D64 | 98-1922 | 05-6169 | Whether the Intermediary's adjustment to allow only a 15% increase in the therapy rate for physical therapy supervisors was proper. |
2005D65 | 00-3600 | 45-7661 | Whether the Intermediary properly disallowed interest expense incurred in connection with the Provider's deferred compensation plan. |
2005D66 | 00-3299 | 19-7213 | 1. Whether the Intermediary's adjustments applying the physical therapy salary guidelines to fee-for-service employee compensation were proper.; 2. Whether the Intermediary's adjustment to reduce allowable related party rental expense was proper. |
2002D24 | 01-0198 | 42-5018 | 1. Was the Intermediary's adjustment combining all SNF and NF cost charges, days, and statistics into one cost center proper?; 2. Was the Intermediary's determination that payroll records were not adequate to support nursing service cost allocation to the SNF distinct part proper?; 3. Was the Intermediary's determination that the allocation of nursing time resulted in an inequitable allocation of cost to the SNF distinct part proper?; 4. Was the Intermediary's decision to disregard statistics and supporting documentation for the allocation of all other general service costs to the SNF distinct part proper? |
2002D37 | 94-3225G, 94-1910G, 93-0483G, 93-0284G, 94-0209G, 95-1245G, 96-0976G, 98-0179 | Various | Whether the Intermediaries' application of reasonable compensation equivalent ("RCE") limits issued by HCFA to limit hospitals' compensation to physicians for Medicare Part A services in cost reporting periods commencing in 1984 to the Providers' physician compensation for hospital services in cost reporting periods commencing in 1987 through 1994 was proper. |
2002D25 | 01-0200 | 42-5102 | 1. Was the Intermediary's adjustment combining all SNF and NF cost charges, days, and statistics into one cost center proper?; 2. Was the Intermediary's determination that payroll records were not adequate to support nursing service cost allocation to the SNF distinct part proper?; 3. Was the Intermediary's determination that the allocation of nursing time resulted in an inequitable allocation of cost to the SNF distinct part proper?; 4. Was the Intermediary's decision to disregard statistics and supporting documentation for the allocation of all other general service costs to the SNF distinct part proper? |
2002D27 | 99-3872 | 55-7633 | 1. Was the Intermediary's adjustment disallowing unsupported compensation paid to the Medical Director proper?; 2. Was the Intermediary's adjustment reducing compensation paid to the Director of Nursing to a reasonable amount proper?; 3. Was the Intermediary's adjustment to the Administrator's salary proper? |
2002D21 | 96-1820 | 44-7442 | Was the Intermediary's adjustment to the Provider's cost report to remove legal fees proper? |
2002D22 | 01-0199 | 42-5112 | 1. Was the Intermediary's adjustment combining all SNF and NF cost charges, days, and statistics into one cost center proper?; 2. Was the Intermediary's determination that payroll records were not adequate to support nursing service cost allocation to the SNF distinct part proper?; 3. Was the Intermediary's determination that the allocation of nursing time resulted in an inequitable allocation of cost to the SNF distinct part proper?; 4. Was the Intermediary's decision to disregard statistics and supporting documentation for the allocation of all other general service costs to the SNF distinct part proper? |
2002D26 | 96-0623 | 23-0227 | Whether the Provider's renal dialysis exception request (the "Exception Request") should be deemed to have been approved, pursuant to 42 U.S.C. Section 1395rr(b)(7), where the Centers for Medicare & Medicaid Services ("CMS") rendered the determination within sixty days but neither the Intermediary nor the Provider received notice of the determination within sixty working days. |
2002D20 | 98-2883 | 06-5332 | Were the Intermediary's adjustments to the Provider's depreciation expense related to the sale and leaseback of the facility proper? |
2002D23 | 96-1189; 97-0797R | 24-0038 | Whether state-funded days may qualify as Medicaid-eligible days for purposes of the Provider's disproportionate share calculation? |
2002D29 | 98-0452 | 16-0026 | Did the Provider qualify for a payment adjustment due to a decline in its discharges for fiscal year ending June 30, 1995? |
2002D28 | 96-1240 | 05-0224 | 1. Was the Intermediary's treatment of cell biology laboratory expense and revenue proper?; 2. Was the Intermediary's determination of reimbursable Medicare bad debts proper?; 3. Was the Intermediary's treatment of the rental expenses for the nursing administration and OB education departments proper?; 4. Was the Intermediary's determination of nonreimbursable costs for the unused space cost center proper? |
2005D67 | 98-2026 | 41-0007 | Whether a resident's research time must be directly related to the disgnosis and usual care of an individual patient in order to include such time in the Full-Time Equivalent (FTE) count for Indirect Medical Education (IME) purposes, and, if so, can the Provider prove that the research time it seeks to include in its FTE count for IME purposes was spect in research directly related to the diagnosis and usual care of individual patients for the fiscal year ended (FYE) 9/30/96. |
2005D69 | 01-3317 | 39-7086 | Whether the Intermediary's adjustment of accounting fees was proper. |
2005D70 | 98-1725; 99-2325; 02-1682 | 21-7084 | 1. Whether the Intermediary's adjustment applying the Salary Equivalency Guidelines (SEGs) or "physical therapy compensation guidelines" to fee-for-service employee compensation was proper (Case Nos. 98-1725 (FYE 6/30/95) and 99-2325 (FYE 6/30/96)).; 2. Whether it was proper for the Intermediary to make an ajustment reclassifying interest expenses. (case No. 02-1682 (FYE 6/30/99)). |
2002D17 | 00-1736 | 39-7095 | Was the Intermediary's reclassification of the salaries and benefits attributable to the unallowable activities from the administrative and general ("A & G") cost center to a non-reimbursable cost center proper? |
2002D14 | 94-3354; 95-1196 | 05-0040 | Was the Intermediary and Center for Medicare and Medicaid Services ("CMS," formerly the Health Care Financing Administration) denial of the Provider's request for a change in its base period for purposes of the TEFRA rate of increase ceiling for its PPS-exempt psychiatric unit in the fiscal years ending ("FYE") June 30, 1992 and June 30, 1993 proper? |
2002D10 | 97-3094 | 06-7199 | Was the Intermediary's adjustment disallowing yellow page advertisement expense proper? |
2002D11 | 98-1968 | 33-5521 | Was the Intermediary's adjustment to unpaid interest expense proper? |
2002D13 | 01-3205G | 50-0023; 44-0131; 45-0059 | Whether the Intermediary improperly determined the Provider's DSH adjustments by excluding observation bed days from the DSH bed day calculation in violation of the applicable regulation and manual provisions. |
2002D16 | 98-2627 | 39-0073 | Was the Intermediary's adjustment to the Provider's number of beds by 116 and corresponding revision of the Provider's reimbursement for indirect medical education costs proper? |
2002D15 | 97-1432 | 20-0066 | 1. Was the Intermediary's denial of the Provider's request for a sole community hospital (SCH) decreased volume adjustment proper?; 2. Does the Board have jurisdictional authority to allow the Intermediary to adjust Provider's Medicare reimbursement for fiscal year (FY) 1994 to include an allowance for Medicare/Medicaid crossover bad debt? |
2002D12 | 00-0479 | 15-7425 | Was the Intermediary's adjustment reclassifying a portion of the Hospice Director's salary proper? |
2002D09 | 00-1180 | 06-7256 | 1. Was the Intermediary's adjustment to reclassify cost to the Community Education cost center proper?; 2. Was the Intermediary's adjustment to reclassify travel expense to the Community Education cost center proper? |
2002D01 | 00-1056, 99-3600, 00-1057 | 45-0352 | Were the Intermediary's adjustments to the number of available beds for disproportionate share (DSH) qualification purposes proper? |
2002D06 | 98-0511 | 03-5145 | Did the Intermediary calculate the provider's bad debts properly? |
2002D05 | 96-0550 | 19-5258 | Was the Intermediary's denial of a routine cost limit exemption as a new provider proper? |
2002D03 | 98-3317G; 98-2888G | 03-0002, 03-0065, 03-0001, 03-0089 | Was the Intermediary's adjustment to home office interest expense proper? |
2002D07 | 98-0490 | 49-0009 | Was the Intermediary's computation of the Provider's graduate medical education cost proper? |
2002D02 | 97-1280G | Various | Did the Intermediary properly reimburse the Provider for drugs and medical supplies purchased from a related party? |
2002D04 | 95-0620 | 36-0163 | Was the Intermediary's adjustment with respect to parking garage revenues proper? |
2002D08 | 97-1048 | 42-0030 | 1. Was the decision of the Health Care Financing Administration ('HCFA'), pursuant to its HCFA Pub. 15-1 Section 2534.5, to refuse to grant an exception for that portion of the Provider's per diem costs which exceed the Routine Cost Limit ('RCL'), but which do not exceed 112 percent of the total peer group mean cost, arbitrary, capricious, an abuse of discretion or not in accordance with law?; 2. Was the Intermediary's adjustment reclassifying the Provider's costs from direct to indirect cost centers arbitrary, capricious, an abuse of discretion or not in accordance with law?; 3. Was the Intermediary's application of the low occupancy adjustment in HCFA Transmittal No. 378, HCFA Pub. 15-1 Section 2534.5.A, arbitrary, capricious, an abuse of discretion or not in accordance with law? |
2001D50 | 98-0787 | 36-0006 | 1. Was the Intermediary's adjustment relating to the determination and calculation of intern and resident FTEs for purposes of the indirect medical education payment proper?; 2. Was the Intermediary's adjustment relating to the determination and calculation of intern and resident FTEs for purposes of the direct medical education payment proper? |
2001D51 | 96-0166 | 04-3001 | Is the Intermediary barred from recovering an overpayment resulting from the issuance of the September 30, 1995 corrected Notice of Program Reimbursement (NPR) for the Intermediary's Notice of Reopening dated January 14, 1987? |
2001D54 | 97-1736 | 44-0161 | Was the decision of the Health Care Financing Administration ('HCFA'), pursuant to its Provider Reimbursement Manual ('PRM') Section 2534.5, to deny an exception for that portion of the Provider's per diem costs which exceed the Routine Cost Limit, but which do not exceed 112% of the total peer group mean cost, arbitrary, caprious, an abuse of discretion or not in accordance with law? |
2001D53 | 96-0180 | 33-0285 | Did the Intermediary use the correct reasonable compensation equivalent ('RCE') limits to disallow a portion of the Provider's hospital-based physicians' compensation? |
2001D52 | 97-2064R, 97-2148R, 98-0474 (On the Record) | 43-0077 | Whether, with respect to the Joint Nursing Education Program, the provisions of Section 4004(b) of the Omnibus Reconciliation Act of 1990 ('OBRA 1990') are applicable to the cost years at issue, and if so, whether the Provider meets the criteria set forth in Section 4004(b)(2) of OBRA 1990 for payment of the claimed costs as reasonable costs? |
2001D48 | 00-1179 | 25-7305 | 1. Was the Intermediary's adjustment, at the Home Office level, to the owner's bonus for untimely liquidation proper?; 2. Was the Intermediary's adjustment, at the Provider level, to employee bonuses for untimely liquidation proper? |
2001D41 | 96-0102 | 17-0001 | Did HCFA properly determine that the SNF routine cost limits exception request was not timely filed? |
2001D43 | 89-1522R | 05-0327 | Was the Provider's computation of the self-disallowance amount of investment income offset against interest expense proper? |
2001D47 | 96-0225 | 14-7525 | Was the compensation paid to HCC's owner reasonable? |
2001D42 | 95-1143 | 33-0285 | Was the Intermediary's application of the reasonable compensation equivalent (RCE) limits to disallow a portion of the Provider's provider-based physician compensation proper? |
2001D44 | 97-1917 | 37-7093 | Was the Intermediary' adjustment to physical therapy labor costs proper? |
2001D49 | 95-1217 | 36-0017 | Was the Intermediary's adjustment disallowing portions of the Part A physician compensation paid by the Provider based on the application of the 1984 reasonable compensation equivalents proper? |
2001D40 | 97-0843 | 01-0079 | Was the Intermediary's disallowance of the Provider's Medicare Part B bad debts for deductibles and coinsurance proper? |
2001D46 | 99-2365G | 06-7032; 06-7201 | Were the Intermediary's adjustments to physical therapy costs proper? |
2001D45 | 98-0095 | 05-7465 | Was the Intermediary's adjustment reclassifying the community liaison's compensation to a non-reimbursable cost center proper? |
2001D32 | 97-2651, 97-2652, 97-2653, 97-2654 | 50-0012; 50-5481 | Did the Health Care Financing Administration ("HCFA") properly deny the Provider's request that its skilled nursing unit ("SNU") receive an exemption from the routine cost limits ("RCLs") as a new provider under 42 C.F.R. Section 413.30(e)? |
2001D33 | 00-1745 | 14-5736 | Was the Intermediary's denial of the Provider's request for an exception to the cost limits relating to the provision of atypical services that were necessary for the efficient delivery of needed health care services proper? |
2001D38 | 98-2619 | 01-5049 | 1. Was the Health Care Financing Administration's ("HCFA's") methodology as set forth in Transmittal No. 378 for determining the amount of the exception from the routine cost limits ("RCLs") for hospital-based skilled nursing facilities ("HB-SNFs") and as applied by the Intermediary to the Provider for fiscal year ended ("FYE") December 31, 1995, a proper interpretation of the Medicare statute and regulations?; 2. Did the Intermediary properly deny the Provider a rollover interim exception for FYE December 31, 1995? |
2001D30 | 97-0160 | 10-4549 | Was the Intermediary's adjustments to the Provider's therapy costs proper? |
2001D37 | 94-2298, 95-1213, 96-0132, 96-2235, 98-0023, 99-0057, 98-2943 | 34-0054 | Was the Intermediary's adjustment to the disproportionate share amount proper? |
2001D35 | 96-0343 | 36-0003 | 1. Was the Intermediary's reclassification of the Provider's allocation of certain administrative salaries and fringe benefits from various ambulatory service areas back to A&G costs proper?; 2. Was the Intermediary's emergency room physician billing revenue against emergency room expense rather than A&G expenses proper? |
2001D31 | 00-0573G | Various | 1. Was the Intermediary's reclassification of routine restorative therapy aide salaries from the physical therapy cost center to the SNF participating and non-participating cost centers proper?; 2. Was the Intermediary's reclassification of the salary used for the employee health and welfare worksheet B-l overhead allocation basis proper? |
2001D34 | 95-1001G | 01-0055, 01-7013, 01-7020, 01-7048, 01-7072 | 1. Was the Intermediary's adjustment to the Provider's allowable costs based on the recapture of depreciation proper?; 2. Does the Intermediary's recapture of depreciation due to a gain on the sale of depreciable assets affect the Provider's calculation of equity capital for prior use? |
2001D39 | 00-2472 | 21-7008 | Was the Intermediary's adjustment subjecting the compensation of employed physical therapists paid on a per visit basis to the contract physical therapy guidelines proper? |
2001D36 | 97-0475 | 36-0003 | 1. Was the Intermediary's reclassification of allocation of certain administrative salaries and fringe benefits proper?; 2. Was the Intermediary's adjustment to clinic dietitians' salary and fringe benefit costs proper? |
2005D68 | 99-2385 | 15-5281 | 1. Whether the Intermediary's adjustment of the square footage statistic for the Physical Therapy department was proper.; 2. Whether the Intermediary's adjustment disallowing owners' compensation was proper.; 3. Whether the Intermediary's denial of the Routine Cost Limit exception request due to the Provider's failure to respond to a documentation request timely was proper. |
2006D20 | 96-1822; 97-1579; 98-1827; 99-2061 | 22-0077 | a. Whether the Centers For Medicare and Medicaid Services' (CMS') determination of the Provider's Medicare Part A / Supplemental Security Income (SSI)percentage, commonly known as the Medicare fraction component of the disproportionate share (DSH)percentage, is incorrect; and, if so, b. Whether the Provider is entitled to (a) an order from the Board directing CMS to correct such determination and the Intermediary to implement and pay any additional amounts due the Provider as the result of such correction; or (b) an order from the Board granting other appropriate relief. |
2001D27 | 99-0095 | 26-7262 | Was the Intermediary's adjustment to remove excess key employee compensation proper? |
2001D20 | 96-1308 | 45-7751 | 1. Was the Intermediary's disallowance of subscription and publication costs proper?; 2. Did the Intermediary properly disallow a portion of the owner's compensation? |
2001D26 | 96-1477, 97-1703, 97-2763 | 29-0007 | Was the Intermediary's determination that the Provider was not eligible for Medicare reimbursement for the disproportionate share adjustment under Section 1886(d)(5)(F)(i)(II) of the Social Security Act proper? |
2001D28 | 97-2018; 99-0881 | 39-5742 | 1. Were the Intermediary's adjustments reclassifying Director of Nursing and Assistant Director of Nursing costs from the Administrative and General Cost Center to the Nursing Administration Cost Center proper?; 2. Were the Intermediary's adjustments reclassifying Social Services costs proper?; 3. Were the Intermediary's adjustments reclassifying over-the-counter drug costs and incontinency costs proper? |
2001D29 | 97-0159 | 10-4549 | Was the Intermediary's adjustments to the Provider's therapy costs proper? |
2001D24 | 97-1699 | 33-0154 | Was the Intermediary's adjustment disallowing certain expenses of compensating hospital based physicians pursuant to the 1984 Reasonable Compensation Equivalency limits proper? |
2001D22 | 98-0229 | 14-7483 | Was the Intermediary's adjustment to skilled nursing and HHA visits proper? |
2001D25 | 99-3163 | 14-7017 | 1. Was the Intermediary's adjustment to the Provider's Administrative and General (A&G) cost center proper?; 2. Was the Intermediary's reclassification adjustment of delivery expenses claimed by the Provider proper?; 3. Was the Intermediary's reclassification adjustment of courier costs claimed by the Provider proper?; 4. Was the Intermediary's adjustment to home office Business Development and Managed Care salaries proper? |
2001D23 | 94-1039; 94-1040 | 23-0001 | Whether the Provider is entitled to interest under 42 U.S.C. Section 1395g(d) for any amounts paid by the Intermediary relating to the Provider's 1990 and 1991 fiscal years, and if so, for what period of time? |
2001D10 | 93-1355 | 45-0388 | Whether the Intermediary erred in determining that there was no capital related interest with respect to interest expense incurred on that portion of the 1989 bonds used to repay the Provider for assets purchased six to twelve months prior to the bond issuance? |
2001D11 | 95-2183; 97-3095 | 36-0051 | Did the Intermediary use the correct reasonable compensation equivalent ("RCE") limits to disallow a portion of the Provider's hospital-based physicians' compensation? |
2001D13 | 95-2033, 96-1979, 97-1498, 98-2049 | 04-0036 | Were the Intermediary's adjustments disallowing pass-through cost reimbursement of nursing education costs proper? |
2001D14 | 95-1296 | 33-0106 | Did the Intermediary use the correct reasonable compensation equivalent ("RCE") limits to disallow a portion of the Provider's hospital-based only physicians' compensation? |
2001D19 | 91-1844 | 05-0457 | Did the Intermediary properly adjust outpatient surgery, anesthesia and supply charges? |
2001D16 | 95-2234, 97-0068, 97-2678 | 22-7029 | 1. Was the Intermediary's adjustment reclassifying advertising costs to a non-reimbursable cost center proper? (1993, 1994, 1995) ; 2. Was the Intermediary's adjustment reclassifying fundraising costs to a non-reimbursable cost center proper? (1994) |
2001D17 | 97-2425 | 05-0455 | 1. Was the Intermediary's adjustment reclassifying the Provider's costs from direct to indirect cost centers proper?; 2. Was the Health Care Financing Administration's ("HCFA's") refusal to grant an exception from that portion of the Provider's per diem cost which do not exceed 112 percent of the total peer group mean cost proper? (On the record.) |
2001D02 | 96-0423G, 99-0448G, 99-2082G | 05-5916, 05-5053, 05-6261, 55-5658 | Were the Intermediary's adjustments to disallow costs related to the Provider's airplane proper |
2001D09 | 92-0111 | 51-0039 | Was the Intermediary's analysis and application of the Medicare "Spend down" ("S-D") procedure for curing $4 million dollars of unnecessary borring ("UB" proper? |
2001D03 | 92-1220; 93-0473 | 05-0025 | Was the Intermediary's adjustment to the number of available beds for indirect medical education ad |
2001D05 | 97-0693 | 05-0390 | Was the Intermediary's determination of inpatient and outpatient Medicare bad debts proper? |
2001D04 | 98-0627 | 15-4014 | 1. Was the Intermediary correct in its disallowance of Provider component hours for provider-based physicians?; 2. Was the Intermediary correct in its adjustments to total charges and Medicare charges for the clinic cost center? |
2001D08 | 94-3107 | 33-0058 | Was HCFA's denial of the Provider's ESRD composite payment rate exception proper? |
2001D07 | 97-2509 | 14-5111 | Was the Intermediary's adjustment to the routine cost limit proper? |
2001D01 | 99-1249 | 14-5335 | Is the Provider entitled to an exception to the skilled nursing facility routine service cost limits for fiscal year ending 1995? |
2001D06 | 97-0139R | 39-5095 | Was the Intermediary's reclassification of employment taxes proper? |
2005D71 | 02-0399, 02-1946 | 15-0029 | Were the Intermediary's adjustments to the count of full-time equivalent interns and residents proper? |
2005D72 | 99-2472 | 05-0603 | Whether CMS' denial of the Provider's request for a new provider exemption based upon a finding of an untimely submission in response to a request for additional documentation was proper. |
2006D01 | 98-0502 | 24-0010 | Was the Intermediary's denial of the Provider's request for an adjustment to its TEFRA target amount due to untimely filing of a request proper? |
2006D02 | 02-1686 | 23-0020 | Is expedited judicial review (EJR) appropriate for the question of whether the Centers for Medicare & Medicaid Services (CMS) undercounted the patient days for patients entitled to Supplemental Security Income (SSI) which is used to compute the disproportionate share (DSH) adjustment? |
2006D03 | 02-1765, 02-1766, 02-1767, 03-0825 | 31-4013 | Whether the Intermediary's adjustments to disallow reimbursement for physicians' professioanl services on a reasonable cost basis was proper. |
2006D04 | 99-1295 | 15-5478 | Was the Intermediary's adjustment to owners' compensation proper? |
2006D05 | 94-2729 | 14-0119 | 1. Whether the Intermediary's adjustment to and calculation of the Provider's disproportionate share hospital payment (DSH) was proper, specifically relating to the inclusion of general assistance days.; 2. Whether the Intermediary's calculation of the number of interns and residents and the amount of allowable costs for fiscal year 1991 for purposes of the Provider's graduate medical education programs (GME) was proper.; 3. Should the Intermediary have reclassified expenses relating to the Inn at University Village as investment losses and offset such losses against investment income rather than disallowing them entirely? |
2006D07 | 99-3690G | Various | 1. Did Michael Reese Hospital (Reese) fail to exhaust its administrative remedies for a correction to its wage data during the February-March 1998 window for correcting wage data?; 2. Did Reese Hospital nevertheless meet the criteria for a correction in the mid-year correction process as a data entry or tabulation error?; 3. Can other hospitals in the same Metropolitan Statistical Area (MSA) seek a correction to the wage data for Reese Hospital? |
2006D08 | 03-0009G | Various | Whether the Intermediary's adjustments reallocating key employee and owners' bonuses were proper. |
2006D09 | 04-0412 | 26-0039 | Whether the Intermediary's computation of the adjustment due the Provider for a decrease in discharges experienced in FY 2000 was correct. |
2006D10 | 03-1555, 04-0387 | 45-0162 | Whether or not Highland Medical Center has 100 or more available beds for Medicare disproportionate share adjustment qualification and payment purposes. |
2000D06 | 96-0053G | 46-5067, 46-5068, 49-5049, 46-5075 | Did the Intermediary improperly disallow the time studies the Providers used for allocation of nursing administration, medical records and social services? |
2000D01 | 97-0602 | 07-7133 | Was the Intermediary's adjustment to disallow franchise fees correct? |
2000D03 | 97-2434 | 05-0109 | Did the Intermediary properly implement PRRB Decision No. 96-D35? |
2000D07 | 94-2649 | 45-0037 | 1. Was the HHA cafeteria allocation statistic proper?; 2. Were the HHA administrative costs proper? |
2000D04 | 94-0426, 94-0429 | 03-0002 | Must the Provider have a written agreement with its related facilities in order to have the resident rotations included in its GME count? |
2000D05 | 94-0327 | 14-0032 | Was the Health Care Financing Administration's ("HCFA") denial of the Provider's request for classification as a sole community hospital proper? |
2000D10 | 94-3018, 94-3019, 94-3020, 94-3021, 95-2194 | 39-5580 | 1. Was HCFA's decision limiting SNF routine cost limit exception relief for fiscal years 1987 through 1990 and 1993 proper?; 2. Was HCFA's denial of the Provider's request for an exception to its routine cost limits for fiscal years ended June 30, 1991 and 1992 due to untimely filing proper? |
2000D13 | 94-0718 | 31-0001 | 1. Did the Intermediary err by including the Provider's fourteen neonatal intensive care unit ("NICU") beds when calculating the Medicare reimbursement for costs relating to indirect medical education ("IME")?; 2. Did the Intermediary err by including NICU days when calculating the Provider's Medicare reimbursement for graduate medical education ("GME") costs? |
2000D14 | 95-1201 | 03-0024 | 1. Were the Intermediary's adjustments excluding certain interest expense proper?; 2. Were the Intermediary's adjustments grossing up days and charges for employee patients proper? |
2000D11 | 96-0498 | 16-0045 | Was HCFA's determination denying the Provider's request for an exception to its routine cost limits for its atypical skilled nursing facility costs proper? |
2000D12 | 95-0068 | 38-0024 | Was the Intermediary's or HCFA's determination regarding the Provider's TEFRA exception request proper? |
2000D08 | 95-0527 | 36-0163 | Was the denial of Provider's End Stage Renal Disease ("ESRD") composite rate exception request based on atypical service intensity/patient mix proper? |
2000D09 | 98-1081 | 06-7201 | Were the Intermediary's adjustments to owners' compensation proper? |
2006D14 | 03-0176 | 07-5407 | Whether the Intermediary properly denied the Provider's new provider exemption request. |
2006D11 | 02-0812 | 05-0069 | Whether the denial of the Provider's request for an exception to the renal dialysis composite rate by the Centers for Medicare and Medicaid Services (CMS) was proper. |
2006D13 | 01-2940 | 05-0145 | Whether for purposes of the Provider's disproportionate share (DSH) adjustment calculation, the Provider is entitled to an increased number of days of care rendered to eligible Medicaid beneficiaries. |
2006D12 | 99-3024 | 24-0093 | Whether the Intermediary's adjustment to reduce the unweighted FTE resident count and related adjustment cap for time spent by residents providing services at the Mankato Clinic was proper. |
2006D15 | 02-1526 | 19-7060 | Whether the Intermediary's disallowance of medical director fees was proper. |
1999D001 | 93-0824+ | 18-0124 | Was the Intermediary's adjustment toMedicare bad debts proper? |
1999D002 | 92-1027 | 50-0054 | Did the Intermediary properly include neonatal intensive care unit ("NICU") beds in the Provider's available bed count used for the indirect medical education ("IME") calculation? |
1999D003 | 95-2373 | 10-7281 | 1. Was the Intermediary's adjustment to employee salary and benfits proper?; 2. Was the Intermediary's adjustment to Advertising proper?; 3. Was the Intermediary's adjustment to Deferred compensation proper?; 4. Was the Intermediary's adjustment topayroll benefits/ profit sharing proper; 5. Was the Intermediary's adjustment to dues and subscriptions proper?; 6. Was the Intermediary's adjustment to auto insurance and auto lease expense proper?; 7. Was the Intermediary's adjustment to liability insurance expense proper?; 8. Was the Intermediary's adjustment to professional accounting expense proper?; 9. Was the Intermediary's adjustment to salaries and benefits for intake coordinators proper?; 10. Was the Intermediary's adjustment to auto mileage/ allowance expense proper?; 11. Was the Intermediary's adjustment to staff travel/education expense proper?; 12. Was the Intermediary's adjustment to education/other expense proper?; 13. Was the Intermediary's adjustment to miscellaneous expense proper?; 14. Was the Intermediary's adjustment to bonus expense proper?; 15. Was the Intermediary's adjustment to owner's compensation expense proper?; 16. Was the Intermediary's adjustment to overhead expense proper?; 17. [withdrawn] |
1999D004 | 95-0907 | 31-0073 | Was the Intermediary's calculation of the Provider's disproportionate share hospital adjustment proper? |
1999D005 | 94-2470 | 39-4023 | Was the Intermediary's use of the reasonable compensation equivalent ("RCE") limits from 1984 to reduce the amount of reimbursable compensation paid to its hospital-based physicians ("HBPs") for fiscal year ended ("FYE") 1991 proper? |
1999D006 | 93-1518+/C | 51-0007 | 1. Was the Intermediary's treatment of equity income as investment income proper?; 2. Does 42 C. F. R. Section 412.106, as promulgated, violate the Medicare Act, the Administrative Procedure Act and/or the Constitution? |
1999D008 | 96-0640 | 21-5264 | 1. Was HCFA's denial of the Provider's request for an exemption from the skilled nursing facility routine cost service limitation, as a new provider, Proper?; 2. Was the Intermediary's denial of the Provider's request for an exemption from the skilled nursing facility routine cost service limitations, based upon atypical services, without an occupancy adjustment, proper? |
1999D009 | 94-2203 | 11-6571 | Was the Intermediary's adjustment to bad debt proper? |
1999D010 | 89-1103 | 05-0128 | Was the Intermediary's adjustment to reclassify all identified purchased repairs and maintenance expences from the individual cost centers to the maintenance overhead cost center proper? |
1999D011 | 97-0831 | 40-7014 | Was the Intermediary's audit adjustment to durable medidcal equipment ("DME") bad debts proper? |
1999D012 | 93-0451, 93-1941 | 44-7425 | Was the Intermediary's adjustment of management fees proper? |
1999D013 | 91-2935M | 07-0016 | Was the Intermediary's refusial to reclassify as graduate medical education ("GME") costs certain physician compensation costs and related secretarial compensation costs originally classified as non-GME operating costs on the Provider's GME base-year cost report proper? |
1999D014 | 94-3074, 95-2199 | 14-0088 | 1. Was the Intermediary's calculation of the Provider's number of beds for purposes of determining the Provider's IME adjustment proper?; 2. Was the Intermediary's payments for outlier cases proper pursuant to 42 U.S.C. Section 1395ww(d)(5)9A0(iv), insofar as total outlier payments by the Secretary in the fiscal years in question were less than five percent of the total payments made based on DRG prospective payments for the years in question? |
1999D015 | 94-0030 | 23-6563 | 1. Was the Intermediary's adjustment to Medicare charges relating to settlement data based on information contained in the PS&R report proper?; 2. Was the Intermediary's adjustment to Medicare payments proper? |
1999D016 | 92-1962G | Various | Should the revised Dallas-Fort Worth wage indexes be effective October 1, 1991? |
1999D017 | 91-2308, 94-2352, 94-1066 | 26-0021 | Was the Intermediary's reclassification of the Provider's nursing school library costs from the nursing school cost center to the administrative and general cost center proper? |
1999D018 | 94-2471 | 39-0142 | Was the Intermediary's methodology for determining physicians'Part A costs (reasonable compensation equivalents) proper? |
1999D019 | 95-1242+, 95-1242C | 39-0118 | Was the Intermediary's determination regarding the Provider's prospective payment system capital rate proper? |
1999D020 | 91-1734 | 50-0025 | Was the Intermediary's adjustment to bad debts proper? |
1999D007 | 94-1896, 95-1021 | 19-0158 | Was the Provider entitled to be reimbursed for the costs incured in connection with an abandoned hospital expansion project? |
1999D022 | 93-1886 | 05-5837 | Is the Provider entitled to the full exception request to the , which is sought from HCFA? |
1999D023 | 93-0178, 93-0518, 92-1084 | 10-4013 | Was the Provider entitled to an adjustment to the TEFRA rate of increase ceiling for the cost reoprt periods ended May 31, 1988, May 31 1989, and May 31, 1990? |
1999D024 | 93-0688, 94-0445, 94-2071 | 45-0007 | 1. Were the Intermediary's disallowances of interest expense resulting from the sale of the Provider to Sid Peterson Memorial Hospital ("SPMH") proper?; 2. Were the Intermediary's adjustments to disallow public relations expense and establish a non-reimbursable cost center for marketing proper? |
1999D025 | 94-2452 | 11-3027 | Were the sale and lease of the Provider Transactions between related organations? |
2006D16 | 04-0426 | 05-0122 | Whether the Intermediary's disallowance of the Provider's inpatient and outpatient Medicare bad debts was proper? |
2006D17 | 99-3635 | 22-5387 | Whether CMS' denial of the Provider's request for an exception to the routine cost limits for skilled nursing facilities as a provider of atypical services was proper? |
2006D18 | 00-0548, 00-0609 | 49-7033 | Was the Intermediary's adjustment applying Medicare's Physical Therapy Compensation Guidelines to the Provider's employee physical therapists proper? |
2006D19 | 04-0133 | 03-0101 | Whether the Intermediary's adjustment of the Provider's disproportionate share (DSH) calculation was based upon a proper interpretation of the Medicare DSH statute as amended by the Benefits Improvement and Protection Act of 2000. |
2006D06 | 97-2444, 98-2580, 99-3445, 99-3383G, 00-1426 | 37-7120, 37-7417 | 1. Whether the adjustments to the Providers' physical therapy costs were proper - applies to Case Nos. 97-2444, 98-2580, 99-3445 and 00-1426.; 2. Whether the adjustments to the Providers' travel costs were proper - applies to Case Nos. 97-2444 and 98-2580.; 3.Whether the adjustments to the Providers' home infusion costs were proper - applies to Case Nos. 99-3383G and 00-1426. |
1999D021 | 91-2474M | 22-0104 | I. Was the Intermediary's reclassification of compensation for payroll physicians proper?; 2. Was the Intermediary's reclassification of teaching compensation for contract physicians proper?; 3. Was the Intermediary's disallowance of teaching time spent by contract physicians proper? |
1999D026 | 94-1159 | 39-0142 | Was the Intermediary's use of reasonable compensation equivalent ("RCE") limits fromm 1984 to reduce the amount of compensation paid by the Provider to its hospital-based physicians for fiscal year 1990 proper? |
2006D21 | 01-0546G | Various | Whether the Intermediary appropriately denied the Provider's requests for an exception to the Medicare allowable hourly salary equivalency amount for physical therapy. |
2006D22 | 01-0820 | 14-0052 | Whether the Intermediary properly excluded patient days attributable to Medicare Health Maintenance Organization (HMO) encounters from the calcualtion of the Provider's disproportionate share adjustment. |
2006D23 | 00-2689 | 39-0102 | Whether the Intermediary's audit adjustments to the Medicare cost report that disallowed the loss on disposal of depreciable assets due to the facility's change of ownership (CHOW) were proper. |
2006D24 | 03-0259; 03-0260 | 31-6597; 31-6625 | Whether the Intermediary's adjustments were proper that disallowed the Providers' claimed Medicare Bad Debts, disallowed in a prior year period. |
2006D25 | 01-1397; 01-1398 | 21-7118 | 1. Whether the Intermediary's application of Medicare's physical therapy guidelines to physical therapists paid on a per-visit basis was proper. (Applies to both cost reporting periods at issue - - case numbers 01-1397 and 01-1398.); 2. Whether the Intermediary's adjustment to include charity care home health visits in the calculation of the Provider's program reimbursement was proper. (Applies only to the Provider's fiscal year 1996 cost reporting period - - case number 01-1397.) |
2006D26 | 02-0632 | 30-0003 | Whether the denial of the Provider's request for an exception to the renal dialysis composite rate by the Centers for Medicare and Medicaid Services (CMS) was proper. |
2006D27 | 00-1020 | 03-0030 | Whether the Intermediary improperly failed to offset investment losses incurred by the Provider's home office against interest income earned on funds the Provider deposited with a trustee to retire the debt associated with an advance refunding transaction. |
2006D28 | 04-0783; 04-0819 | 14-0007; 04-0093 | Whether the Intermediary's adjustment to school of nursing costs was based upon a proper application of the effective date articulated in Section 6205(a)(2) of the Omnibus Budget Reconciliation Act of 1989. |
2006D29 | 97-1202; 99-2900 | 33-0059 | 1. Were the Intermediary's adjustments offsetting rental income received by the Provider for employee housing against both operating and capital costs proper?; 2. Was the Centers for Medicare & Medicaid Services' methodology for determining the Provider's exceptions to the hospital-based skilled nursing facility cost limits proper? |
2006D30 | 00-3284; 00-3619; 01-0598 | 19-5301; 19-5302; 19-5304 | Whether the Intermediary's adjustments to reduce the Providers' outpatient therpay costs by 10 percent were proper? |
2006D31 | 93-1227+; 93-1227C | 05-0040 | Whether the Provider is entitled to the benefit of the previously granted change in the TEFRA bas period, from fiscal year ending (FYE) June 30, 1985 to FYE June 30, 1988, for the purpose of applying the TEFRA limit for the Provider's FYE June 30, 1990. |
2006D32 | 01-2850 | 37-0078 | 1. Whether the closing costs of $943,089, incurred for the sale of the hospital are allowable as a deduction from the salles price to determine gain or loss on the sale.; 2. Whether a portion of the sales proceeds received by the Provider from the sale of its hospital should be allocated to medical records and assembled work force assets to determine the amount of gain or loss on the sale. |
1999D27 | 94-2772 | 45-0035 | Was the denial of the Provider's request for an adjustment to the TEFRA limits because of untimely filing, proper? |
1999D28 | 94-0152 | 39-0158 | Was HCFA's denial of the Provider's request for an exceptionfor its TEFRA target rate adjustment for its exempt psychiatric unit for the fiscal year June 30, 1988 due to untimely filing, proper? |
1999D29 | 92-0668 | 34-0113 | Did the Intermediary properly reopen the Provider's cost report and recoup an overpayment made to the Provider? |
1999D30 | 93-1376G | Various | Was the Intermediary's classification of the Louisianna franchise tax as an operating cost rather than a capital cost proper? |
1999D31 | 93-1475 | 05-0329 | Was the Intermediary's adjustment offsetting revenue associated with physician and guest meals, while, at the same time, setting up a nonreimbursable cost center for these nonallowable costs, proper? |
1999D32 | 97-1195; 97-1192; 95-1564; 97-1191 | 23-7201 | 1. Was the Intermediary's adjustment to the asset valuation of the employee stock ownership plan (ESOP) proper? (For 1990, 1991, and 1992 only); 2. Was the Intermediary's adjustment to interest expense proper? (For 1992 and 1994 only) |
2006D33 | 00-2873; 00-2874; 01-1931 | 09-7000 | Whether the Intermediary's adjustment applying Medicare's Physical Therapy Compensation Guidelines to the Provider's employee physical therapists was proper. |
2006D34 | 95-0315G | 45-4069; 45-3038 | Whether the Intermediary's denial of the Providers' request for an exception to the related organization principle for calendar years 1989 through 1992 was proper. |
2006D35 | 01-0991 | 14-4646 | 1. Whether the Intermediary's adjustment to complete all cost reporting forms in conformity with current regulations and instructions was proper.; 2. Whether the Intermediary's adjustment to correct all math and flow-through errors arising on revision of the cost report was proper.; 3. Whether the Intermediary's adjustment to the amortization of start-up costs applicable to the 1998 cost reporting period was proper.; 4. Whether the Intermediary's adjustment to unsupported/unliquidated expenses related to accounting and consulting services, legal fees, computer billing expenses, housekeeping costs and accrued A&G costs was proper.; 5. Whether the Intermediary's adjustment reclassifying costs associated with medical and professional services was proper.; 6. Whether the Intermediary's adjustment to expenses associated with the Chicago Community Education Program was proper.; 7. Whether the Intermediary's adjustment to food costs from Sam's Club was proper.; 8. Whether the Intermediary's adjustment to unsupported interest and banking charges, contract labor, psychiatrist's services, professional services - group therapy and catering expenses was proper.; 9. Whether the Intermediary's adjustment to rent expense was proper.; 10. Whether the Intermediary's adjustment to depreciation expense was proper.; 11. Whether the Intermediary's adjustment reclassifying telephone and wire service expenses to the Administrative and General (A&G) cost center was proper.; 12. Whether the Intermediary's adjustment reclassifying security and maintenance expenses to the Plant Operations cost center was proper.; 13. Whether the Intermediary's adjustment incorporating Medicare charges per the Provider Statistical and Reimbursement Report (PS&R) dated 2/29/00 was proper.; 14. Whether the Intermediary's adjustment to reflect gross salaries statistics on Worksheet B-1 was proper.; 15. Whether the Intermediary's adjustment to the square footage statistics was proper.; 16. Whether the Intermediary's adjustment to reflect the settlement data shown on the PS&R dated 2/29/00 was proper.; 17. Whether the Intermediary's adjustment to bad debts was proper. |
2006D36 | 02-2110G | Various | Whether the Intermediary properly determined that bad debts claimed related to uncollectible deductibles and coinsurance for services rendered to patients that were dually eligible for Medicare and Medicaid, also known as qualified Medicare beneficiaries (QMB), that were paid under the Medicare Part B fee screen do not constitute bad debts under applicable Medicare law and regulations. |
2006D37 | 02-0140 | 07-0007 | Whether the Intermediary's adjustment to disallow the Connecticut Sales Tax was proper. |
2006D38 | 98-1822 | 07-0028 | Whether the Intermediary's adjustment to disallow the Connecticut Sales Tax was proper. |
2006D39 | 01-2871 | 05-0327 | Whether the denial of the Provider's request for an exception to the end stage renal disease (ESRD) composite rate by the Centers for Medicare and Medicaid Services (CMS) was proper. |
2006D40 | 01-2872 | 05-2550 | Whether the denial of the Provider's request for an exception to the end stage renal disease (ESRD) composite rate by the Centers for Medicare and Medicaid Services (CMS) was proper. |
1999D33 | 91-2887 | 14-0087 | Was the Intermediary's netting of the balance due to Edgewood Hospital of liabilities owed to the program by Edgewood Medical Center proper? |
1999D34 | 97-0354G | Various | Did the Providers properly classify workers' compensation costs under the category of administrative and general costs instead of employees benefits costs? |
1999D35 | 89-1782R | 33-0041 | Were the Intermediary's adjustments reclassifying the lease rental costs reported as capital costs proper? |
1999D36 | 91-1440 | 05-0194 | Was the Intermediary's adjustment modifying the disproportionate share adjustment amount proper? |
1999D37 | 84-0407; 88-1478 | 26-6512 | Jurisdiction: 1. Were the Intermediary's PSRO and PIP deductions from the remittance advices in payment checks in the amount of $25,455 proper?; 2. Did the Intermediary fail to make timely reimbursement to the Provider for its covered services?; 3. Should the Intermediary reimburse the Provider for its cost of money by paying interest on all payments or awards granted by the PRRB?; 4. Was the Intermediary's adjustment to interim payments proper?; 5.Was the Intermediary's adjustment toerrors on non-covered charges proper?; 6. Did the Intermediary fail to make proper state Medicaid filings?; 7. Was the Intermediary's adjustment to the Provider of remittance advices and payment checks proper?; 8. Did the Intermediary fail to make timely reimbursement to the Provider for its covered services thereby entitling the Provider to interest on such late payments and on all payment checks granted by the PRRB? |
1999D38 | 96-2150 | 22-5664 | Was the Provider entitled to an exemption from the skilled nursing facility routine service cost limits as a "new provider"? |
1999D39 | 93-1522 | 05-4003 | Was the Intermediary's or the Health Care Financing Administration's ("HCFA") determination of the Provider's request for an adjustment to the rate-of-increase ceiling proper? |
1999D40 | 88-0373 | 06-0098 | Was the DRG amount, other than outlier payments, calculated correctly under Medicare law and PPS regulations? |
1999D41 | 96-2199 | 16-0088 | 1. Did the Intermediary, in the course of considering the Provider's request for a Medicare Dependent Hospital (MDH) volume adjustment, have jurisdiction to waive compliance with the applicable time requirement and to grant the Provider a one-day extension of time?; 2. If so, did the circumstances in this case merit such a waiver and extension? |
1999D42 | 92-0215; 94-0239 | 05-0226 | Was the Intermediary's adjustment to offset investment income earned from a related organization proper? |
1999D43 | 89-0910 | 05-0153 | Was the Health Care Financing Administration's ("HCFA") refusal to excude the Campbell alcohol and chemical dependency recovery unit from the prospective payment system ("PPS") because it did not meet applicable State licensure law proper? |
1999D44 | 96-0529 | 52-5394 | Were the Intermediary's adjustments to ancillary cost centers proper? |
1999D45 | 98-0105 | 23-6616 | Was the Intermediary's adjustment to owner's compensation Proper? |
1999D46 | 95-1043 | 39-5481 | Was the Intermediary's determination that the transportation costs for services provided by Today's Staffing Services Incorporated were not reasonable, necessary or related to patient care proper? |
1999D47 | 95-0931 | 01-0139 | Was the Provider's request for an exception to its TEFRA target rate proper? |
1999D48 | 95-0492E; 97-0952E;97-2389E | 20-7026 | 1. Were the Intermediary's adjustments to building costs by the creation of separate cost centers and the elimination of common area costs proper?; 2. Was the Intermediary's adjustment reclassifying supervisor salaies and benefits proper? |
1999D49 | 93-1505 | 22-0077 | Was the Intermediary's disallowance of Medicare bad debts proper? |
1999D51 | 94-0198 | 01-0079 | Was the Intermediary's attempt to recover Disproportionate Share Hospital (DSH) payments from the Provider for FYs 89 and 90 proper? |
1999D52 | 94-2925 | 28-0034 | Was the Intermediary's disallowance of the Provider's excess dialysis costs, based upon the Health Care Financing Administration ("HCFA's") denial of the Provider's exception request, correct? |
1999D53 | 94-1156 | 39-4023 | Was the Intermediary's application of the 1984 Reasonable Compensation Equivalent (RCE) limits proper? |
1999D54 | 97-3024 | 55-7160 | Was the Intermediary's adjustment reclassifying non-allowable costs of community liason employees to a non-reimbursable cost center proper? |
1999D55 | 94-2504 | 04-0022 | Were the Intermediary's adjustments disallowing the pass-through of nursing education costs proper? |
1999D56 | 96-0174G | Various | Were the Intermediaries' adjustments eliminating or disallowing the Providers' "gross-up" of drug charges and costs in order to allocate indirect costs to those cost centers correct? |
1999D57 | 95-1188R | 050235; 55-5046 | Was the Intermediary's denial of the Provider's Routine Cost Limits exception proper? |
1999D58 | 95-0308R | 05-0235; 55-5046 | Was the Intermediary's denial of the Provider's Routine Cost Limit exception proper? |
1999D59 | 97-0139 | 39-5095 | 1. Was the Intermediary's reclassification of employment taxes proper?; 2. Was the Intermediary's adjustment to owner's compensation proper? |
1999D60 | 96-2056 | 23-7141 | 1. Was the Intermediary's adjustment to interest expense relating to employment taxes proper?; 2. Was the Intermediary's adjustment to interest expense relating to property taxes proper? |
1999D61 | 97-2340 | 01-5049 | 1. Was HCFA's methodology as set forth in Transmittal 378 for determining the amount of the exception from the routine cost limits for hospital-based skilled nursing facilities, and as applied by the Intermediary to the Provider for FYE December 31, 1994, a proper interpretation of the Medicare statute and regulations?; 2. Did the Intermediary properly deny the Provider a rollover interim exception for FYE December 31, 1994? |
1999D62 | 96-0122 | 38-5161 | Was the Intermediary's adjustment limiting contracted occupational therapy and speech therapy costs to $104 per hour proper? |
1999D63 | 94-3180 | 36-0085 | Was the Intermediary's adjustment to the outlier payments proper? |
1999D64 | 96-1263 | 52-5419 | Was the Intermediary's adjustment to apply the lower-of-costs or charges principle to the Provider's Part B cost of physical, occupational, and speech therapy properly applied? |
1999D65 | 94-3026 | 19-7317 | Was the Intermediary's adjustment to Worksheet A-8-3 proper? |
1999D66 | 98-0211GE | Various | Did the Intermediary properly determine that the Providers had less than 100 "beds" for the fiscal years in question? |
1999D67 | 96-0869 | 19-0207 | Was HCFA's measurement of an exception to the cost limits for hosiptal-based SNFs from 112% of the mean hospital-based inpatient routine service costs, instead of from the hospital-based SNF routine cost limit, proper? |
1999D68 | 98-2042; 98-2046 | 33-7005; 33-7002 | This decision is a reissuance of the original PRRB Dec. No. 99-D68 issued on 9/17/1999. In the original decision, the Board modified the Intermediary's adjustment and specified a new utilization and apportionment statistic. The parties to the decision asked the Board to clarify how the adjustment should be implemented. This decision more clearly defines the adjustment methodology. ; 1. Was the Intermediary's adjustment to home health aide hours proper?; 2. Was the Intermediary's adjustment to public relations costs proper?; 3. Was the Intermediary's adjustment to medical supply costs proper? |
1999D69 | 97-0503 | 21-5282 | Was the Health Care Financing Administration's ("HCFA") denial of the Provider's request for an exemption to the routine cost limits as a new provider under 42 C.F.R. Section 413.30(e) proper? |
1999D71 | 96-1086 | 44-0182 | 1. Was the Intermediary's adjustment disallowing Medicare reimbursement for a portion of the Provider's bad debts proper?; 2. Was the Intermediary's reclassification of home health agency costs proper? |
1999D72 | 97-2381 | 26-7140 | Did the Health Care Financing Administration ("HCFA") properly deny the Provider's request for an exception to the home health agency cost limits based on atypical services ? |
1998D001 | 92-1498 | 14-0179 | 1. Was the Intermediary's necessity of borrowing determination with regard to the Provider's Illinois Health Facility Authority (IHFA) loan proper?; 2. Did the Intermediary properly include the Provider's neonatal unit beds and days in the indirect medical education (IME) and graduate medical education (GME) patient load calculation for the fiscal year ended June 30, 1989?; 3. Did the Intermediary properly allocate the Providers investment income consistent with the allocation of interest expense? |
1998D002 | 91-1163E; 92-0895 | 24-0036 | Was the Intermediary's adjustment excluding from capital-related costs the Provider's payments for the rental of a mobile magnetic resonance imaging ("MRI") unit proper? |
1998D003 | 91-0133 | 03-4001 | Is the Provider entitled to an adjustment to its TEFRA limits for malpractice insurance costs for FYEs June 30, 1986 and June 30, 1987? |
1998D004 | 91-1441 | 06-0015 | Was the Intermediary's adjustment reclassifying air ambulance lease rental payments from capital costs to operating expenses proper? |
1998D005 | 96-2054 | 45-7789 | Was the Intermediary's adjustment shifting nursing and home health aide costs to a privite duty nursing cost center proper? |
1998D006 | 93-0228 | 24-0053 | Did the Intermediary properly disallow the physician's Part A compensation? |
1998D007 | 94-3386 | 33-7243 | Was the Intermediary's adjustment reversing the direct assignment of the New York sub-unit costs proper? |
1998D008 | 91-2866M | 33-0214 | Were the Intermediary's adjustments to the graduate medical education ("GME") base year costs proper? |
1998D013 | 96-2058 | 10-5883 | Is the Provider exempt from the skilled nursing facility ("SNF") routine cost limits as a "new provider"? |
1998D014 | 92-0430 | 10-5201 | Was the Health Care Financing Administration's (HCFA) denial of the Provider's exception request proper? |
1998D016 | 85-1109 | 39-0079 | Were the Intermediary's adjustments to the Provider's interest expense to account for the hospital's 1983 advance refunding of debt proper? |
1998D017 | 89-0303 | 39-0079 | Were the Intermediary's adjustments to the Provider's interest expense to account for the hospital's 1983 advance refunding of debt proper? |
1998D018 | 93-1769 | 05-5632 | Was the Intermediary's classification of the salaries of restorative nursing aides from the physical therapy cost center to the routine cost area proper? |
1999D70 | 92-0110G | Various | Were the pre-composite rate End Stage Renal Disease (ESRD) screens invalid and therefore not applicable to limit the Providers reimbursement for ESRD treatments? |
1999D50 | 95-0523; 96-0510 | 52-7143 | Were the Intermediary's adjustments to reclassify certain costs and visits from skilled nursing to either other visits or private duty visits proper? |
1998D019 | 91-2800M | 05-0239 | 1. Was the retroactive audit of Graduate Medical Education (GME) costs proper?; 2. Was the Intermediary's determination classifying malpractice insurance costs as administrative and general costs rather than direct GME costs proper? |
1998D020 | 91-2842M | 05-0103 | 1. Was the retroactive audit of Graduate Medical Education (GME) costs proper?; 2. Was the Intermediary's determination classifying malpractice insurance costs as administrative and general costs rather than direct GME costs proper? |
1998D011 | 95-0380 | 52-6514 | Was the Intermediary's modification of cost reporting form 2088-79 for the calculation of reimbursable cost proper? |
1998D021 | 89-2023 | 05-0179 | Was the Intermediary's adjustment to the amortization of the loss on the sale of Turlock Community Hospital proper? |
1998D015 | 91-2414M | 24-0053 | Was the Intermediary's denial of the reclassification of the accrued surgery residency costs from the operating room cost center to the interns and residents cost center in calculating the Provider's base year graduate medical education costs proper? |
1998D022 | 93-1156 | 38-0018 | Was the Provider's request to reopen the calculation of the disproportionate share adjustment to exclude employee self-insured days proper? |
1998D023 | 95-1661 | 06-6549 | Does the Provider Reimbursement Review Board have jurisdiction over Provider extension locations that are not surveyed for purposes of certification? |
1998D024 | 92-0662 | 47-4001 | Did the Health Care Financing Administration (HCFA) correctly conclude that the Provider's requests for adjustment to its Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA) limits were not timely filed and were therefore improper? |
1998D025 | 95-0308 | 05-0235 | Was the Intermediary's denial of the Provider's Routine Cost Limit exception proper? |
1998D009 | 92-1679 | 39-0142 | Was the Intermediary's application of the 1984 Reasonable Compensation Equivalent (RCE) limits proper? |
1998D010 | 93-1749 | 10-6639 | Was the Provider entitled to the lower of cost or charges (LCC) carryforward which was generated under the prior ownership? |
1998D012 | 86-0429 | 05-0289 | Was the Intermediary's denial of the full TEFRA incentive payment to the Provider proper? |
1998D026 | 91-2673M | 39-0028 | 1. Were the GME regulations at 42 CFR Section 413.86 valid?; 2. Were the HCFA GME Program Instructions (GME-PI) implementing the reaudit provisions of 42 CFR Section 413.86 valid?; 3. Was the Intermediary's adjustment reclassifying the GME costs for the Medical Library (ML) and Department of Continuing Education (DCE) to Administrative and General (A&G) proper?; 4. Was the Intermediary's adjustment reclassifying a portion of the teaching physicians salaries from GME to A&G proper?; 5. Was the Intermediary's adjustment reclassifying costs for the salaries and expenses related to GME support personnel from GME to A&G costs proper?; 6. Do the Intermediary's adjustments no. 3 and 6 violate the consistantcy rule stated in 42 CFR Section 412.113(b)(3) (1989)?; 7. Was the Intermediary's adjustment revising the number of FTE residents used in determining the Provider Average Per Resident amount proper?; 8. Was the Intermediary's failure to include the costs associated with the Provider's Anesthesiology and Radiology GME programs in the GME base year proper?; 9. Should the GME clinic costs, mistakenly classified as operating costs in the base year, be included when calculating the APRA?; 10. Should the GME laboratory costs, mistakenly classified as operating costs in the base year, be included when calculating the APRA? |
2006D41 | 00-3942 | 14-7589 | Whether the Intermediary's disallowance of accrued compensation for the Provider's President/Chief Executive Officer (CEO) and Vice-President/Operations Manager was proper. |
2006D42 | 00-3347 | 34-6538 | 1. Was the Intermediary's adjustment to disallow costs due to missing records proper?; 2. Did the Intermediary improperly reopen the cost report?; 3. Was the Intermediary's adjustment to physical therapy salaries proper?; 4. Was the Intermediary's adjustment to the accrued 401(K) plan proper?; 5. Was the Intermediary's adjustment to the accrued payroll taxes proper?; 6, Was the Intermediary's adjustment to accrued profit sharing plan proper?; 7. Was the Intermediary's adjustments to accrued FICA and Federal withholding proper?; 8. Was the Intermediary's adjustment to health insurance cost paid on behalf of physical therapists proper?; 9. Was the Intermediary's adjustment to contract physical therapy and Quality Assurance consultant expenses proper?; 10. Was the Intermediary's adjustment to contracted occupational therapy proper?; 11. Was the Intermediary's adjustment to contracted speech therapy proper?; 12. Was the Intermediary's adjustment to auto expense proper?; 13. Was the Intermediary's adjustment to auto lease expense proper?; 14. Was the Intermediary's adjustment to administrative recruiting proper?; 15. Was the Intermediary's adjustment to telephone expenses proper?; 16. Was the Intermediary's adjustment to accounting expense proper?; 17. Was the Intermediary's adjustment to occupational therapy dues proper?; 18. Was the Intermediary's adjustment to administrative dues proper?; 19. Was the Intermediary's adjustment to nursing home rent expense proper?; 20. Was the Intermediary's adjustment to rent expense proper?; 21. Was the Intermediary's adjustment to office lease expense proper?; 22. Was the Intermediary's adjustment to other charges- occupational, physical and speech therapy proper?; 23. Were the Provider's requests for additional costs for depreciation, contracted occupational therapy services, recruiting- physical therapy, recruiting- administrative and accounting expenses proper? |
2006D43 | 04-0025 | 17-0032 | Whether the Provider was improperly denied a Medicare low-volume adjustment. |
2006D44 | 04-0643 | 01-0092 | Whether the Fiscal Intermediary/Centers for Medicare and Medicaid Services' (FI/CMS) denial of the request to include additional pension costs as wage-related costs for purposes of the Provider's FY 2004 wage index was proper. |
2006D45 | 02-0224 | 39-0256 | Was the Centers for Medicare and Medicaid Services' (CMS) denial of the Provider's request for an exception to the End Stage Renal Disease (ESRD) composite rate proper? |
2006D46 | 03-0940 | 33-0078 | Whether the Intermediary properly calculated the Provider's indirect medical education (IME) reimbursement for its fiscal year ending December 31, 1999. |
2006D47 | 03-1587; 03-1592 | 14-0119 | Whether the Intermediary should have used the "aggregation methodology" when implementing the updated reasonable compensation equivalent (RCE) limits on compensation paid to Provider's hospital-based physicians. |
2006D48 | 98-2103; 99-1746; 00-2563; 03-0127; 03-0484; 03-1471; 03-1472 | 09-0007 | Whether the Intermediary properly adjusted the Provider's available beds for the purpose of determining the amount of its indirect medical education payment. |
2006D49 | 96-2013G | 07-5234; 07-5210 | Whether the Intermediary's adjustments to disallow rental expense as a cost incurred with a related organization were proper. |
2006D50 | 01-1326G | 07-5234; 07-5210; 07-5198 | Whether the Intermediary's adjustments to disallow rental expense as a cost incurred with a related organization were proper. |
2006D51 | 02-1212 | 52-0087 | Whether the denial of the Provider's End Stage Renal Disease (ESRD) exception request was in compliance with 42 C.F.R. section 413.180(h), which states: "(h) Approval of an exception request. An exception request is deemed approved unless it is disapproved within 60 working days after it is filed with its Intermediary." |
2006D52 | 04-0565 | 50-1304 | 1. Whether the Intermediary's adjustment to direct nursing costs was proper.; 2. Whether the Intermediary's adjustment increasing the total patient days to include respite care days was proper. |
2006D53 | 96-0480 | 26-0104 | Whether the Intermediary's adjustment that disallowed the consolidation of all of the Provider's therapy services into a single cost center was proper. |
2006D54 | 02-1420 | 10-0122 | Whether the Intermediary's adjustment of disproportionate share hospital (DSH) reimbursement based on its determination that the Provider had less than 100 available beds for DSH eligibility purposes was proper. |
2006D55 | 98-0580; 98-0463 | 14-5314 | Whether the Provider's exception requests to the skilled nursing facility (SNF) routine service cost limits under 42 C.F.R. Section 413.30(f) was properly denied because the Provider did not request the exceptions within 180 days of the original notices of program reimbursement. |
2006D56 | 04-0660 | 05-0444 | Whether the Provider's regular Medicare outpatient bad debts are not allowable until all collection efforts including those of a collection agency have ceased. |
2006D57 | 05-0051 | 51-5028 | Whether the Intermediary properly disallowed bad debts claimed for uncollectible deductibles and coinsurance related to therapy services furnished to Medicare beneficiaries dually eligible for Medicare and Medicaid, and paid under the Part B fee schedule. |
2006D58 | 03-0895 | 34-0168 | Whether the Intermediary's disallowance of Medicare bad debts claimed by the Provider was justified. |
2007D01 | 97-0174 | 16-0024 | Was the Intermediary's disallowance of the loss on disposal of assets resulting from a merger proper? |
2007D02 | 03-0482G | 31-0108; 31-0039; 31-0005 | Whether it was proper for the Centers for Medicare and Medicaid Services (CMS) to include the 1999 information for Memorial Medical Center at South Amboy in the 2003 calculation of the Middlesex-Somerset-Hunterdon, New Jersey Metropolitan Statistical Area (MSA) Wage Index. |
2007D03 | 04-0372 | 33-7089 | Whether the Intermediary's adjustment to reconcile the fiscal year ended (FYE) 12/31/00 home health agency aide charges to the Provider Statistical & Reimbursement Report (PS and R) was proper. |
2007D04 | 99-1159; 01-2664; 02-0866 | 20-0024 | Whether the Intermediary's denial of the Provider's request for an adjustment to its TEFRA target amount was proper. |
2009D13 | 02-0488; 03-1001 | 05-4144 | Whether the Intermediary's determination of the Provider's direct graduate medical education (DGME) payment was proper. |
2009D12 | 08-2907G | Various | Whether the Board has jurisdiction over a challenge to the validity of the Supplemental Security Income percentage under the doctrine of equitable tolling where the appeals were not filed within three years of the issuance of Providers' Notices of Program Reimbursement. |
2009D11 | 05-1360G; 05-1362G; 05-1363G; 05-1527G | Various | Whether the Intermediary improperly disallowed from the calculation of the Providers' Disproportionate Share Hospital (DSH) payments, patient days associated with Medicaid patients who were admitted to the hospital prior to the day of giving birth and that were characterized by the Intermediary as "labor days". |
2009D10 | 07-1969G | 19-5350; 11-5612; 15-5473; 11-5535 | Whether the Intermediary's adjustments to disallow Medicare bad debts written off by Kindred Healthcare and claimed as worthless after the year end date of the terminating cost report it filed for each skilled nursing facility, due to change of ownership, were proper. |
2007D12 | 03-1464 | 05-0308 | Whether all of the Provider's outpatient total cost, total charges, and Medicare charges for separately billable End Stage Renal Disease (ESRD) drugs should be reported together on line 56 (drugs charges to patients), on line 57 (renal dialysis), or on a separate cost center line of the Medicare cost report. |
2007D10 | 04-0209 | 13-0029 | Whether the Intermediary was correct in its determination that no costs for physician assistant emergency room availability are allowable as Medicare Part A reimbursable expenses. |
2007D09 | 01-3592G; 02-2153G; 03-0960G | Various | Whether the Intermediary properly calculated the Providers' 1996 Indirect Medical Education (IME) base year Full-Time Equivalency (FTE) cap specifically regarding residents rotating to nonhospital settings. |
2007D08 | 05-0448 | 25-0085 | Whether the Provider Reimbursement Review Board may grant jurisdiction for the adjustment included in the Provider's initial Notice of Program Reimbursement.; 2. Whether the Intermediary's adjustment to remove unliquidated liabilities in the year incurred was proper. |
2007D07 | 01-1443; 01-1444 | 45-0011 | Whether the Intermediary's made a proper determination that Provider should be paid at the prospective payment rate for rural providers after it was certified as a provider-based entity of a hospital entitled to receive the higher urban prospective payment rate. |
2007D06 | 04-0575 | 17-0086 | Whether the Intermediary's revised Notice of Program Reimbursement issued on July 25, 2003, that increased the Provider's Disproportionate Share Hospital (DSH) payment, included all Medicaid eligible days that would qualify for inclusion under HCFA Ruling 97-2. |
2007D05 | 02-1833G | Various | Whether all the patient days related to patients that were eligible for medical assistance under an approved state Medicaid plan for such days were included in the Medicaid ratio of the Medicare disproportionate share hospital (DSH) payment calculation. |
2011D06 | 05-0508G; 06-0784G; 07-0510G; 08-1412G | Various | Whether the Intermediary/Medicare Administrative Contractor properly calculated the Providers' 1996 resident cap for purposes of direct graduate medical education and indirect graduate medical education payments. |
2011D08 | 09-1927 | 37-1633 | 1. Has the Provider demonstrated that it is entitled to a hearing before the Board because there is at least $10,000 in controversy?; 2. To what extent, if at all, Medicare's $397,228 demand for repayment from the Provider for fiscal year 2007, calculated pursuant to the existing regulation, would be decreased if the Provider's proposed manner of calculation is adopted. |
2011D09 | 08-2162GC; 08-2165GC; 08-2186G; 08-2233GC et al | Various | Whether the Intermediary properly excluded the Ohio Hospital Care Assurance Program (HCAP) days from the Medicare disproportionate share hospital (DSH) calculation. |
2011D10 | 00-3532G; 04-1657G; 06-0468G; 07-2031G; 08-2585G | Various | Whether the Intermediary's non-inclusion of the Indiana Hospital Care for the Indigent (HCI) program patient days as Medicaid eligible days, whether paid or unpaid, in the calculation of the Medicaid proxy for Medicare Disproportionate Share Hospital (DSH) eligibility and payment determinations, including any impact such would have on capital DSH, was proper. |
2011D11 | 06-2033 | 01-0164 | Whether the Centers for Medicare and Medicaid Services (CMS), reversal of the Provider's rural referral center (RRC) classification was proper. |
2011D12 | 06-2376; 06-2377; 06-2378; 06-2379; 06-2381; 06-2383; 06-2385; 06-2410 | Various | Whether the Fiscal Intermediary properly adjusted the Providers' bad debts for the fiscal year ended December 31, 2004. |
2011D13 | 08-1695 | 05-0746 | Whether it was proper for the Centers for Medicare and Medicaid Service to reduce by two percent the Medicare annual payment update for Western Medical Center - Santa Ana for federal fiscal year 2008. |
2011D14 | 06-1927G; 08-0138G; 09-1545GC | Various | Whether the Intermediary properly excluded Connecticut's State-Administered General Assistance (SAGA) program days from the Medicare disproportionate share hospital (DSH) calculation for fiscal year-ends (FYEs) September 30, 2001 through September 30, 2004 for the two hospitals in these group appeals. |
2011D15 | 09-1796 | 05-0018 | Whether the Provider is entitled to the full market basket update for Federal Fiscal Year ending 2009 under the Reporting Hospital Quality Data for Annual Payment Update Program. |
2011D16 | 09-1058 | 33-0094 | Was CMS' determination to reduce the Provider's inpatient prospective payment system market basket update for federal fiscal year (FY) 2009 by two (2.0) percentage points proper? |
2011D17 | 05-1761 | 51-0022 | Whether the provider has a right to a hearing on certain graduate medical education costs and kidney acquisition costs that were not claimed on the cost report. |
2011D18 | 05-1032; 06-1173 | 09-0001 | Whether the Intermediary properly extrapolated the sample error rate to the population in adjusting Medicaid eligible days. |
2007D11 | 97-2446 | 05-0597 | Whether the Intermediary's determination of reimbursable Medicare bad debts for beneficiaries without Medicaid eligibility (non-crossover beneficiaries) was proper. |
2009D37 | 98-3491 | 39-0160; 39-5580 | Whether the Centers for Medicare and Medicaid Services' methodology for determining the Provider's exception to the hospital-based skill nursing facility (HB-SNF) routine cost limit was proper. |
2009D38 | 06-0316G; 06-0317G; 06-0318G; 06-0319G | Various | Whether the Intermediary improperly computed the numerator of the Medicaid fractions that were used to calculate the Provider's disproportionate share hospital (DSH) payments for fiscal years 1999, 2000, 2001, and 2002 by excluding inpatient days attributable to individuals who received assistance under the Massachusetts Uncompensated Care pool for such days. |
2009D36 | 06-1080G; 06-1081G | Various | Whether the Intermediary"s adjustments to the Provider's reimbursable capital cost after denying "new hospital" status was proper. |
2009D35 | 04-2261G | Various | Whether the Intermediary's calculation of the Provider's Medicare disproportionate share hospital (DSH) payments improperly omitted days attributable to patients who were dually eligible for Medicare Part A and Medicaid, but for which Medicare Part A did not make payment, from the numerator of the "Medicaid fraction" described in 42 U.S.C. Section 1395ww(d)(5)(F)(vi)(II) and 42 C.F.R. Section 412.106(b). |
2009D34 | 99-1786; 99-2499; 00-2047; 01-1820 | 22-0042; 22-5699 | 1. Whether the Intermediary's audit adjustment disallowing the entire loss on the disposition of assets claimed by the Provider, when the Provider corporation merged with another provider corporation, were appropriate.; 2. Whether the Intermediary properly denied the Provider's application for a new provider exemption from the routine service cost limits (RCLs) for its hospital-based skilled nursing facility (HB-SNF). |
2007D28 | 03-0513; 04-0456 | 44-0070 | Whether the FYEs 6/30/00 and 6/30/01 ambulance cost per trip limits were improperly low because the Intermediary improperly applied the 5.8% outpatient operating cost reduction and the 10% outpatient capital cost reduction to base year costs utilized to calculate those limits. |
2008D22 | 04-0183 | 31-0014 | Whether the Medicare fiscal intermediary erred by not including in the calculation of the disproportionate share hospital (DSH) payment for fiscal year 2000 all of the Provider's inpatient days relating to patients who were not entitled to Medicare, but who qualified for medical assistance under the New Jersey Charity Care Program. |
2008D20 | 06-0763; 06-2010 | 24-0213 | Whether the Intermediary's refusal to reimburse the Provider for capital-related costs under the hold harmless methodology was proper. |
2008D08 | 99-3188 | 45-7001 | 1. Whether the disallowance of $595,069 as an adjustment to administrative and general pooled costs related to a management service organization, Home Health First, was proper?; 2. Whether the disallowance of $35,390 to remove the portion of Home Health First management fees attributable to the cost of a deffered compensation plan for executives was proper.; 3. Whether the disallowance of $351,012 as cost in excess of the physical therapy salary equivalency guidelines (SEGs) was proper. |
2007D18 | 02-2080 | 45-0688 | Whether the Intermediary's determination of allowable Medicare bad debts based upon collection effort was proper. |
2007D17 | 97-2936 | 05-0279 | Whether the Intermediary improperly limited the Provider's hospital-based Skilled Nursing Facility's (SNF) routine cost limit exception amount to costs in excess of 112 percent of its peer group costs rather than costs in excess of the routine cost limit. |
2007D16 | 03-0818 | 05-0578 | Whether the Intermediary properly increased the number of available beds used to determine the Provider's indirect medical education (IME) payment. |
2007D15 | 00-1836 | 21-7134 | Whether the Intermediary's adjustment to disallow the cost of accrued compensatory time was proper. |
2007D14 | 00-3662G; 00-3663G; 00-3664G; 02-0983G; 04-0180G; 04-0443G | Various | Whether the offshore captive investment limitations prescribed in section 2162.2.A.4 of the Provider Reimbursement Manual may properly be applied to disallow all of the premiums paid by the Providers to First Initiatives Insurance, Ltd. For the 1997-2002 cost reporting periods. |
2007D67 | 03-0522G | Various | Whether the Intermediary failed to properly adjust the wage data for Rochester General Hospital used in the calculation of the Federal Fiscal Year (FFY) 2003 Wage Index for The Rochester, New York Metropolitan Statistical Area (MSA). |
1998D030 | 90-2029 | 05-0388 | Was the Intermediary's adjustment disallowing the costs associated with the repossessed equipment proper? |
1998D029 | 89-1782 | 33-0041 | Were the Intermediary's adjustments reclassifying the lease rental costs reported as capital costs proper? |
1998D028 | 87-0480E | 33-0085 | Was the Intermediary's denial of the Provider's request for rural referral center status for the fiscal year ended December 3, 1986 proper? |
1998D027 | 95-1188 | 05-0235 | Was the Intermediary's denial of the Provider's Routine Cost Limit exception proper? |
2007D24 | 03-1199G | Various | Whether the Intermediary should include all MediKan patient days, primary and secondary, in the Providers' disproportionate share hospital (DSH) calculation. |
2007D23 | 01-2214 | 22-0060 | Whether the Intermediary's denial of the application of Jordan Hospital for a new provider exemption from the routine cost limits for its provider-based skilled nursing facility was justified. |
2007D22 | 01-0654; 02-0235 | 01-7009 | Whether the relevant claims were timely filed by Alacare under 42 C.F.R. Section 424.44. |
2007D21 | 03-0268; 03-0269 | 05-0045 | Whether the Intermediary's adjustments disallowing the Provider's regular Medicare bad debts were proper. |
2007D20 | 03-0573 | 36-0141 | 1. Did the Intermediary err in refusing to include Provider's cost for contracted perfusionist services in its wage index calculations?; 2. Did the Intermediary err in refusing to include Provider's cost for contracted pharmacy services in its wage index calculations? |
2007D19 | 99-3470; 99-3471 | 39-0037; 39-0036 | Whether the Intermediary's denial of a loss on disposition of assets due to a consolidation of Sewickley Valley Hospital and The Medical Center of Beaver was correct. |
2007D13 | 97-2986 | 14-0119 | 1. Should the Provider's transplant surgery residents be included in the full-time equivalent (FTE) count for the purposes of both direct graduate medical education (DGME) and indirect medical education (IME) reimbursement?; 2. To the extent transplant surgery residents are not included in the FTE counts for purposes of DGME and IME, is the Provider entitled to reimbursement for costs it incurred with such individuals pursuant to 42 C.F.R. Section 4105.523?; 3. In calculating the Provider's Disproportionate Share Hospital (DSH) payment, should all of the Medicaid Health Maintenance Organization (HMO) days, as reported by the Illinois Department of Public Aid, be included?; 4.Was the intermediary's disallowance of a portion of the depreciation expense claimed for the Atrium Pavilion proper? |
1998D031 | 91-2986M | 33-0153 | Were the Intermediary's adjustments made foe graduate medical education (GME) settlement purposes proper? |
1998D032 | 95-0495 | 39-0181 | Was the Intermediary's adjustment disallowing the Provider's claimed loss on disposal proper? |
1998D033 | 95-2125 | 53-7025 | Did the Intermediary properly disallow a portion of the owner's compensation? |
1998D034 | 97-1914 | 11-6670 | 1. Did the Intermediary properly adjust Medicare charges?; 2. Did the Intermediary properly adjust Medicare deductables, co-insurance and payments?; 3. Did the Intermediary properly adjust physical therapy salary equivalency limits?; 4. Was the Intermediary's adjustment to legal and accounting costs and other offset items proper?; 5. Was the Intermediary's adjustment to other self-disallowed costs proper? |
1998D035 | 93-2004 | 10-0114 | Does the recapture of depreciation due to the gain on the sale of depreciable assets have any effect on the Provider's equity capital for prior years? |
1998D036 | 93-0337 | 05-0034 | Was the Provider's request for an adjustment to the TEFRA target amount for the 1989 fiscal year filed on a timely basis? |
1998D037 | 93-0145 | 52-0091 | Was the Intermediary's denial of sole community status under 42 C.F.R. Section 412.92 proper? |
1998D038 | 95-2447 | 17-7215 | 1. Was the Intermediary's adjustment to the administrative and general seminar costs proper?; 2. Was the Intermediary's adjustments disallowing health education compensation and nursing compensation proper? |
1998D039 | 97-0111G; 97-0112G | Various | Were the Intermediary's adjustments to occupational therapy and speech therapy costs proper? |
1998D040 | 96-2419 | 52-5569 | Should the Provider be granted a "new Provider" exemption from the routine cost limits in accordance with 42 C.F.R. Section 413.30(e)? |
1998D042 | 93-0048 | 05-0102 | Was the Intermediary's adjustment disallowing Medicare bad debts proper? |
1998D041 | 93-0590 | 36-0062 | Was the Intermediary's adjustment offsetting employee benefits proper? |
1998D043 | 92-0033 | 50-0044 | Was the Intermediary's denial of the Provider's request for an adjustment to its TEFRA target rate for its rehabilitation unit proper? |
1998D044 | 96-0320 | 14-7273 | Was the Intermediary's adjustment reducing allowable owner's compensation correct? |
1998D046 | 92-1582 | 39-6563 | Was the Intermediary's adjustment to the Provider's reasonable costs proper? |
1998D047 | 96-2128 | 39-0023 | Was the Provider's request for additional adjustment payments for routine and ancillary services under 42 C.F.R. Section 413.40(g)(3) timely? |
1998D048 | 97-0050G | Various | Did the Intermediary properly adjust the Provider's occupational and speech therapy costs? |
1998D049 | 91-2824M | 14-0180 | 1. Was the Intermediary's adjustment reclassifying physcian salaries for medical education from interns and residents to the administrative and general cost center proper?; 2. Was the Intermediary's adjustment disallowing 50 percent of the Chicago Medical School ("CMS") faculty salaries related to teaching of undergraduate medical students proper?; 3. Was the Intermediary's adjustment reclassifying the salary of a fellow from interns and residents to the adults and pediatric cost center proper?; 4. Was the Intermediary's adjustment of the weighted average full-time equivalence of the interns and residents proper?; 5. Was the Provider's request for Hill Burton 3 percent interest subsidy in total allowable costs proper?; 6. Was the Intermediary's failure to include expenses related to graduate medical education ("GME") which was not filed on the Medicare cost report proper?; 7. Should the laundry and linen statistic be adjusted to include laundry processed for residents?; 8. Should the meals served statistic be adjusted to include meals consumed by residents in the GME base period?; 9. Should the square footage statistic be adjusted to include residents sleeping and conference rooms? |
1998D050 | 94-2093G; 94-2094G; 94-2095G; 96-1323G; 96-1325G | Various | 1. Should the Intermediary have appled the exception to the related organizations principal in computing the Provider's reimbursement for the serices of Data-Med, Inc. the organization which supplies the data processing and other computer services to the Providers?; 2. Was the Intermediary's adjustment to directly allocate salaries proper?; 3. Was the Intermediary's disallowance of owners' compensation costs proper? |
2007D68 | 99-2630; 00-3142;01-1808; 02-1095; 03-1383; 01-2158 | 24-0063; 24-0210 | 1. Whether the Intermediary's exclusion of certain non-Medicaid general assistance and other state-only funded patient days (General Assistance Days or GADs) from the Provider's Medicaid Proxy was proper based on the instruction contained in Program Memorandum A-99-62. (St. Joseph's for FYE 1997 through 2000); 2. Whether Medicare + Choice days were properly treated in the Provider's disproportionate share hospital (DSH) calculation. (St. Joseph's for FYE 1998, 1999 and 2000); 3. Whether the Intermediary properly excluded, for indirect medical education (IME) and direct graduate medical education (DGME) reimbursement purposes, certain resident rotations at related non-hospital locations. (St. Joseph's for FYE 1997, 1998 and St. John's for FYE 1998) |
2007D71 | 00-3350 | 34-6538 | 1. Was the Intermediary's adjustment to Medicare bad debts proper? (Provider Issue 1); 2. Were the Intermediary's adjustments to salaries - administrative proper? (Provider Issue 2); 3. Was the Intermediary's adjustment to salaries - physical therapy proper? (Provider Issue 2); 4. Was the Intermediary's adjustment to salaries - speech therapy proper? (Provider Issue 2); 5. Was the Intermediarys adjustment to salaries - occupational therapy proper? (Provider Issue 2); 6. Was the Intermediary's adjustment to other charges - physical therapy proper? (Provider Issue 3); 7. Was the Intermediary's adjustment to other charges - speech therapy proper? (Provider Issue 3); 8. Was the Intermediary's adjustment to other charges - occupational therapy proper? (Provider Issue 3); 9. Was the Provider's request for additional costs for depreciation proper? (Provider Issue 4 and Intermediary Issue 17 in Initial Position Paper) |
2007D69 | 00-3348 | 34-6538 | 1. Did the Intermediary improperly reopen the cost report? (Provider Issue 1); 2. Was the Intermediary's adjustment to physical therapy salaries proper? (Provider Issue 2); 3. Was the Intermediary's adjustment to contracted occupational therapy services proper? (Provider Issue 3); 4. Was the Intermediary's adjustment to contracted speech therapy services proper? (Provider Issue 4); 5. Was the Intermediary's adjustment to contracted administrative services proper? (Provider Issue 5); 6. Was the Intermediary's adjustment to recruiting costs - physical therapy proper? (Provider Issue 6); 7. Was the Intermediary's adjustment to recruiting costs - occupational therapy proper? (Provider Issue 7); 8. Was the Intermediary's adjustment to recruiting costs - speech therapy proper? (Provider Issue 8); 9. Was the Intermediary's adjustment to recruiting costs - other proper? (Provider Issue 9); 10. Was the Intermediary's adjustment to recruiting costs - Rehab Resources proper? (Provider Issue 10); 11-14. Were the Intermediary's adjustments to seminars - physical therapy, occupational therapy, speech therapy and administrative proper? (Provider Issues 11, 12, 13 and 14); 15. Was the Intermediary's adjustment to administrative dues proper? (Provider Issue 15); 16-19. Were the Intermediary's adjustments to supplies - physical therapy, occupational therapy, speech therapy and administrative proper? (Provider Issues 16, 17, 18 and 19); 20. Was the Intermediary's adjustment to accounting expense proper? (Provider Issue 20); 21. Was the Intermediary's adjustment to telephone expense proper? (Provider Issue 21); 22. Was the Intermediary's adjustment to auto lease expense proper? (Provider Issue 23); 23. Was the Intermediary's adjustment to nursing home lease expense proper? (Provider Issue 24); 24. Was the Intermediary's adjustment to related party rent expense proper? (Provider Issue 25); 25. Was the Intermediary's adjustment to office equipment lease expense proper? (Provider Issue 26); 26. Was the Intermediary's adjustment to insurance expense proper? (Provider Issue 27); 27. Was the Intermediary's adjustment to home office costs proper? (Provider Issue 30); 28. Was the Provider's request for additional costs for depreciation proper? (Provider Issue 28) |
2007D72 | 00-3351 | 34-6538 | 1. Was the Intermediary's adjustment to bad debts proper?; 2. Was the Intermediary's adjustment to salaries proper?; 3. Was the Intermediary's adjustment to contracted labor proper?; 4. Was the Intermediary's adjustment to travel and lodging expense proper?; 5. Was the Intermediary's adjustment to utilities expense proper?; 6. Was the Intermediary's adjustment to office supply expense proper?; 7. Was the Intermediary's adjustment to dues and subscriptions expense proper?; 8. Was the Intermediary's adjustment to professional fees proper?; 9. Was the Intermediary's adjustment to other expenses proper?; 10. Was the Intermediary's adjustment to rent expense proper?; 11. Was the Intermediary's adjustment to additional accounts payable/capital related costs proper?; 12. Was the Intermediary's adjustment to interest expense proper?; 13. Was the Intermediary's adjustment to advertising expense proper?; 14. Was the Intermediary's adjustment to home office costs proper? (Provider's Issue 15); 15. Were the Provider's requests for the inclusion of costs incurred in settling the cost report after termination from the Medicare program proper? (Provider's Issue 14) |
2007D73 | 00-3352 | 42-6548 | 1. Did the Intermediary improperly reopen the cost report?; 2. Was the Intermediary's adjustment to Medicare bad debts proper?; 3. Was the Intermediary's adjustment to physical therapy salaries proper?; 4. Was the Intermediary's adjustment to recruiting costs - other proper?; 5. Was the Intermediary's adjustment to recruiting costs - Rehab Resources proper?; 6. Was the Intermediary's adjustment to supplies - physical therapy proper?; 7. Was the Intermediary's adjustment to supplies - administrative proper?; 8. Was the Intermediary's adjustment to office supplies proper?; 9. Was the Intermediary's adjustment to accounting expense proper?; 10. Was the Intermediary's adjustment to contract services - physical therapy proper?; 11. Was the Intermediary's adjustment to contract services - occupational therapy proper?; 12. Was the Intermediary's adjustment to contract services - administrative proper?; 13. Was the Intermediary's adjustment to rent expense proper?: 14. Was the Intermediary's adjustment to telephone expense proper?; 15. Was the Intermediary's adjustment to home office costs proper? (Provider's Issue 16); 16. Was the Provider's request for the inclusion of additional costs for depreciation for which there were no adjustments made proper? (Provider's Issue 15) |
2007D75 | 00-3353 | 42-6548 | 1. Did the Intermediary improperly reopen the cost report?; 2. Was the Intermediary's adjustment to salaries - physical therapy proper?; 3. Was the Intermediary's adjustment to salaries - speech therapy proper?; 4. Was the Intermediary's adjustment to salaries - occupational therapy proper?; 5. Was the Intermediary's adjustment to salaries - administrative proper?; 6. Was the Intermediary's adjustment to travel expenses proper?; 7. Was the Intermediary's adjustment to accounting expense proper?; 8. Was the Intermediary's adjustment to recruiting cost - Rehab Resources proper?; 9. Was the Intermediary's adjustment to occupational therapy expense proper?; 10. Was the Intermediary's adjustment to consultant expense proper?; 11. Was the Intermediary's adjustment to maintenance expense proper?; 12. Was the Intermediary's adjustment to contract services - administrative and general (A&G) proper?; 13. Was the Intermediary's adjustment to contract services - occupational therapy proper?; 14. Was the Intermediary's adjustment to contract services - physical therapy proper?; 15. Was the Intermediary's adjustment to rent expense proper?; 16. Was the Intermediary's adjustment to telephone expense proper?; 17. Was the Intermediary's adjustment to total charges - physical therapy proper?; 18. Was the Intermediary's adjustment to other charges - physical therapy proper?; 19. Were the Provider's requests for the inclusion of additional costs for depreciation and reimbursable bad debts for which no adjustments were made proper? (Provider's Issues 19 and 20); 21. Was the Intermediary's adjustment to total expenses proper? |
2008D13 | 00-1904G | Various | Whether the Intermediary's calculation of the disproportionate share hospital (DSH) payment was proper. |
1998D055 | 93-0846 | 36-5746 | Was the Intermediary's adjustment of the nursing cost proper? |
1998D054 | 91-1799 | 41-0005 | Was the Intermediary correct in applying reasonable compensation equivalent calculations to physicians who are employees of the management firm with which the hospital contracted to provide administrative services in the hospital's exempt psychiatric unit? |
1998D053 | 96-0229 | 45-7663 | 1.Was the Intermediary's adjustment disallowing a portion of interest cost incurred proper?; 2. Was the Intermediary's proposed adjustment disallowing all interest cost related to accounts receivable financing proper? |
1998D052 | 92-1562 | 45-0068 | 1. Was the Intermediary's adjustment of depreciation on equipment placed at the Provider by the University of Texas Health Science Center at Houston proper?; 2. Was the Intermediary's disallowance of the Provider's claimed loss on disposal of certain depreciable assets proper? |
1998D051 | 95-2407G | Various | Whether the physical therapy salary equivalent guidelines as issued and applied to the Providers are arbitrary, capricious and/or not in accordence with 42 C.F.R. Section 413.106 or other law? |
2011D39 | 09-0206GC | Various | Whether inpatient days for Medicaid-eligible patients who were enrolled in a Medicare+Choice (M+C) plan under Part C of the Medicare statute were properly excluded from the numerator of the Medicaid fraction that is used to calculate the disproportionate share hospital (DSH) payment. |
2011D40 | 10-0069GC | Various | Whether inpatient days for Medicaid-eligible patients who were enrolled in a Medicare+Choice (M+C) plan under Part C of the Medicare statute were properly excluded from the numerator of the Medicaid fraction that is used to calculate the disproportionate share hospital (DSH) payment. |
2011D41 | 04-1753G; 04-1824G; 04-1825G; 05-0375G; 05-1794G; 06-1093G; 07-0888GC; 09-2062GC; 10-0941GC; et al | Various | Whether Medicare+Choice (M+C) days should be included in the Medicaid fraction used to calculate the disproportionate share hospital (DSH) adjustment. |
2011D42 | 98-2219; 98-2218; 01-2534; 03-1358 | 45-0610 | Does the Board have jurisdiction over the issue of whether the Provider is entitled to be reimbursed for the interest implicit in the capital lease of the hospital facilities and equipment? |
1998D045 | 92-0507 | 05-0457 | Did the Intermediary properly adjust outpatient surgery, anesthesia and supply charges? |
1998D060 | 89-1568 | 37-0094 | Was the Intermediary's offset of investment income earned on the Provider's funded depreciation account against interest expense proper? |
1998D061 | 91-2894M; 92-1709; 94-1277; 94-1278; 94-1702; 94-2063 | 36-0152 | 1. Should the costs incurred by the Provider's General Practice Center ("GPC") for the Family Practice Residency Program be costs of a separate outpatient cost center or costs of the interns and residents medical education cost center and included in the graduate medical education ("GME") base year cost and "rate" year per resident amounts?; 2. Should the salaryand incentive compensation of GPC's director and assistant director be costs of a separate outpatient ancillary cost center or costs of the interns and residents medical education cost center and included in the graduate medical education ("GME") base year cost and "rate" year per resident amounts? |
1998D059 | 93-1280 | 40-0098 | Was the Intermediary's disallowance of the Provider's request for a reevaluation of assets and allowance of interest expense due to a change in ownership proper? |
1998D057 | 94-1800C | 29-0021 | Was the revision to the hospital-specific portion of the Provider's payment under the Medicare prospective payment system made by the Provider's fiscal Intermediary pursuant to a revised Notice of Reimbursement dated August 31, 1993, valid? |
2009D17 | 09-0764G; 09-1053GC | Various | Should the Provider Reimbursement Review Board (Board) grant expedited judicial review over the question of whether Secretary's elimination of the budget neutrality adjustment factor (BNAF) used in the calculation of hospice payment rates was proper? |
2009D16 | 05-1296G; 05-1315G; 05-2197G; 06-1668G | 07-0010; 07-0022; 07-0018 | Whether the Intermediary properly disallowed direct graduate medical education (DGME) and indirect medical education (IME) payments with respect to discharges of Medicare beneficiaries who were enrolled in the Medicare + Choce or other Medicare risk plans in fiscal years ending September 30, 1998, 1999, 2000 and 2001. |
2009D15 | 92-1212; 92-1522 | 45-0196 | Whether the denial of the Provider's request for an exception to the Tax Equity and Fiscal Responsibility Act (TEFRA) rate for its rehabilitation unit was proper. |
2009D14 | 04-1293 | 08-5029 | 1. Whether the Intermediary's notification of the reopening of the Provider's 1996 cost report was timely pursuant to regulatory standards.; 2. Whether the Intermediary's determination to disallow costs for the Provider's contracted therapy services was proper. |
2007D74 | 00-3354 | 42-6548 | 1. Was the Intermediary's adjustment to Medicare bad debts proper?; 2-5. Were the Intermediary's adjustments to salaries - administrative, physical therapy, occupational therapy, and speech therapy - proper?; 6. Was the Intermediary's adjustment to travel expense - administrative proper?; 7. Was the Intermediary's adjustment to telephone expense proper?; 8. Was the Intermediary's adjustment to consultant expense proper?; 9. Was the Intermediary's adjustment to rent expense proper?; 10-12. Was the Intermediary's adjustment to other charges - physical, speech and occupational therapy proper? (Provider's Issue 10) |
2008D19 | 04-1995G | 35-0002; 35-0015 | Whether the Intermediary properly disallowed reimbursement for direct graduate medical education (DGME) and indirect medical education (IME) costs in the non-hospital setting by reducing the Provider's full-time equivalent (FTE) resident counts. |
2008D16 | 89-1584 | 45-0101 | 1. Whether capitalized interest that may have been amortized in future years can be expensed in the current year when future cost reports are no longer subject to reopening.; 2. Whether the Intermediary's determination of allowable interest expense which deducted Hillcrest Medical Tower (HMT)interest from allowable versus total expense is proper.; 3. Whether the Intermediary's adjustment to disallow accrued FICA expense is proper.; 4. Whether the Intermediary's adjustment to the cafeteria revenue offset is proper.; 5. Whether the Intermediary's adjustment to limit bond cost amortization is proper.; 6. Whether the Intermediary's adjustment to disallow debt cancellation costs is proper.; 7. Whether the Intermediary's adjustment to disallow depreciation expense is proper.; 8. Whether the Intermediary's determination that a portion of the 1985 bonds were unnecessary is proper.; 9. Whether the Intermediary's adjustment to disallow accrued zero coupon bond interest expense is proper. |
2008D14 | 01-0215 | 39-5526 | Whether the Intermediary's adjustment to remove Nursing Administration, Medical Records, and Social Services allocation statistics from the Provider's ancillary cost centers on the Medicare cost report were proper? |
2008D17 | 04-0088G | Various | Whether the Providers are entitled to receive additional indirect medical education (IME) and direct graduate medical education (DGME) payments for Medicare managed care enrollees for fiscal years ended December 31, 1998 and 1999. |
1998D062 | 94-3278 | 23-0132 | Was the denial of the TEFRA exception request proper? |
1998D063 | 96-0535 | 18-0127 | Were the Intermediary's adjustments to Medicare bad debts proper? |
2009D18 | 09-0801 thru 09-0810; 09-0815; 09-0816 | 05-0126 | Whether the Board has jurisdiction over the Intermediary's refusal to reopen cost reports to adjust the Supplemental Security Income percentages where the request for reopening were filed more than three years after the issuance of the Notices of Program Reimbursement (NPR). |
2009D19 | 05-1873; 05-1879; 05-1880; 05-1881 | 24-0036 | Whether the Intermediary should have included all general assistance days in the computation of the Provider's Medicare Disproportionate Share (DSH) adjustment calculation for the Provider's fiscal years ended June 30, 1997, 1998, 1999, and 2000. |
2009D21 | 09-0380GC | Various | Whether the Board has jurisdiction over a challenge to an overpayment recoupment action involving the Provider's liability for erroneous payments made to the former owners of the skilled nursing facilities (SNFs) after the change of ownership. |
1998D058 | 85-0058 | 33-0136 | Was the Intermediary's refusal to reopen the Provider's cost reports for the fiscal years ending December 31, 1979, and December 31, 1980, an abuse of discretion? |
1998D064 | 96-0340 | 36-5946 | Was HCFA's denial of the Provider's request for an exemption fron the routine cost limit ("RCL") as a new provider proper? |
1998D065 | 96-1352; 96-1353 | 14-7472 | Were the Intermediary's adjustments to disallow legal fees deemed not related to patient care proper? |
1998D066 | 94-0070 | 36-0054 | Does the Provider meet the criteria for receiving disproportionate share payments based on application of undisputed facts? |
1998D067 | 94-1389E; 94-1390E; 94-1525E | 39-4001 | Did the Intermediary err in reopening the Provider's cost reports to calculate Graduate Medical Education reimbursement? |
1998D068 | 92-1805; 93-0196; 94-0366; 95-0672; 96-0750; 97-0104 | 14-7407 | 1. Was the Intermediary's adjustments offsetting key employees' compensation proper?; 2. Was the Intermediary's adjustments to disallow Christmas gifts made to employees and third parties proper?; 3. Was the Intermediary's adjustments to offset charitable contributions proper?; 4. Was the Intermediary's adjustments to the Board of Directors' fee proper?; 5. Was the Intermediary's adjustments to coinsurance amounts proper?; 6. Was the Intermediary's adjustments to Medicare program visits proper?; 7. Was the Intermediary's adjustments to medical supply charges proper?; 8. Was the Intermediary's adjustments offsetting legal service fees proper?; 9. Was the Intermediary's adjustments offsetting auto expense proper?; 10. Was the Intermediary's adjustments applying sequestration factors proper? |
2010D27 | 04-0114G; 05-0286G; 06-0943G; 06-1377G; 07-0311G; 04-0940 | Various | Whether the Intermediary underpaid the Providers' fiscal years 2000 through 2004 Medicare operating and capital disproportionate share hospital (DSH) adjustments by not including the Providers' New Jersey Charity Care Program (NJCCP) inpatient days in the calculations of the numerator of the Medicaid proxy. |
2010D28 | 05-0289 | 33-0224 | Whether the Intermediary properly adjusted the Provider's Family Practice residency program direct graduate medical education (DGME) and indirect medical education (IME) full-time equivalent (FTE) count for the fiscal year ended December 31, 2000. |
2010D29 | 08-1848; 09-1547; 10-0106; 06-1773; 07-2384; 08-2266; 09-1565 | 10-1406; 10-1416 | Was the Intermediary's adjustment disallowing bad debts arising from coinsurance and deductibles for dual eligible Medicare and Medicaid beneficiaries proper? |
2010D30 | 09-0071 | 11-0034 | Whether the Board has jurisdiction over the Provider's appeal of the question of whether the disproportionate share (DSH) adjustment was incorrectly determined due to a significant error in the Supplemental Security Income (SSI) percentage where the request for hearing was filed more than three years after the issuance of the NPR. |
2010D31 | 09-0072 | 11-0034 | Whether the Board has jurisdiction over the Provider's appeal of whether the disproportionate share (DSH) adjustment was incorrectly determined due to a significant error in the Supplemental Security Income (SSI) percentage where the appeal was not filed within 180 days of the issuance of the final determination. |
2009D20 | 04-1997G | Various | Whether the Intermediary improperly disallowed direct graduate medical education (DGME) and indirect medical education (IME) payments with respect to discharges of Medicare beneficiaries who were enrolled in Medicare+Choice or other Medicare risk plans in fiscal years ended December 31, 1998, December 31, 1999 and December 31, 2000. |
1998D056 | 93-0509 | 05-0381 | Was the Intermediary's refusal to reopen the Provider's cost reports an abuse of discretion? |
1998D069 | 90-0989 | 41-0001 | Was the Health Care Financing Administration's ( 'HCFA' ) denial of the Provider's request for reconsideration of the TEFRA exception request proper? |
1998D070 | 94-1740 | 05-0183 | Did the Intermediary's Notice of Reopening (NPR) and issuance of a revised NPR meet the requirements of 42 C.F.R. Sections 405.1885 and 405.1887? |
1998D071 | 95-2007 | 05-0457 | Was the Intermediary's refusal to reopen the Provider's cost report an abuse of discretion? |
1998D072 | 90-1070 | 04-0062 | 1. Were the Intermediary's adjustments to record rent expense for lease equipment as administrative and general costs, rather than capital-related costs proper?; 2. Were the Intermediary's adjustments denying treatment of costs relating to the installation of the Hopital Information System as start-up costs proper? |
1998D073 | 91-2671M | 23-0032 | Was the Intermediary's denial of the Provider's request to revise the 1985 base year average per resident amount to include pathologists teaching expenses proper? |
1998D074 | 93-0513 | 11-0198 | Was the Intermediary's elimination of space rental costs proper? |
1998D076 | 94-0353 | 23-0032 | Was the Intermediary's denial of the Provider's request to revise the 1985 base year average per resisent amount proper? |
1998D077 | 94-2804 | 45-0137 | Was the Health Care Financing Administration's ("HCFA") denial of the Provider's application for an exception/ adjustment to the TEFRA limit for the fiscal years ended ("FYE") September 30,1987, 1988 and 1989 proper? |
1998D079 | 95-0436 | 05-0183 | Was HCFA's denial of an exception to the routine cost limit filed within 180 days of the revised NPR in accordance with the Medicare statutes and regulations? |
1998D080 | 93-0054 | 15-4033 | Was the issue relating to denial of new provider exemption proper and should the Provider's base year be changed from fiscal 1984 to 1990? |
2010D32 | 05-1693; 05-1694 | 36-0175 | Was the Intermediary's adjustment to include outpatient observation bed days in the bed count for purposes of calculating the Provider's indirect medical education (IME) reimbursement proper? |
2010D33 | 05-0171G; 05-0172G; 05-0173G; 06-0153G; 07-0453G; 08-1308G; 09-0964GC | Various | Whether days for which patients received charity care in Pennsylvania were required by the Medicare statute to be included in the numerator of the Medicaid proxy of the Medicare DSH calculation. |
2010D34 | 08-0382; 08-0383 | 19-1555 | Whether the Intermediary followed the proper reopening procedures prior to the issuance of the Intermediary's letter dated June 11, 2007 (Notice of Effect of Inpatient Day Limitation and Hospice Cap Amount) recalculating the hospice cap for years ending October 31, 2003 and October 31, 2004, respectively. |
2010D35 | 98-0850G; 09-1633GC; 09-1634GC; 09-1635GC; 07-2034G; 07-2032G; 07-2033G | Various | Whether the Centers for Medicare and Medicaid Services' methodology for determining the exception from the routine cost limits (RCL) for hospital-based skilled nursing facilities (HB-SNF) was proper. |
1998D075 | 88-1339 | 10-0060 | Did the Intermediary correctly apply the lower of cost or charge limit? |
1998D078 | 91-1509 | 05-0040 | Was the Health Care Financing Administration's ("HCFA") denial of portions of the Provider's request for exceptions and adjustments to the rate of increase ceiling ("TEFRA Limit") for the exempt psychiatric unit proper? |
1998D081 | 92-2398 | 42-T078 | Was HCFA's denial of the Provider's request for an adjustment to its TEFRA target rate for certain costs proper? |
1998D083 | 92-1569 | 05-0191 | Was the Provider's request for an adjustment to the TEFRA limits for the fiscal year ended June 30, 1989 timely? |
1998D084 | 96-0066G | Various | Was the Intermediary's inclusion of neonatal intensive care unit ("NICU") beds in the indirect medical education ("IME") calculation proper? |
1998D085 | 96-0378 | 05-0281; 55-5294 | Should the Provider's Medicaid patient days in its "subacute unit" be included in calculating the disproportionate share hospital ("DSH") adjustment? |
2007D25 | 06-0110G; 06-0111G | 67-7270: 37-7097 | Whether the Intermediary's adjustment to include the Dixie Diamond Ranch as an "other" component on Schedule G of the home office cost statement was proper? |
2009D39 | 04-1799G | Various | Whether inpatient hospital days attributable to individuals who applied to the Providers for, and received, assistance under Georgia's Indigent Care Trust Fund ("ICTF") should be counted in the number of Medicaid-eligible days in the numerator of the Medicaid fraction used to calculate the Medicare disproportionate share hospital (DSH) payments to the Providers. |
2009D40 | 05-1291; 05-1292; 05-1293 | 10-4504; 10-4561; 10-4560 | Whether the Intermediary's adjustments reflected in the revised Notices of Program Reimbursement (NPR), that reduced allowable home office costs, were proper. |
2009D41 | 05-0350; 06-0452 | 33-0004 | Whether the intermediary properly adjusted the Provider's direct graduate medical education (DGME) and indirect medical education (IME) full-time equivalent (FTE) count for the fiscal years ended December 31, 2000 and December 31, 2001. |
2009D42 | Various | 26-2011; 26-2010 | Whether the Intermediary's adjustments treating the Management Services Corporation (MSC) pool payments the Providers received as provider refunds, which were offset against the allowable provider tax expense, were proper. |
2010D01 | 01-2484 | 06-0024 | Whether the Intermediary's determination that the resident time was not spent in the hospital complex was proper and with respect to some residents, the resident time was adequately documented as occurring in the contested area. |
2010D02 | 06-1078G; 06-1079G | Various | Whether the Intermediary's adjustments to the Provider's reimbursable capital costs after denying "new hospital" status was proper. |
2010D03 | 07-0793G | Various | Did the Centers for Medicare & Medicaid Services (CMS) err in calculating a budget neutrality adjustment to the PPS standardized amount to account for the effect of the rural floor on the wage index? |
2007D26 | 04-1774 | 42-0023 | 1. Whether the Intermediary properly adjusted the Provider's Medicare bad debts.; 2. Whether the Intermediary properly adjusted the Provider's medical benefit plan costs. |
2007D27 | 04-0552 | 24-0001 | Whether the FY 2000 ambulance cost trip limits were improperly low because the Intermediary improperly applied the 5.8% outpatient operating cost reduction and the 10% outpatient capital cost reduction to base year costs utilized to calculate those limits. |
2007D29 | 02-0361G | Various | Whether Arizona state-funded days, such as Medically Needy/Medically Indigent (MN/MI), Eligible Low Income Children (ELIC), and/or Eligible Assistance Children (EAC) qualify as Medicaid days for purposes of determining the Provider's Medicare Disproportionate Share Hospital (DSH) adjustments for fiscal years 1994 through 2000. |
2007D30 | 99-2858 | 17-0122 | Whether the Intermediary's computation of the IME and DGME count as it relates to the following components was correct: a) Family practice rotations to the continuity care clinic; b)Internal medicine rotations to the St. Joseph campus of the Provider; c)Exclusion of psychiatric rotations in clinical research activities from IME FTE Count |
2007D31 | 01-3521G | 31-0015; 31-0051 | Whether the cost report instructions improperly apply the indirect medical education (IME) full-time equivalent (FTE) cap to discharges prior to October 1, 1997. |
2007D32 | 00-2803 | 52-0174 | Whether the Intermediary's determining disallow post-retirement health benefits costs for a terminated provider was proper. |
2007D33 | 04-2009 | 45-1320 | Whether the Provider is eligible to receive payment on a reasonable cost basis for anesthesia services provided in its critical access hospital (CAH) by certain qualified non-physician anesthetists pursuant to 42 C.F.R. Section 412.113(c). |
2007D34 | 06-0456 | 05-0222 | Whether the Intermediary improperly excluded from the Disproportionate Share Hospital (DSH) Medicaid fraction days attributable to the labor and delivery portion of stays of maternity patients who occupied licensed inpatient beds located in Labor, Delivery, Recovery and Postpartum (LDRP) rooms. |
2010D04 | 05-0917; 05-0916 | 26-4020 | Whether the Intermediary properly declined to establish a per-resident amount (PRA) and full-time equivalent (FTE) cap applicable to Provider's graduate medical education (GME) costs. |
2010D05 | 03-0859G; 04-1027G; 05-1256G | Various | Whether Intermediary properly excluded New Jersey Charity Care Program (NJCCP) days from the Medicare disproportionate share (DSH) calculation for fiscal year-ends (FYEs) 2000 to 2002 for the hospitals in this group appeal. |
2010D06 | 08-0429 | 42-0078 | Whether the intermediary's disallowance of resident time spent in didactic activities for purposes of the indirect medical education adjustment was proper. |
2010D07 | 06-0301; 06-0302 | 16-0083 | Whether the Intermediary improperly calculated the Provider's Medicare disproportionate share hospital (DSH) payment by excluding patient days attributable to hospital inpatients who were eligible for Medicaid and enrolled in Medicare Part A for all or a part of the period at issue. |
2010D08 | 08-2068 | 37-1633 | 1. Has the Provider demonstrated that it is entitled to a hearing before the Board because there is $10,000 in controversy?; 2. To what extent, if at all, Medicare's $720,991 demand for repayment from the Provider for fiscal year 2006 would be decreased if the Provider's proposed manner of calculation of the amount of the hospice cap is adopted in lieu of the Intermediary's calculation which was issued pursuant to the existing regulation. |
2010D09 | 00-3325 | 05-0146; 05-7037 | Whether the Provider timely filed its Tax Equity and Fiscal Responsibility Act (TEFRA) exception request. |
2010D10 | 98-3417G | Various | Whether the Intermediary's deletion of therapy costs from line 25, column 9 of Worksheet B-1 of the Providers' Medicare cost reports is proper and in accordance with Medicare cost reporting practices and procedures. |
2010D11 | 04-0228G | Various | Whether the various Intermediaries properly disallowed reimbursement to the Providers for uncollected coinsurance and deductible amounts relating to outpatient therapy services claimed as bad debt during the Providers' respective cost-reporting years ending in 2001. |
2010D37 | 02-0816 | 22-5681 | Was the Intermediary's denial of the Provider's request for a new provider exemption from Medicare routine service cost limits proper in light of the standards set forth in St. Elizabeth's Medical Center of Boston, Inc. v. Thompson, 396 Fed. 3rd 1228 (D.C. Cir. 2005)? |
1998D082 | 94-2577 | 17-0086 | Was the Intermediary's reopening of the Medicare cost report to reduce reimbursement for indirect medical education ("IME") expense proper? |
1998D086 | 94-3045 | 33-2546 | Was the Intermediary's denial of the Provider's request for an exception to its End-Stage Renal Disease ("ESRD") composite rate proper? |
1998D087 | 97-0682G | Various | Were the Intermediary's adjustments to occupational and speech therapy costs proper? |
1998D088 | 90-1201;91-1310 | 45-0021 | 1. Was the Intermediary's adjustment offsetting intercompany interest income proper?; 2. Was the Intermediary's adjustment disallowing staff physician Part A salary costs proper?; 3. Was the Intermediary's adjustment offsetting investment income earned on loans to physicians proper?; 4. Was the Intermediary's adjustment disallowing intercompany interest expense proper? |
1998D089 | 91-2907M | 39-0196 | 1. Did the Intermediary improperly exclude physician compensation costs, attributable to teaching and supervision of interns and residents in the departments of surgery, from the graduate medical education ("GME") costs used to compute the Provider's average per resident amount?: 2. Did the Intermediary improperly exclude physician compensation costs, attributable to teaching and supervision of interns and residents in the departments of radiation therapy, from the GME costs used to compute the Provider's average per resident amount?: |
1998D090 | 92-0948 | 50-0064 | 1. Did the Provider maintain adequate documentation to properly determine the paramedical education costs claimed for the physical therapy clinical training program and did those costs qualify as paramedical education costs reimbursable on a pass-through basis?; 2. Was the Provider's inclusion of foreign medical graduates in its resident count proper?; 3. Was the Provider's documentation adequate to support additional claimed costs related to the County Treasurer's costs of services performed for the Provider? |
1998D091 | 95-1921 | 05-0468 | Should the Provider's Medicaid patient days in its "subacute unit" be included in calculating disproportionate share hospital ("DSH") adjustment? |
1998D092 | 95-0303 | 05-4078 | Was the Intermediary's adjustment to the property tax expense proper? |
1998D093 | 92-0591 | 16-0083 | Was the Intermediary's allowcation of the Provider's physician billing costs proper? |
1998D094 | 95-0100 | 39-0110 | Did the Intermediary use the proper bed count when computing the Provider's indirect medical education ("IME") adjustment for fiscal year 1992? |
1998D095 | 97-2589 | 10-0237 | Did the Intermediary improperly reopen the Provider's fiscal year ended ("FYE") september 30, 1001 cost report? adjustment to |
1998D096 | 97-3046 | 67-7584 | Were the cost limits issued prospectively by New Mexico Blue Cross Blue Shield for FY 95 and as applied in FY 95, correct or were the lower cost caps retroactively applied in FY 96 by Palmetto (the successor Intermediary) correct? |
2008D18 | 01-0801 | 14-0174 | Whether the Intermediary's adjustment disallowing the loss on disposal of depreciable assets through consolidation was proper. |
2008D21 | 01-1910 | 05-6833 | Whether the Intermediary properly disallowed bad debts claimed for uncollectible deductibles and coinsurance amounts related to outpatient therapy services furnished to Medicare beneficiaries dually eligible for Medicare and Medicaid, and paid under the Part B fee schedule. |
1998D108 | 96-0568G | Various | Was the Intermediary's audit adjustments reducing charges for occupational and speech therapy services based upon the prudent buyer concept proper? |
1998D107 | 96-2053G | Various | Was the Intermediary's audit adjustments reducing charges for occupational and speech therapy services based upon the prudent buyer concept proper? |
1998D106 | 96-0175G | Various | Were the Intermediary's audit adjustments reducing charges for occupational and speech therapy services based upon the prudent buyer concept proper? |
1998D105 | 96-0590 | 50-5344 | Was the Intermediary's audit adjustment reducing charges for occupational and speech therapy services based upon the prudent buyer concept proper? |
1998D104 | 94-0284G | Various | Was the Intermediary's inclusion of neonatal intensive care unit ("NICU") beds in the indirect medical education ("IME") calculation proper? |
1998D103 | 93-0429 | 05-0230 | Was the Intermediary's adjustment offseting revenue associated with physician and guest meals, while, at the same time, setting up a nonreimbursable cost center for these nonallowable costs, proper? |
1998D102 | 94-1146 | 36-0045 | Was the Intermediary's calculation of the number of full-time equivalents ("FTEs") when counting thw number of interns and residents for FYE December 31, 1989 proper? |
1998D101 | 89-0706 | 05-0578 | Was the Intermediary's determination of the amount of Medicare outlier payments proper? |
1998D100 | 93-1013 | 05-0152 | Did the Intermediary abuse its discretion in refusing to reopen the Provider's cost reports for the fiscal Years ("FYE") ended June 30, 1982 and 1983? |
1998D099 | 89-1522 | 05-0327 | Was the Provider's computation of the self-disallowance amount of investment income offset against interest expense proper? |
1998D098 | 89-1753 | 05-0450 | Was the Provider's request for additional payment due to volume decrease, properly made within 180 days from the date of the revised Notice of Program Reimbursement (NPR)? |
1998D097 | 97-3047 | 67-7413 | Were the HHA cost limits issued prospectively by New Mexico Blue Cross Blue Shield for FY 95 and as applied in FY 95, correct or were the lower costs limits retroactively applied by Palmetto (the successor Intermediary) correct? |
2008D15 | 00-1182 | 39-0242 | Whether the Intermediary's denial of the loss on disposal of assets claimed by Allentown Osteopathic Medical Center (AOMC) was proper? |
2008D25 | 05-1788 | 05-0599 | Whether the Intermediary can make an adjustment to the Provider's Medicare cost report more than three years after the original Notice of Program Reimbursement date. |
2008D24 | 01-0679; 02-0244 | 05-0043 | Whether the TEFRA base year used by the fiscal intermediary to compute a target amount for the Provider's excluded psychiatric unit for the February 28, 1998 and February 28, 1999 cost years was proper. |
2008D23 | 04-1953; 05-1582 | 45-0076 | 1. Whether the Intermediary properly disallowed the Provider's request for an adjustment to the TEFRA rate-of-increase ceiling to account for the cost of new drugs that were not approved in the 1983 base year.; 2. Whether the Intermediary properly calculated the Provider's 1996 reasonable cost that were included in the denominator of the fraction used to determine the payment-to-cost ratio for purposes of the Outpatient Prospective Payment System (OPPS) hold harmless payment. |
2010D40 | 01-1346G | Various | Whether the Intermediary's calculation of the Providers' Medicare disproportionate share hospital ("DSH") payments improperly excluded "expansion waiver" days attributable to patients who received medical assistance through Tennessee's Medicaid demonstration project waiver program approved by the Secretary under section 1115 of the Social Security Act ("section 1115"). |
2010D41 | 04-0495G | Various | Whether the Intermediary erred in excluding certain contract labor costs, home office costs, and wage-related costs that were claimed by Bon Secours-DePaul Medical Center, Maryview Medical Center, and Mary Immaculate Hospital (collectively, the "Bon Secours Hospitals") and used to calculate the federal fiscal year 2004 wage index for the Norfolk Metropolitan Statistical Area ("MSA"). |
2010D42 | 98-1025 | 23-0029 | 1. Whether the Medicare bad debt payment was computed properly.; 2. Whether the Medicaid Proxy component of the disproportionate share hospital (DSH) adjustment was computed properly.; 3. Whether the Medicare Proxy component of the disproportionate share hospital adjustment must be remanded to the Intermediary without adjudication by the Board pursuant to CMS Ruling No. 1498-R. |
2010D43 | 02-0162 | 10-5990 | In light of the August 29, 2007 Remand Order from the Administrator of the Centers for Medicare and Medicaid Services ("CMS"), what is the proper regulation and manual provision to apply to the facts of this case and what is the relevance of the Provider's cost reporting period and skilled nursing facility's ("SNF") Medicare certification date with respect to the reimbursement scheme that should govern payments? |
2010D44 | 04-2270; 07-0278; 07-1351; 08-0169 | 37-0202 | Whether the hospital as a new provider is entitled to capital hold-harmless methodology under the prospective payment system beyond the 10-year transition period. |
2010D45 | 04-0380; 05-1209; 06-0688 | 03-0064 | 1. Whether the Intermediary properly excluded resident rotations for research and other scholarly activities when calculating the resident full time equivalent (FTE) count for indirect medical education (IME) adjustment purposes.; 2. Whether the Intermediary's calculation of the new program add-on to the Provider FTE cap was improper by virtue of the fact that it omitted time spent by residents in research and scholarly activities. |
2000D22 | 96-1930; 97-1708; 98-2034 | 34-0061 | Did the Intermediary properly use the Reasonable Compensation Equivalent limits from 1984 to reduce the amount of reasonable compensation paid by the Provider to its hospital-based physicians for 1993, 1994 and 1995? |
2000D23 | 96-1736 | 31-0062 | 1. Was the Intermediary's calculation of the number of maintained beds proper?; 2. Was the Intermediary's adjustment excluding certain resident Full-Time Equivalents (FTEs)proper?; 3. Was the Intermediary's adjustment excluding certain allowable fringe benefits proper?; 4. Was the Intermediary's adjustment disallowing certain amounts related to contract labor proper?; 5. Was the Intermediary's adjustment disallowing certain amounts related to Part B physician salaries and hours proper? |
2000D24 | 94-0302G; 94-0304G | Various | Were the Intermediary's adjustments to the Providers' home office cost statementsproper? |
2000D25 | 95-0326 | 50-0057 | Were HCFA's determinations of the Provider's ESRD exception requests proper? |
2000D26 | 95-1566 | 31-0075 | Was the Intermediary's failure to apply updated reasonable compensation equivalents limits proper? |
2000D27 | 96-0036 | 36-0085 | Was the Intermediary's adjustment to the outlier payments proper? |
2000D28 | 91-2846M | 33-0354 | Was the Intermediary's failure to include supervising physician costs in the Provider's final base-year average per resident graduate medical education (GME) amount proper? |
2000D29 | 91-2887 | 14-0087 | Was the Intermediary's netting of the balance due to Edgewater Hospital of liabilities owed to the program by Edgewater Medical Center proper? |
2000D30 | 95-0459 | 05-0684 | Was the Intermediary's elimination of square footage statistics for the fourth floor storage area correct? |
2000D48 | 96-0861 | 24-2004 | Was the Intermediary's adjustment to disallow the Minnesota Care Tax proper? |
2000D49 | 96-0804 | 24-0003 | Was the Intermediary's adjustment to disallow the Minnesota Care Tax proper? |
2000D50 | 96-0918 | 51-0001 | Was the Intermediary's adjustment reclassifying the depreciable assets as "new" capital proper? |
2000D47 | 96-0644 | 24-0063 | Was the Intermediary's adjustment to disallow the Minnesota Care Tax proper? |
2000D46 | 97-2385 | 36-6007 | Is the Provider entitled to an exemption from the routine cost limits ("RCL") as a new provider under 42 C.F.R. section 413.30(e)? |
2000D45 | 94-0614 | 14-0087 | Was the Intermediary's calculation of the Provider's disproportionate share ("DSH") adjustment proper? |
2000D44 | 94-0616 | 14-0087 | Was the Intermediary's calculation of the Provider's disproportionate share ajustment ("DSH") proper? |
2000D43 | 96-0527 | 01-0068 | Was the Intermediary's adjustment disallowing portions of compensation paid to physicians based on the application of the 1984 reasonable compensation equivalents ("RCE") proper? |
2000D42 | 95-0577 | 39-0049 | Was HCFA's denial of the Provider's request for an exception to the renal dialysis composite rate based on atypical service intensity proper? |
2000D41 | 96-2423 | 33-0048 | Was the Intermediary's refusal to increase the Provider's disproportionate share percentage to include eligible Medicaid days where Medicare was the primary payor proper? |
2000D40 | 95-0535 | 52-0098 | Was HCFA's denial of the Provider's request for an exception rate for self-dialysis training using an accelerated method proper? |
2000D39 | 91-2592M; 94-0951; 94-0952; 94-0953; 94-1386 | 49-0063 | 1.Whether the Intermediary proper omitted all of the pathology teaching costs incurred in the Graduate Medical Education ("GME") base year from the GME costs used to compute the Provider's average per resident amount ("APRA")?; 2. In the alternative, whether the Intermediary properly included the 4.42 full-time equivalent ("FTE") residents who worked in the approved pathology program during the GME base year in the resident count used to compute the APRA? |
2000D38 | 98-0273 | 45-6689 | Was the Intermediary's adjustment to the accrued salaries proper? |
2000D37 | 95-2401; 95-2402; 95-2403 | 39-0029 | 1. Did HCFA properly deny the PRovider's requests for a permanent adjustment to its TEFRA base year in fiscal years ("FY") 1989 and 1990, and the "assignment of a new base period" in FY 1991?; 2. Did HCFA properly grant only limited cost year specific adjustments? |
2000D36 | 97-0795 | 01-7009 | Was the Intermediary's adjustment calculation proper to bring the expenses of Healthstar, Inc., a related party, to the cost of ownership? |
2000D35 | 97-2148 | 43-0077 | 1.Was the Intermediary's classification of School of Nursing Joint Education Program cost proper; 2. Was the Intermediary's adjustment eliminating Part A hours for Medical Directors proper? |
2000D34 | 97-2064 | 43-0077 | Was the Intermediary's classification of School of Nursing Joint Education Program cost proper? |
2000D31 | 96-2587 | 34-7021 | Was the Intermediary's adjustment disallowing the Provider's employee recruitment expense proper? |
2000D32 | 98-0448 | 24-0053 | Was the Intermediary's disallowance of the physician Part A compensation due to inadequate physician time studies proper? |
2000D33 | 97-2391 | 33-0158 | Were the Intermediary's adjustments to the reasonable compensation equivalent ("RCE") limits proper? |
2000D52 | 96-2570 | 16-0059 | Was the Intermediary's adjustment disallowing the Provider's loss on the sale of its assets proper? |
2000D53 | 88-0649 | 22-3026; 22-5190 | Was HCFA's methodolgy for measuring the entitlement of hospital-based skilled nursing facilities ("HB-SNF") to exception relief under 42 C.F.R. section 413.30(f) and HCFA's denial of the Provider's fiscal year ("FY") 1985 exception request proper? |
2000D54 | 96-2623 | 05-0559 | Did the Intermediary properly include the Provider's inpatient Part B charges with outpatient Part B charges, subjecting the inpatient Part B charges to the 5.8% outpatient cost reduction? |
2000D51 | 95-2202 | 33-0399 | Was the Intermediary's adjustment reducing the allowable cost to charge retio that should be applied to outpatient charges proper? |
2000D55 | 97-1810 | 10-7123 | Was the Intermediary's adjustment to the Provider's visit statistic proper? |
2000D56 | 96-1215 | 44-0072 | 1. Was the Intermediary's adjustment disallowing Medicare reimbursement for a portion of the bad debts proper?; 2. Was the Intermediary's reclassification for home health agency costs proper? |
2000D58 | 96-2027; 97-2271 | 53-0002 | Was the Provider entitled to an exception to the home health agency ("HHA") cost limits for the fiscal years ended June 30, 1993 and June 30, 1994? |
2000D57 | 96-0939 | 05-0267 | 1. Did the Intermediary properly include the Provider's inpatient Part B charges with outpatient Part B charges, thereby subjecting the inpatient Part B charges to the 5.8% outpatient cost reduction?; 2. Was the Intermediary's calculation of the Provider's disproportionate share ("DSH") adjustment proper? |
2000D59 | 96-2619 | 03-5104 | Was the Intermediary's adjustment disallowing indigent Part B bad debts proper? |
2009D25 | 00-3473G | Various | Whether the Intermediary properly excluded Connecticut's State-Administered General assistance (SAGA) program days from the Medicare disproportionate share hospital (DSH) calculation for fiscal year-ends (FYEs) 1994 to 1998 for hospitals in this group appeal. |
2007D35 | 95-0795; 97-1098; 00-3556G; 01-2892G; 01-2936G; 01-2937G; 02-1810G; 03-1423G | Various | Whether the Intermediary improperly omitted certain inpatient hospital days from the numerator of the Medicaid low-income proxy used to calculate the Providers' disproportionate share hospital (DSH) adjustment. |
2007D36 | 98-2095 | 33-7019 | 1. Whether the Intermediary's adjustment to related party transaction cost was proper.; 2. Whether the Intermediary's adjustment to disallow portions of membership dues expense was proper.; 3. Whether the Intermediary's adjustment to disallow certain meeting/conference expenses was proper. |
2007D37 | 00-0774 | 53-7025 | Whether the Intermediary's disallowance of accrued employee benefit costs that were not liquidated within one year after the end of the Provider's cost reporting period was proper. |
2007D38 | 00-01032; 01-2147 | 24-5610 | Whether the denial of the Provider's request for a new provider exemption from the skilled nursing facility routine cost limits was proper. |
2007D39 | 04-0644 | 23-0230 | Whether the Intermediary properly determined the full-time equivalent (FTE) intern and resident count for purposes of computing the Provider's indirect medical education adjustment (IME) and the direct graduate medical education (DGME) payment. |
2007D40 | 04-2269 | 05-0150 | Whether the Provider's regular Medicare outpatient bad debts are not allowable until all collection efforts including those of a collection agency have ceased. |
2000D60 | 95-0079; 95-2394; 96-0287 | 26-7002 | 1. Was the Intermediary's adjustment disallowing the salary and related expenses of the Director of the Volunteer Department proper?; 2. Was the Intermediary's adjustment disallowing the expenses of the television recruitment advertisement proper (FY 93 only)? |
2000D61 | 96-2534 | 23-0132 | Was the denial of the TEFRA exception request proper? |
2000D63 | 97-0643; 98-0770; 99-3555; 99-0613 | 55-7253 | 1. Was the Intermediary's adjustment to Physical Therapy costs proper?; 2. Was the Intermediary's adjustment to owner's compensation proper? |
2000D64 | 96-0847 | 24-0106 | Was the Intermediary's adjustment offsetting the Provider-paid surcharge (tax) to the Minnesota Medicaid Program proper? |
2000D65 | 91-2887R | 14-0087 | Was the Intermediary's netting of the balance due to Edgewater Hospital of liabilities owed to the program by Edgewater Medical Center proper? |
2000D66 | 92-0209; 94-2362; 98-0428; 99-0130; 99-0131 | 01-0068 | Was the Intermediary's adjustment disallowing portions of compensation paid to physicians based on the application of the 1984 reasonable compensation equivalents proper? |
2000D67 | 94-0654 | 45-0358 | Was the Intermediary's adjustment reclassifying costs related to equipment which was part of a aupply purchase agreement proper? |
2000D68 | 99-0286 | 31-7062 | 1. Was the interest paid on working capital loans from the Friend Center Fund and commercial banks necessary and allowable?; 2. Was the interest paid to Cadwalder Properties, a related party, allowable as an ownership cost under 42 C.F.R. section 413.153? |
2000D69 | 90-1357 | 05-0076 | Was the Provider entitled to an adjustment to its TEFRA target rate as a result of the addition of cardiovascular surgery services during the last three months of its TEFRA base year? |
2000D70 | 97-0407 | 36-0125; 36-6048 | Did HCFA properly deny a new provider exemption request for the Provider's distinct part skilled nursing facility inder 42 C.F.R. section 413.30(e)? |
2000D62 | 92-0668R | 34-0113 | Did the Intermediary properly reopen the Provider's cost report and recoup an overpayment made to the Provider? |
2000D71 | 95-1279; 95-1280 | 13-0037 | Were the Intermediary's adjustments disallowing costs associated with the Certified Nurse Anesthetist proper? |
2000D72 | 93-1920; 94-0007 | 05-0226 | Do equitable tolling principles apply to a matter of law to PRRB appeals under section 1878 of the Social Security Act, codified at 42 C.F.R. section 1395oo, and Boards appeals under the regulations at 42 C.F.R. Subpart R? |
2000D73 | 94-1477; 94-1520 | 45-0023 | Were the Intermediary's initial, amended and reopening adjustments to interest expense and bond related cost proper? |
2000D74 | 88-1494G; 88-1495G; 88-1496G | Various | Should the federal portion of the prospective payment system ("PPS") rate be adjusted because it was based on 1981 hospital cost report data which incorporated an invalid method of reimbursing malpractice costs, that is, the 1979 malpractice rule? |
2000D75 | 93-0073G; 92-1509G; 93-0888G | Various | Should the federal portion of the prospective payment system ("PPS") rate be adjusted because it was based on 1981 hospital cost report data which incorporated an invalid method of reimbursing malpractice costs, that is, the 1979 malpractice rule? |
2011D19 | 09-0003GC; 04-2135G; 04-2136G; 04-2137G; 06-1907G; 06-1906G; 08-2753GC; 08-2757GC; 08-2847GC | Various | Whether the Intermediary should include dual-eligible, Medicare + Choice (M + C) patient days in the numerator of the Medicaid proxy in determining Medicare reimbursement for disproportionate share hospital (DSH) payments in accordance with the Medicare statute at 42 U.S.C. Section 1395ww(d)(5)(F)(vi)(II). |
2011D20 | 08-2752GC; 04-2131G; 04-2132G; 04-2133G; 04-2134G; 08-2845GC; 08-2756GC | Various | Whether for fiscal years 1995-1998 the Intermediary should include dual-eligible, Medicare health maintenance organization (HMO) patient days in the Medicaid proxy in determining Medicare reimbursement for disproportionate share hospital (DSH) payments in accordance with the Medicare statute at 42 U.S.C. Section 1395ww(d)(5)(F)(vi)(II). |
2011D21 | 04-0327; 04-0328 | 45-0728 | Whether the Provider is entitled to payment of "fair compensation" pursuant to 42 C.F.R.Section 413.13. |
2011D22 | 04-0661; 04-0663 | 45-0705 | Whether the Provider is entitled to payment of "fair compensation" pursuant to 42 C.F.R. Section 413.13. |
2011D23 | 05-0476 | 45-0068 | Whether the Intermediary properly disallowed the loss claimed by Hermann Hospital representing a complete write-off of the book value of its depreciable assets as a result of the merger with the Memorial Hospital System. |
2011D25 | 00-2803 | 52-0174 | Whether the Provider's post-retirement health benefit costs are allowable costs in the Provider's terminating cost report under Provider Reimbursement Manual (PRM) Section2176. |
2011D26 | 08-0384 | 19-1555 | Whether a full or partial waiver is permissible for the Provider's hospice inpatient day limitation overpayment for the cap year November 1, 2004 through October 31, 2005. |
2011D27 | 08-1474 | 33-0005 | 1. Whether the Intermediary's adjustment of the Provider's direct Graduate Medical Education per resident amount was proper.; 2. Whether the Intermediary properly excluded research time the Provider alleges was related to patient care from the Full Time Equivalent resident count for direct Graduate Medical Education and Indirect Medical Education. |
2010D12 | 06-2136G; 07-2590G;08-2765GC;082961GC;08-2963GC; 08-2964GC | Various | Whether the Intermediary's disallowance of the Illinois provider tax assessment was proper. |
2010D13 | 06-1800 | 10-1440 | Was the Intermediary's adjustment disallowing bad debts arising from coinsurance and deductibles for dual eligible Medicare and Medicaid beneficiaries proper? |
2010D14 | 05-0828 | 10-0061 | Whether the provider has a right to hearing on correction of its cost report to reclassify certain nurse expenses. |
2010D15 | 08-1816 | 36-0151 | Does the Board have jurisdiction over the resident-to-bed ratio where an alleged error in the filed cost report was discovered by the Provider after the final determination was issued? |
2010D16 | 07-2546; 07-2547; 07-2548; 07-2549 | 22-1990 | Whether the Fiscal Intermediary's denial of the Provider's nursing education program costs as pass-through costs was valid when that denial was based on a finding that the Commission for the Accreditation of Christian Science Nursing Organization/Facilities, Inc. (Commission) is not a "recognized national professional organization for the particular activity" under the provisions of 42 C.F.R. section 413.85(e) for purposes of accrediting the Provider's nursing education programs. |
2010D17 | 07-2533; 08-0470 | 05-1991 | Whether the Fiscal Intermediary's denial of the Provider's nursing education program costs as pass-through costs was valid when that denial was based on a finding that the Commission for the Accreditation of Christian Science Nursing Organization/Facilities, Inc. (Commission) is not a "recognized national professional organization for the particular activity" under the provisions of 42 C.F.R. section 413.85(e) for purposes of accrediting the Provider's nursing education programs. |
2010D18 | 07-2532 | 05-1993 | Whether the Fiscal Intermediary's denial of the Provider's nursing education program costs as pass-through costs was valid when that denial was based on a finding that the Commission for the Accreditation of Christian Science Nursing Organization/Facilities, Inc. (Commission) is not a "recognized national professional organization for the particular activity" under the provisions of 42 C.F.R. section 413.85(e) for purposes of accrediting the Provider's nursing education programs. |
2010D19 | 07-2538; 07-2544 | 45-1990 | Whether the Fiscal Intermediary's denial of the Provider's nursing education program costs as pass-through costs was valid when that denial was based on a finding that the Commission for the Accreditation of Christian Science Nursing Organization/Facilities, Inc. (Commission) is not a "recognized national professional organization for the particular activity" under the provisions of 42 C.F.R. Section 413.85(e) for purposes of accrediting the Provider's nursing education programs. |
2010D20 | 00-4034G; 00-4035G; 00-4036G; 05-0157G | Various | Whether the Providers have been properly paid for bad debts for Medicare deductible and coinsurance amounts associated with Medicaid eligible inpatients for services between May 1, 1994 and June 30, 1998. |
2010D21 | 07-2829 | 10-1472 | Was the Intermediary's adjustment disallowing bad debts arising from coinsurance and deductibles for dual eligible Medicare and Medicaid beneficiaries proper? |
2010D22 | 04-2157; 05-0706 | 39-0204; 39-0022 | Whether General Assistance (GA) days should be added to the numerator of the "Medicaid" proxy in the Disproportionate Share (DSH) payment calculation. |
2010D23 | 07- 0459; 07-2370 | 03-5143 | Whether the CMS must-bill policy applies to the Provider's dual-eligible bad debts when the Provider did not participate in the Medicaid program. |
2010D24 | 01-2257 | 12-0001 | Whether First Coast Service Options, Inc. (Intermediary) improperly excluded patient days associated with patients who were dually eligible for both the Medicare and Medicaid programs but for such days there was no Medicare Part A payment or coverage available (dual eligible days) from the numerators of both the Medicaid and Supplemental Security Income (SSI) percentages of the Medicare disproportionate share hospital (DSH) computation for purposes of The Queen's Medical Center's (Provider) fiscal year ended June 27, 1998 (FYE 6/27/98) Medicare cost report. |
2010D25 | 08-0251G | Various | Whether the CMS must-bill policy applies to the Providers' dual-eligible bad debts when the Providers did not participate in the Medicaid program. |
2010D26 | 05-1790G | Various | Should patient days associated with Medicare Part A and Title XIX eligible patients that were not included in the Supplemental Security Income (SSI) percentage factor of the Medicare disproportionate share formula be included in the Medicaid days factor or the SSI percentage factor used in the determination of their Medicare Disproportionate Share Hospital (DSH) payment in accordance with the Medicare DSH statute at 42 U.S.C. Section 1395ww(d)(5)(F)(vi)? |
2011D24 | 03-1199G | 17-0040; 17-0086; 17-0122 | Whether the Intermediary should include all MediKan patient days, primary and secondary, in the Providers' disproportionate share hospital (DSH) calculation. |
2000D76 | 98-0455 | 26-7281 | 1. Was the Intermediary's adjustment disallowing salaries and benefits proper?; 2. Was the Intermediary's adjustment to automobile expense peoper?; 3. Was the Intermediary's adjustment to square footage proper?; 4. Was the Intermediary's adjustment reversing the Provider's reclassification of physical therapy costs proper?; 5. Was the Intermediary's adjustment to physical therapy salaries and bebfits proper? |
2000D77 | 97-2085 | 05-7470 | Was the Intermediary's disallowance of interest expense proper? |
2000D78 | 98-2068G | 05-7470; 55-7643; 55-7625 | Was the Intermediary's disallowance of interst expense proper? |
2000D79 | 98-1396G | Various | Was the Intermediary's adjustment to worker's compensation expense proper? |
2000D80 | 96-0184G | Various | Whether the claims of welfare bad debt under Provider Reimbursement Manual Part 1, Section 322, must be based on a bill to the Medicaid agency, and if not, what must the Provider document to recieve bad debt reimbursement? |
2000D81 | 96-2281G | Various | Whether HCFA's methodology of determining the amount of the exception from the routine cost limits for freestanding skilled nursing facilities (SNF) as set forth in HCFA Pub. 15-1, Section 2534.5, Transmittal No. 378, is correct? |
2009D22 | 99-1340 | 39-0028 | Whether interest is due on the continuing underpayments that exist as a result of the fiscal Intermediary's 10 year delay in implementing the PRRB's case number 91-2673. |
2009D23 | 99-0584R (on Remand) | 39-0080 | Whether the Jeanes Hospital merger was a bona fide sale. |
2009D24 | 99-2786 | 22-0118 | Whether the Intermediary's disallowance of the Provider's claim for a loss in connection with its October 1, 1996 statutory merger was proper. |
2000D82 | 96-2052 | 52-5504 | Was the Intermediary's recalculation of the Provider's gross-up method proper? |
2000D83 | Various | Various | Was the Intermediary's inclusion of maintenance treatments in the Provider's cost aportionment statistics for Medicare reimbursement proper? |
2000D84 | 95-0711 | 52-0094 | Did HCFA inappropriately deny the Provider's end stage renal disease ("ESRD") composite rate exception request for atypical service intensity (patient mix) on the grounds that the Provider did not file a fully documented exception request? |
2000D85 | 96-2085 | 05-0090 | Was the Intermediary's calculation of the Skilled Nursing Facility (SNF) Routine Cost Limits (RCL) proper? |
2000D86 | 97-2707 | 45-0717 | 1. Was the Intermediary's adjustment reclassifying the Provider's cost from direct to indirect cost centers proper?; 2. Did the Intermediary properly apply the low occupancy adjustment in HCFA Transmittal No. 378 to HCFA Pub. 15-1 section 2534.5A?; 3. Was HCFA's refusal to grant an exception for that portion of the Provider's per diem costs which does not exceed 112% of the total peer group mean cost proper? |
2000D87 | 95-0634 | 05-0017 | Was HCFA's denial of the Provider's routine cost limit (RCL) exception request proper? |
2000D88 | 99-3515G | Various | Were the Intermediary's adjustments reclassifying workers' compensation and unemployment insurance expenses from the administrative and general cost center to the varying cost centers where employees were assigned proper? |
2000D89 | 97-2390 | 52-0109 | Were the Intermediary's adjustments offsetting investment income related to the sale of HMO stock proper? |
2000D90 | 97-2601 | 20-0016 | Was the Intermediary's denial of the Provider's request for a sole community hospital decreased volume adjustment proper? |
2010D36 | 07-2626G; 06-2111GC; 09-2298GC | Various | Should the Provider Reimbursement Review Board grant the Providers' request for expedited judicial review (EJR) over the validity of the provisions of the Centers for Medicare & Medicaid Services Ruling CMS-1498-R, which if valid, render moot and deny jurisdiction over the dual-eligible group appeals? |
2007D41 | 04-0805 | 05-4135 | Whether the Intermediary's decision to deny the Provider's request for an adjustment/exception to its Tax Equity and Fiscal Responsibility Act (TEFRA) target amount was proper. |
2007D42 | 00-1882G | Various | Whether the Intermediary's adjustments disallowing the loss claimed by Medicare Providers on the disposition of assets resulting from the statutory merger of California Medicorp into Presbyterian Health Services Corporation were proper. |
2007D43 | 98-1942 | 44-0048 | Whether the Provider is entitled under CMS Program Memorandum (PM) A-99-62 to include Social Security Act, Section 1115 waiver days for the expanded Medicaid populations (a/k/a TennCare) days in the Medicaid component of the disproportionate share hospital (DSH) calculation. |
2007D44 | 01-2519 | 45-0039 | Whether the Provider timely filed additional information required to entitle it to an exemption from the skilled nursing facility (SNF) routine cost limit under 42 C.F.R. section 413.30(e). |
2007D45 | 02-0162 | 10-5990 | Whether the Centers for Medicare and Medicaid Services (CMS) properly denied the request(s) of the Provider for an exemption from the Routine Service Cost Limits (RCLs) for the fiscal year ended December 31, 1998. |
2009D27 | 05-1370 | 52-0051 | Whether the Medicare statute requires the Provider's Long Term Respiratory Unit (LTRU) days to be excluded from the Medicaid Proxy of the Medicare DSH calculation under 42 U.S.C. Section 1395ww(d)(5)(F)(vi)(II). |
2009D26 | Various | Various | Whether the Intermediary properly excluded dual eligible patient days from the Medicaid eligible days in determining the Medicaid percentages that were used for the disproportionate share hospital (DSH) adjustment payments. |
2009D33 | 06-0814 | 45-0296 | Whether the Intermediary's adjustment of the disproportionate share hospital (DSH) reimbursement, based on its determination that the Provider had less than 100 available beds for DSH eligibility purposes, was proper. |
2009D32 | 05-1133; 06-0127 | 05-0234 | 1. Whether the Intermediary's calculation of the Provider's disproportionate share hospital (DSH) payments, as it pertains to subacute unit days was proper.; 2. Whether the Intermediary's calculation of the Provider's disproportionate share hospital (DSH) payments, as it pertains to Medicare Part A exhausted days for dual eligible patients was proper. |
2009D31 | 05-2010 | 45-0299 | Whether the Intermediary's adjustment of Disproportionate Share Hospital (DSH) reimbursement, based on its determination that the Provider had less than 100 available beds for DSH eligibility purposes, was proper. |
2009D30 | 04-2128G | Various | Whether the exclusion of patient days attributable to Medicare + Choice (M+C) enrollees from the Medicaid fraction in calculating the Providers' disproportionate patient percentages contravenes the statute and regulations. |
2009D29 | 98-0892 | 17-0122 | Whether the Intermediary's adjustments disallowing a loss claimed by St. Francis Regional Medical Center upon its consolidation with St. Joseph Medical Center to form Via Christi Regional Medical Center was proper. |
2009D28 | 04-0597G; 05-0663G; 06-0682G; 03-0282G; 04-0598G | Various | Whether paid lunch period time should be added to hours used to calculate the Providers' hourly wage rates. |
2007D50 | 00-1757; 00-1859; 01-0958; 03-0180; 04-0110 | 44-0049 | Whether the Intermediary's adjustment to the Provider's per resident amount (PRA) was proper. |
2007D49 | 01-1010 | 38-0033 | 1. Whether the exception review process engaged in by the Health Care Financing Administration (HCFA) and the Fiscal Intermediary violated due process and fundamental fairness, including violations of the time limits established by federal regulation and the Provider Reimbursement Manual so as to cause the exception request to be deemed approved in full.; 2. Whether HCFA and the Fiscal Intermediary improperly denied the Tax Equity and Fiscal Responsibility Act (TEFRA) adjustment in its entirety, when at a minimum Oregon Medical Professional Review Organizations (OMPRO's) independent medical review supported a reduced exception amount.; 3. Whether HCFA and the Fiscal Intermediary erred in denying the Provider's revised TEFRA exception request without correcting the Intermediary's use of an incorrect TEFRA target rate. |
2007D48 | 05-0310 | 23-2029 | Whether the Intermediary and CMS erred in denying the Provider's rate adjustment request made under the Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA). |
2007D47 | 05-0658 | 45-7789 | 1. Whether the Intermediary properly allocated home office cost from the finalized home office cost statement to the Provider.; 2. Whether the Intermediary's adjustment to the salaries, benefits and mileage of the program managers was proper.; 3. Whether the Intermediary's adjustment to Dara Stewarts's salary and benefits was proper.; 4. Whether the Intermediary's reopening was proper. |
2007D46 | 97-1239; 97-1240 | 21-5279; 21-5280 | Whether the Intermediary properly denied requests by Franklin Square and Good Samaritan for New Provider Exemptions from the routine cost limits for fiscal years ending 6/30/97 and 6/30/98. |
2008D26 | 02-0326; 03-0730; 04-1130 | 05-0327 | Whether the payment for indirect medical education (IME) and direct graduate medical education (DGME) was understand because not all managed care days and discharges for inpatient services for Medicare beneficiaries were included in the calculation. |
2008D28 | 02-0463 | 03-7205 | Whether the Intermediary properly reclassified professional fees from the Administrative and General (A and G) -reimbursable cost center to the A and G-Shared cost center for the cost reporting period ending December 31, 1999. |
2008D27 | 05-1219 | 17-1302 | Was the Intermediary's adjustment to the provider's claimed owner's compensation proper? |
2008D30 | 02-0050; 02-0615 | 14-4036 | 1. Whether the Intermediary properly adjusted Medicare bad debts.; 2. Whether the Intermediary properly adjusted the Provider's treatment of asset relifing.; 3. Whether the Intermediary properly adjusted public relations and marketing expenses.; 4. Whether the Intermediary properly adjusted officers' life insurance and wind down expenses. (Fiscal year ended (FYE) 10/31/99 only) |
2008D29 | 05-0133G; 05-243G | Various | Was the Provider's reimbursement for indirect medical education (IME) and direct graduate medical education (DGME) for Medicare managed care patients properly disallowed for fiscal year 1999 and fiscal year 2000 for failure to file UB92s in accordance with CMS instruction. |
2008D31 | 02-0705 | 05-0241 | Whether the Intermediary may recoup an overpayment relative to the Provider's 1987 cost reporting period through a revised Notice of Program Reimbursement (NPR) issued in January 2002. |
2008D32 | 03-0778; 04-0914 | 23-0216 | 1. Whether the Provider was required to submit a claim to the Michigan Medicaid program and to obtain a Medicaid remittance advice in order to receive Medicare reimbursement for Part B bad debts relating to services furnished to patients dually eligible for Medicare and Medicaid.; 2. Whether the sampling methodology used by the Intermediary for determining the Provider's entitlement to bad debt payment for the fiscal year ended 6/30/2000 was proper. (CN: 03-0778 only) |
2008D33 | 98-0019; 02-0785 | 22-5682 | 1. Whether the Provider is entitled to a new provider exemption from the skilled nursing facility (SNF) routine service cost limits under 42 C.F.R. section 1413.30(e) for the cost reporting year ended December 31, 1995.; 2. Whether the Intermediary's denial of the Provider's request to be reimbursed the Transitional Period Rate for SNFs under 42 C.F.R. section 413.340(e) for the cost reporting year ended December 31, 1999 was proper. |
2007D70 | 00-3349 | 34-6538 | 1. Did the Intermediary improperly reopen the cost report? (Provider Issue 1); 2. Was the Intermediary's adjustment to bad debts proper? (Provider Issue 2); 3. Was the Intermediary's adjustment to salaries proper? (Provider Issue 3); 4. Was the Intermediary's adjustment to travel expense - speech therapy proper? (Provider Issue 4); 5. Was the Intermediary's adjustment to travel expense - physical therapy proper? (Provider Issue 5); 6. Was the Intermediary's adjustment to travel expense - occupational therapy proper? (Provider Issue 6); 7. Were the Intermediary's adjustments to travel expense - administrative and general proper? (Provider Issue 7); 8. Was the Intermediary's adjustment to auto expense proper? (Provider Issue 8); 9. Was the Intermediary's adjustment to contracted services - occupational therapy services proper? (Provider Issue 9); 10. Was the Intermediary's adjustment to contracted services - speech therapy proper? (Provider Issue 10); 11. Was the Intermediary's adjustment to contracted services - administrative and general proper? (Provider Issue 11); 12. Was the Intermediary's adjustment to consulting expenses proper? (Provider Issue 12); 13. Was the Intermediary's adjustment to accounting expense proper? (Provider Issue 13); 14. Was the Intermediary's adjustment to legal fees proper? (Provider Issue 14); 15. Was the Intermediary's adjustment to supply expense proper? (Provider Issue 15); 16. Was the Intermediary's adjustment to seminar expense proper? (Provider Issue 16); 17. Was the Intermediary's adjustment to telephone expense proper? (Provider Issue 17); 18. Was the Intermediary's adjustment to administrative dues and subscription expense proper? (Provider Issue 18); 19. Was the Intermediary's adjustment to office supply expense proper? (Provider Issue 19); 20. Was the Intermediary's adjustment to rent expense - building and equipment proper? (Provider Issue 20); 21. Was the Intermediary's adjustment to maintenance agreement expense proper? (Provider Issue 21); 22. Was the Intermediary's adjustment to depreciation expense proper? (Provider Issue 22); 23. Was the Intermediary's adjustment to recruiting costs - Rehab Resources proper? (Provider Issue 23); 24. Was the Intermediary's adjustment to total charges - physical therapy proper? (Provider Issue 24); 25. Was the Intermediary's adjustment to total charges - occupational therapy proper? (Provider Issue 24); 26. Was the Intermediary' adjustment to total charges -speech therapy proper? (Provider Issue 24); 27. Was the Intermediary's adjustment to other charges - physical therapy proper? (Provider Issue 24); 28. Was the Intermediary's adjustment to other charges - occupational therapy proper? (Provider Issue 24); 29. Was the Intermediary's adjustment to other charges - speech therapy proper? (Provider Issue 24); 30. Were the Provider's requests for additional costs for depreciation and contracted services - physical therapy proper? (Provider Issues 25 and 26) |
2008D39 | 00-1456 | 39-0098 | Whether the Intermediary's adjustments disallowing the loss on disposal of depreciable assets through consolidation were proper. |
2008D37 | 04-1083; 04-1091; 04-1093; 04-1950 | 22-0033 | 1. Whether the Intermediary improperly computed the numerator of the Medicaid fractions that were used to calculate the Provider's disproportionate share hospital (DSH) payments for fiscal years (FYs) 1999, 2000, 2001, and 2002 by excluding inpatient days attributable to individuals who were both eligible for medical assistance under an approved Medicaid State plan and enrolled in a Medicare +Choice (M+C) plan for such days.; 2. Whether the Intermediary improperly computed the numerators of the Medicaid fractions that were used to calculate the Provider's DSH payments for FYs 1999, 2000, 2001 and 2002 by excluding inpatient days attributable to individuals who allegedly received assistance under the Massachusetts Uncompensated Care Pool for such days.; 3. Whether the Intermediary improperly computed the Medicaid fraction that was used to calculate the Provider's DSH payment for fiscal year 2002 by i) excluding from the numerator inpatient days attributable to individuals who were in a labor and delivery room at the census-taking hour and who had not previously occupied a routine bed and ii) including such days in the denominator.; 4.Whether the Medicare/Supplemental Security Income (SSI) fraction that was used to calculate the Provider's DSH payment for FY 1999 should be recalculated, or, in the alternative, whether the Medicare SSI fraction should be revised. |
2008D38 | 00-1454 | 39-0067 | Whether the Intermediary's adjustments disallowing the loss on disposal of depreciable assets through consolidation were proper. |
2008D40 | 06-0987 | 27-1328 | Whether the Intermediary's adjustment to Certified Registered Nurse Anesthetist (CRNA) cost was proper. |
2008D41 | 06-0614 | 23-0097 | Whether the Intermediary correctly limited the Provider's ambulance reimbursement to its charges. |
2008D43 | 04-1792; 05-2073; 05-2074; 05-2154; 06-0010; 06-0300 | 37-0078 | Whether the Intermediary properly adjusted the Provider's indirect medical education full-time equivalent (FTE) cap? |
2008D42 | 04-0393G | 23-0412; 23-0270; 23-0176 | Whether as a result of underpayment of Medicare reimbursement during the ten-year transition period of the Capital Prospective Payment System (CPPS), the Providers are entitled to a payment of interest under the Medicare statute, 42 U.S.C. Section 1395g(d), the applicable Medicare regulation, 42 C.F.R. Section 405.378, and the Medicare Intermediary Manual (CMS Pub. 13-2) Section 2219. |
2007D78 | 02-0328; 03-0383; 04-0283; 05-1327 | 05-0396 | 1. Whether the Intermediary improperly disallowed direct graduate medical education (DGME) and indirect medical education (IME) payments with respect to discharge of Medicare beneficiaries who were enrolled in the Medicare + Choice or other Medicare risk plans in fiscal years ending December 31, 1998, 1999, 2000 and 2001.; 2. Whether the Intermediary improperly disallowed residents' time spent in non-provider settings within the scope of the Provider's approved medical residency training programs from the Provider's full-time equivalent resident counts for DGME and IME purposes. |
2008D01 | 05-0686 | 15-0011 | Whether the recission of the hospital's approved request for Sole Community Hospital (SCH) status was proper. |
2008D03 | 01-2270; 02-1573; 03-1015 | 10-0032 | Whether the Intermediary improperly disallowed direct graduate medical education (DGME) and indirect medical education (IME) payments with respect to discharges of Medicare beneficiaries who were enrolled in the Medicare + Choice or other Medicare risk plans in fiscal years ending June 30, 1998, June 30, 1999, and December 31, 1999. |
2008D02 | 01-1674G | Various | 1. Whether the Providers entitled to have general relief (GR) days included in the calculation of their disproportionate share percentage to the hold harmless provisions of Program Memorandum A-99-62.; 2. Whether the failure to allow the Providers to include GR days in the calculation of their disproportionate share percentage was arbitrary and capricious and in violation of law. |
2008D05 | 06-1478 | 31-5381 | Whether the Intermediary properly adjusted Medicare bad debts. |
2008D07 | 03-1056 | 52-0051 | 1. Whether the CMS improperly calculated St. Mary's Hospital's Medicare disproportionate share hospital (DSH) adjustment by excluding fifty two (52) patient days from the Supplemental Security Income (SSI) fraction.; 2. Whether the Intermediary improperly calculated St. Mary's Medicare DSH adjustment by excluding 366 Long Term Respiratory Unit (LTRU) patient days from the Medicaid proxy of the DSH calculation. |
2008D44 | 03-1643 | 37-0190 | Whether the Intermediary properly treated the Provider as an acute care prospective payment system (PPS) facility instead of an excluded cancer hospital. |
2008D06 | 99-3140 | 05-0369 | Whether the Intermediary improperly allowed 0.54 intern and resident full time equivalent (FTE) for indirect medical education (IME) purposes on the Provider's fiscal year ended December 31. 1996 cost report. |
2007D77 | 00-3356 | 44-6530 | 1. Did the Intermediary improperly reopen the cost report?; 2. Was the Intermediary adjustment to contract services - administrative proper?; 3-4. Were the Intermediary's adjustment to contract services - speech and occupational therapy proper?; 5. Was the Intermediary's adjustment to travel - speech therapy proper?; 6-8. Were the Intermediary's adjustments to travel - physical therapy, occupational therapy and administrative proper?; 9. Was the Intermediary's adjustment to accounting expense proper?; 10. Was the Intermediary's adjustment to telephone expense proper?; 11. Was the Intermediary's adjustment to office supplies proper?; 12. Was the Intermediary's adjustment to recruiting costs proper?; 13. Was the Intermediary's adjustment to rent expense proper?; 14. Was the Intermediary's adjustment to total expense proper?; 15. Was the Intermediary's adjustment to interim payments proper? (Provider Issue 16); 16. Was the Intermediary's adjustment to home office costs proper? (Provider Issue 17); 17. Was the Provider's request for costs incurred in the settling of cost reports after termination from the Medicare program proper? (Provider Issue 15) |
2008D45 | 05-1891; 05-1887; 04-1831; 05-0731; 06-1938 | 14-0228 | Whether the Intermediary's adjustments reducing the 1996 base year IME/GME FTE count for osteopathic and allopathic medicine interns and residents and their effect on the May 31, 1999 through May 31, 2003 FTE counts are correct. |
2011D43 | 05-0023 | 33-0201 | Whether the Provider's cost reimbursement should be computed taking into account the charges included in the Provider's log of late charges which have not been billed to Medicare. |
2011D44 | 05-1144 | 33-0201 | Whether the Provider's cost reimbursement should be computed taking into account the charges included in the Provider's log of late charges which have not been billed to Medicare. |
2011D45 | 05-1802 | 39-3050 | Whether the Intermediary properly reimbursed the Provider based on the blended rate for inpatient rehabilitation facilities (IRF) versus the 100 percent federal prospective payment system (PPS) rate for IRFs. |
2011D46 | 08-1452; 08-1800; 08-2699; 08-2533; 08-2534; 08-1156; 08-2532; 09-0914 | Various | 1. Whether the Intermediary's adjustment to the direct graduate medical education and indirect medical education counts for residents training at the Kalamazoo Center for Medical Studies/Michigan State University nonhospital site clinics was proper.; 2. Whether the Intermediary's calculation of Borgess Medical Center's Supplemental Security Income percentage, the proportion of the patients eligible for Medicare Part A or Part C who are also eligible for supplemental security income, for cost reporting period ending June 30, 2003 was proper. |
2011D47 | 09-2261CG | 23-0024; 23-0104; 23-0273; 23-0277 | Whether the Intermediary properly disallowed the Providers' pension costs for the fiscal year ended December 31, 2006 in determining the Medicare geographical wage index for federal fiscal year (FFY) 2010. |
2012D01 | Various | Various | 1. Whether the Fiscal Intermediary and CMS properly determined the Wage Indexes for St. Elizabeth Medical Center (18-0035); St. Luke Hospital East (18-0001); St. Luke Hospital West (18-0045); Mercy Hospital Anderson (36-0001); University Hospital, Inc. (36-0003); Jewish Hospital (36-0016); Mercy Hospital Fairfield (36-0056); Mercy Franciscan Hospital Western Hills (36-0113); Fort Hamilton Hospital (36-0132); Christ Hospital (36-0163); Mercy Franciscan Hospital - Mt. Airy (36-0234); and Mercy Hospital Clermont (36-0236) and the Cincinnati-Middletown, OH-KY-IN Core Based Statistical Area (CBSA) for Federal Fiscal Year 2009.; 2. Whether the fiscal intermediary and the Centers for Medicare and Medicaid properly determined the Wage Indexes for St. Elizabeth Medical Center (18-0035) and the Cincinnati-Middleton, Ohio-Kentucky-Indiana Core Based Statistical Area (CBSA). |
2012D02 | 08-2202; 08-2203 | 25-0117 | 1. Whether CMS is precluded from recovering the alleged overpayments from the Provider's fiscal year end 12/31/97 and 10/31/98 cost reports due to the Intermediary's issuance of the Notice of Program Reimbursement over ten years after the cost report year ends.; 2. Whether the Intermediary improperly disallowed bad debts claimed and costs related to the hospital's unduplicated census for fiscal year ends 12/31/97 and 10/31/98. |
2012D03 | 09-0957 | 23-0021 | Whether the Intermediary's disallowance of Medicare bad debts that had been referred to an outside collection agency was proper. |
2011D28 | 08-2579 | 05-0126 | Did CMS properly reduce the Provider's federal fiscal year (FFY) 2008 inpatient prospective payments system market basket adjust by two (2.0) percentage points? |
2011D29 | 05-0148 | 31-0091 | Whether the Intermediary properly included all appropriate Medicaid eligible days in calculating the Provider's disproportionate patient percentage for purposes of the Medicare disproportionate share hospital (DSH) adjustment under the Prospective Payment System (PPS) for inpatient operating and capital costs for the fiscal year ended (FYE) December 31, 2001. |
2011D30 | 07-0084GC | Various | Whether the Fiscal Intermediary improperly disallowed the Provider's claimed Medicare bad debts solely on the ground that accounts related to such bad debts were still pending at outside collection agencies. |
2011D31 | 04-0848 | 09-0001 | Whether the Intermediary's adjustments of the Provider's bad debts, because they were written off while they remained at an outside collection agency, were appropriate. |
2011D32 | 06-2319 | 06-0009 | Whether the Intermediary properly disallowed the Provider's entire Medicare disproportionate share hospital (DSH) payment. |
2011D33 | 08-1168; 08-1169; 08-1170; 08-1171; 09-0911; 09-0130; 09-1195 | 19-0090 | Whether the Provider is eligible to be classified and reimbursed as a Medicare Dependent Hospital (MDH) for the fiscal years ended (FYEs) 2/31/01, 12/31/02, 12/31/03, 12/31/04, 12/31/05, 03/31/07, and 03/31/08. |
2011D34 | 05-1740G | Various | Whether the Intermediary improperly disallowed direct graduate medical education (DGME) and indirect medical education (IME) payments related to managed care days, discharges, and simulated payments solely on the grounds the provider failed to submit UB 92 claim forms for Medicare managed care. |
2011D35 | 09-1970 | 14-0094 | Whether CMS properly reduced the Provider's Outpatient Prospective Payment System (OPPS) Calendar Year (CY) 2009 market basket update by two (2.0) percentage points. |
2011D36 | 06-1431; 06-2384 | 40-0110 | Whether the Intermediary improperly excluded certain days attributable to Puerto Rico Medicaid enrollees who were classified by the Administration De Seguros De Salute De Puerto Rico as category six, for which Puerto Rico receives no Federal matching funds in computing the fraction reflecting the percentage of inpatients who were entitled to medical assistance under an approved state plan (the Medicaid fraction) for purposes of the Medicare disproportionate share hospital calculation. |
2011D37 | 06-0867GC; 08-2122GC; 08-1592GC | Various | Should patient days attributable to Medicare beneficiaries who elected to enroll in a Medicare+Choice (M+C) plan be included in the numerator of the Medicaid fraction that was used to calculate each of the Providers' Disproportionate Share Hospital (DSH) payments under Section 1886(d)(5)(F) of the Social Security Act (42 U.S.C. Section 1395ww(d)(5)(F)), and 42 C.F.R. Section 412.106 for the cost reporting periods at issue? |
2011D38 | 07-0522 | 50-1312 | Whether the Intermediary's adjustment to the Provider's ambulance service rates was proper. |
2007D76 | 00-3355 | 42-6548 | 1. Was the Intermediary's adjustment to salaries proper?; 2. Was the Intermediary's adjustment to contract labor proper?; 3. Was the Intermediary's adjustment to advertising expense proper?; 4. Was the Intermediary's adjustment to utilities expense proper?; 5. Was the Intermediary's adjustment to travel expense proper?; 6. Was the Intermediary's adjustment to rent expense proper?; 7. Was the Intermediary's adjustment to professional fees proper?; 8. Was the Intermediary's adjustment to office expense proper?; 9. Was the Intermediary's adjustment to dues and subscriptions proper?; 10. Was the Intermediary's adjustment to physical therapy - total charges proper?; 11. Was the Intermediary's adjustment to home office costs proper? (Provider Issue 12); 12. Was the Provider's request for costs incurred in settling the cost reports after termination from the Medicare program proper? (Provider Issue 11) |
2007D51 | 01-0883 | 20-0018 | Was CMS' denial of the end stage renal disease (ESRD) composite rate exception correct based on applicable Medicare law? (Case 2004D26 was remanded by the US District Court) |
2007D52 | 02-0530G | Various | Whether St. Luke's Hospital's letter of March 8, 2001 requesting corrections to its hospital wage data for its fiscal year ended 6/30/1999 (including documentation contained in Exhibit 1-7) satisfied the requirements established by CMS (then HCFA) set forth in 66 Fed. Reg. 39828 -39871 (Aug 1, 2001) for a timely request to the hospital's intermediary to correct any incorrectly reported wage data on its cost report for purposes of the wage data correction process. |
2007D53 | 00-1081 | 08-0003 | Whether the Intermediary's application of the reasonable compensation equivalent (RCE) limits was proper. |
2007D54 | 00-1411 | 39-0128 | Whether the Intermediary properly disallowed the Provider's loss on disposal of depreciable assets as a result of the merger with UPMC Braddock, a subsidiary of the University of Pittsburgh Medical Center (UPMC). |
2007D55 | 02-1565; 03-0517; 04-0338 | 23-0070 | 1. Whether the Intermediary properly determined the full-time equivalent (FTE) intern and resident count for purposes of computing the Provider's indirect medical education (IME) adjustment and the direct graduate medical education (DGME) payment for FYEs 6/30/99, 6/30/00 & 6/30/01.; 2. Whether bank fees claimed by the Provider are allowable interest related costs. (FY 6/30/99); 3. Whether the hospital-based physician compensation should be reimbursed under Medicare Part A or Part B. (FY 6/30/99); 4. Whether the proper statistic to allocate housekeeping costs is hours worked or square footage. (FY 6/30/00); 5. Whether the Intermediary properly adjusted the hospital's cafeteria costs by removing all non-administrative Home Health Agency (HHA) FTEs from the Worksheet B-1 statistical base. (FY 6/30/00); 6. Whether the Intermediary properly disallowed the allocation of nursing administration costs to the HHA. (FY 6/30/00); 7. Whether the Intermediary properly weighted Worksheet B-1 statistics to account for the psychiatric unit being closed during the year. (FY 6/30/00); 8. Whether the Intermediary properly adjusted the rehabilitation unit hospital-based physician compensation from Medicare Part A to Part B. (FY 6/30/00). |
2007D56 | 04-0823 | 35-0070 | Whether the Provider is entitled to Transitional Outpatient Payments (TOPs). |
2007D57 | 00-2326 | 14-0088 | Whether the time spent by residents conducting research in the Provider's facility as part of an approved residency program should be in the Indirect Medical Education FTE calculation. |
2007D58 | 03/0759 | 22-0089 | Whether the Provider's Notice of Program Reimbursement (NPR) dated September 24, 2002 was an original or a revised NPR. |
2008D04 | 04-1796 | 22-0070 | Whether the Intermediary's determination of the Provider's dental intern and resident count for purposes of calculating its direct and indirect medical education adjustment was accurate. |
2008D11 | 03-1549 | 31-0001 | Whether the Medicare fiscal intermediary erred by not including all of the Provider's inpatient days relating to patients who were not entitled to Medicare, but who qualified for medical assistance under the New Jersey Charity Care Program in the calculation of the disproportionate share hospital (DSH) payment for fiscal year 2002. |
2008D09 | 03-0811 | 04-0091 | Whether the Provider's Disproportionate Share Hospital (DSH) adjustment was correctly calculated. |
2008D10 | 02-0363 | 31-0001 | Whether the Intermediary's adjustments to the Provider's direct graduate medical education and indirect medical education full-time equivalent counts were proper. |
2008D12 | 04-1491; 04-1495; 04-1496 | 18-0080 | Whether the Intermediary properly adjusted Medicare bad debts accounts considered indigent by the Provider. |
2008D35 | 05-2054 | 36-0112 | 1. Whether the Intermediary's adjustment to include outpatient observation bed days in the bed count for purposes of calculating the Provider's indirect medical education (IME) reimbursment was proper.; 2. Whether the Intermediary's adjustment to include Medicaid outpatient observation days when determining disproportionate share hospital (DSH) eligibility and payment was proper. |
2008D34 | 02-1010; 02-0892; 02-1663; 02-2148; 30-0597; 03-1011; 04-0021; 04-0022 | 23-0053 | 1. Whether the Intermediary properly excluded FTEs attributable to rotations by residents in certain unaccredited training programs.; 2. Whether the Intermediary properly excluded IME FTEs attributable to time spent by residents in research that was required by the residents' approved medical residency programs.(On the Record); 3. Whether the Intermediary properly excluded FTEs attributable to resident leave time when it is taken during rotations in which the resident is conducting reserarch.; 4. Whether the Intermediary properly excluded from the FTE cap, FTes attributable to time spent by residents in new programs. |
2008D36 | 99-3519M | 05-0625 | Whether the Intermediary may refuse to apply a revised graduate medical education base year average per resident amount to the subsequent cost years that fall outside the three-year reopening period set forth in 42 C.F.R. Section 405.1885. |
2009D01 | 96-1627G | 39-0001 | Whether the Medicaid percentage component of the Provider's disproportionate share hospital (DSH) adjustment has been properly computed to contain all Medicaid patient days including Medicaid eligible days. |
2001D18 | 99-2430; 00-0769 | 17-7087 | 1. Was the Intermediary's adjustment to owner's compensation proper?; 2. Was the Intermediary's adjustment to community liason salary and benefits proper?; 3. Was the Intermediary's adjustment to franchise fees proper? |
2001D15 | 94-0463 | 24-0053 | Were the Intermediary's adjustments to SNF routine cost limits proper? |
2001D21 | 97-1287 | 37-0161 | Were the Intermediary's adjustments reducing the loss on asset disposal proper? |
2009D09 | 07-1153 | 27-1325 | Whether the Intermediary's disallowance of the Provider's certified registered nurse anesthetist (CRNA) on-call costs was proper. |
2009D08 | 98-3176G | 05-0008; 05-0058; 05-0132; 05-0152; 05-0655 | Whether the Centers for Medicare and Medicaid Services' (CMS) methodology for determining the Providers' exception to the hospital-based skilled nursing facility cost limits was proper. |
2009D07 | 05-1420G | Various | Whether the Intermediary's adjustment to utilization review costs was proper. |
2009D06 | 04-1790G | 03-0002; 03-0065; 03-0018 | Whether the Intermediary improperly omitted certain inpatient hospital days from the numerator of the Medicaid low-income proxy used to calculate the Providers' disproportionate share hospital (DSH) adjustment. |
2009D05 | 06-1300; 06-1301; 06-1307 | 03-0103 | Whether the Intermediary used proper cost to charge ratios in calculating the Provider's outlier payments. |
2009D03 | 04-2130G | 50-0024 | Whether the Intermediary should include dual-eligible, managed care days in the Medicaid proxy in determining Medicare reimbursement for disproportionate share hospital (DSH) payments in accordance with the Medicare statute at 42 U.S.C. Section 1395ww(d)(5)(F)(vi)(II). |
2009D04 | 04-1915 | 03-0023 | Whether the Intermediary properly calculated and applied the Provider's ambulance cost per trip limit. |
2009D02 | 04-0596G | Various | Whether the intermediary properly determined the Rochester New York Metropolitan Statistical Area (MSA) wage index for fiscal year 2004 in a manner that reflected the relative hospital wage level in that geographic area as compared to the national average. |
2007D66 | 01-3169; 03-1194 | 23-5472; 23-0121 | Whether the Intermediary improperly limited the Provider's hospital-based Skilled Nursing Facility's (SNF's) routine cost limit exception amount to costs in excess of 112 percent of its peer group costs rather than costs in excess of the routine cost limit. |
2007D65 | 03-0132 | 44-0048 | 1. Whether the Centers for Medicare and Medicaid Services (CMS) properly disallowed the Provider's request for an exception to its Skilled Nursing Facility (SNF) Routine Service Cost Limit(RCL).; 2. Whether the Provider is entitled under CMS Program Memorandum (PM) A-99-62 to include the Social Security Act, Section 1115 waiver days for the expanded Medicaid populations (a/k/a Tenn Care) days in the Medicaid component of the disproportionate share hospital (DSH) adjustment calculation. |
2007D64 | 04-0831; 04-0833 | 08-5034 | 1. Whether the Intermediary's notification of the opening of the Provider's 1996 and 1997 final settled cost reports was timely pursuant to regulatory standards.; 2. Whether the sampling methodology used by the Intermediary to disallow charges for the Provider's rehabilitation services was proper. |
2007D63 | 03-0721; 04-0473 | 23-0059 | Did the Intermediary properly calculate the Provider's disproportionate share payment adjustment in accordance with Medicare regulations as set forth in 42 C.F.R. Section 412.106? |
2007D62 | 96-2468 | 05-0279 | Whether the Intermediary's determination of non-allowable physician office and vacant space costs was proper. |
2007D61 | 96-1582 | 33-0059 | Whether the Intermediary improperly limited the Provider's hospital-based Skilled Nursing Facility's (SNF's) routine cost limit exception amount to costs in excess of 112 percent of its peer group costs rather than costs in excess of the routine cost limit. |
2007D59 | 05-1792 | 05-0260 | Whether the Intermediary properly required the use of a full year's Medicaid days in the Disproportionate Share Hospital (DSH) calculation based on its interpretation of the Benefit Improvements and Protection Act (BIPA) of 2000. |
2007D60 | 04-1341; 04-1369 | 65-0001 | Whether the Intermediary's adjustment disallowing the Provider's claimed withholding tax expense was proper. |
2005D33 | 03-0055 | 05-8034 | Was the Intermediary's adjustment to start-up costs proper? |
2004D45 | 00-2151G | Various | 1. Whether the Intermediary's disallowance of the Provider's therapy management fees was Proper?; 2. If the Providers are found to be entitled to a reversal of the Intermediary's disallowance, does the Board have subject matter jurisdiction to determine what entity is entitled to payment? |
2004D34 | 99-3196; 00-0018 | 39-7001 | Were the Intermediary's adjustments applying Medicare's Physical Therapy Compensation Guidelines to the Provider's employee physical therapists proper? |
2004D12 | 97-1685 | 23-0122 | For purposes of allocation of Administrative and General costs, should the Part B physicians' compensation and related fringe benefits be included in total expenses of the private physician practices? |
2011D01 | 06-0419G; 06-1433G; 06-1482G; 06-1451G; 07-0020G | Various | Whether the Intermediary has improperly adjusted the Providers' direct graduate medical education (GME) intern and resident full-time equivalent (FTE) counts for their respective fiscal years ended (FYE) 12/31/1999 through 12/31/2003 by disallowing various FTEs associated with rotations to the Providers' outpatient medical office clinics in FYE 12/31/1996, the GME FTE cap base year. |
2011D02 | 06-1009; 07-0237 | 06-0031 | Whether the Intermediary improperly recouped alleged overpayments resulting from an incorrect cost-to-charge ratio (CCR) calculated and applied by the Intermediary to determine outlier payments made to the Provider for inpatient rehabilitation services furnished during the cost reporting periods at issue. |
2011D03 | 08-0298G | Various | Whether the Intermediary's adjustments to the Providers' Medicare bad debts were proper. |
2011D04 | 06-0828 | 05-0090 | Whether the Intermediary's reclassification of clinic meals statistics on Worksheet B-1 from the reimbursable "clinic" cost center (clinic) to a non-reimbursable cost center was proper. |
2011D05 | 05-2270 | 19-7717 | Whether the Provider Statistical and Reimbursement Reports (PS&Rs) used to settle the Provider's cost reports for the fiscal years ended May 31, 1998 and March 17, 1999 are accurate. |
2010D53 | 05-1261 | 23-0053 | 1. Whether the Intermediary properly determined the Provider's full time equivalents (FTEs) counts used for purposes of calculating payment for direct graduate medical education (DGME) and indirect medical education (IME), based on its exclusion of residents in other approved programs, including unaccredited programs.; 2. Whether the Intermediary properly determined the Provider's FTE counts used for purposes of calculating payment for IME based on its exclusion of residents' time for research. |
2010D52 | Various | Various | Whether Medicare+Choice (M+C) days should be included in the Medicaid fraction used to calculate the disproportionate share hospital (DSH) adjustment. |
2010D51 | 04-2159 | 18-0141 | Whether the Intermediary improperly reduced the Provider's numbers of resident full-time equivalents ("FTEs") used for purposes of Medicare direct graduate medical education ("GME") and indirect graduate medical education ("IME") based on its contention that the Provider did not meet the written agreement requirement for counting resident time spent in non-provider settings in 42 C.F.R. Sections 412.105 and 413.86. |
2010D50 | 06-1889; 06-1886; 06-1890; 02-1517; 06-1888; 06-1887; 06-0755; 06-0524; 06-1142 | 03-0061 | 1. Whether the Provider's nursing education program qualified as provider-operated.; 2. Whether, assuming the Provider's nursing education program did not qualify as provider-operated, the Provider is entitled to receive an additional payment to account for services provided to Medicare managed care patients (fiscal years 2000-2003 only). |
2010D49 | 10-0056 | 37-1635 | Whether the amount in controversy requirement under 42 C.F.R. Section 405.1835 is satisfied. |
2010D48 | Various | Various | Should the ProviderReimbursement Review Board grant the Provider's request for expedited judicial review (EJR) over the validity of the provisions of the Centers for Medicare & Medicaid Services Ruling CMS-1498-R, which if valid, render moot and deny jurisdiction over these appeals of the disproportionate share adjustment (DSH) supplemental security income (SSI) issue? |
2010D47 | 08-2017 | 14-0132 | Whether the Provider Reimbursement Review Board has jurisdiction over Medicaid eligible days that were not specifically considered within the implementation of a revised Notice of Program Reimbursement (NPR). |
2010D46 | 97-0206 | 05-0008 | Whether the Intermediary properly denied the Provider's Tax Equity and Fiscal Responsibility Act (TEFRA) exception request because of the timeliness of the request. |
2012D04 | 09-0894; 08-1351; 09-0892 | 23-0142 | Did the Oakwood Annapolis Family Practice Residency Program, which received "provisional accreditation" from the Accreditation Council for Graduate Medical Education (ACGME) meet the definition of a "new" program in 2004. |
2012D05 | 02-0531G | Various | 1. Did the Intermediary err in refusing to exclude Provider's "bonus" or "call back" hours paid from its Federal Fiscal Year (FFY) 2002 wage index calculations?; 2. Did the Intermediary err in refusing to include salary costs for Provider's Senior Vice President of Medical and Academic Affairs (Medical Director) from its FFY 2002 wage index calculations?; 3. Did the Intermediary err in refusing to include Provider's costs for contracted pathology services in its FFY 2002 wage index calculations?; 4. Did the Intermediary err in refusing to include Provider's costs for contracted perfusionist services in its FFY 2002 wage index calculations?; 5. Did the Intermediary err in refusing to include Provider's costs related to its self-insured workers' compensation fund in its FFY 2002 wage index calculations?; 6. Did the Intermediary err in refusing to include Provider's costs associated with an on-site day care center in its FFY 2002 wage index calculations? |
2012D06 | 10-1386GC | Various | Whether inpatient days for Medicaid-eligible patients who were enrolled in a Medicare+Choice (M+C) plan under Part C of the Medicare statute were properly excluded from the numerator of the Medicaid fraction that is used to calculate the disproportionate share hospital (DSH) payment. |
2012D07 | 06-1709; 05-0627; 06-0192; 06-1710 | 28-0081 | Were the Intermediary's adjustments to disallow the Provider's indirect medical education (IME) and direct graduate medical education (DGME) reimbursement for its graduate medical education activities correct? |
2012D08 | 96-0819; 97-1814 | 14-0119 | 1. Did the Intermediary properly calculate the number of interns and residents for FY 1993 for purposes of the Provider's graduate medical education?; 2-A. Were the Intermediary's adjustments to the Provider's bed count as used for purposes of the indirect medical education (IME) calculation proper?; 2-B. In calculating the Provider's bed count as used for purposes of the IME calculation, should there have been a reduction for beds used for observation purposes?; 2-C. For purposes of the Provider's intern and resident count for IME, was the Intermediary correct in disallowing research rotations for residents participating in an approved medical residency program at the Provider? |
2012D09 | 00-2351 | 14-0119 | 5-A. Were the Intermediary's adjustments to the Provider's bed count as used for purposes of the indirect medical education (IME) calculation proper?; 5-B. In calculating the Provider's bed count as used for purposes of IME calculation, should there have been a reduction for beds used for observation purposes?; 5-C. For purposes of the Provider's intern and resident count for IME, was the Intermediary correct in disallowing research rotations for residents participating in an approved medical residency program at the Provider? |
2012D10 | 98-0460 | 05-0211 | Whether the District of Columbia District Court's memorandum decision issued in this case finding the Secretary's methodology was improper under the precedent established in. Alaska Professional Hunters Association, Inc. vs. FAA, 177 F.3d 1030 (D.C. Cir. 1999) ("Alaska Hunters"), also applies to the Secretary's low occupancy adjustment. |
2012D11 | 07-0900; 06-1259; 07-0824; 09-0905; 09-0908; 09-0903; 09-0904 | 05-0464 | Whether the Intermediary improperly eliminated all direct medical education and indirect medical education reimbursement for the Provider's family practice residency program for fiscal years ended May 31, 2001 through May 31, 2007. |
2012D12 | 06-0269 | 26-0027 | Whether the Intermediary's determination of additional amounts paid to the Provider for nursing and allied health (N&AH) education costs associated with Medicare+ Choice (M+C) enrollees was proper. |
2012D13 | 02-0529G | Various | Whether the Fiscal Intermediary and the Centers for Medicare and Medicaid Services (CMS) appropriately included certain paid hours not actually worked by Parkview Health System (Parkview) employees for purposes of calculating the federal fiscal year 2002 wage index for the Fort Wayne, Indiana, Metropolitan Statistical Area (MSA). |
2012D14 | 09-0704 | 07-0034 | Whether the Provider Reimbursement Review Board has jurisdiction over Medicaid eligible days for which there was no adjustment made by the Intermediary within the Notice of Program Reimbursement. |
2012D15 | 09-0008 | 19-1555 | Whether a full or partial waiver is permissible for the Provider's hospice inpatient day limitation overpayment for the cap year November 1, 2005, through October 31, 2006. |
2011D07 | 00-1489 | 05-0107 | Whether a loss on disposal of assets is required to be recognized by Medicare as a result of the April 24, 1997 statutory merger of the Provider. |
2012D16 | 07-0552; 07-2253 | 28-0081 | Were the Intermediary's adjustments to disallow the Provider's indirect medical education (IME) and direct graduate medical education (DGME) reimbursement for its graduate medical education activities correct? |
2012D17 | 04-2249G; 10-0431GC; 10-432GC; 10-433GC; 10-434GC; 10-435GC; 10-0436GC; 04-2265G; 10-1206GC; 10-1211GC; 10-1212GC; 10-1213GC; 10-1214GC; 10-1215GC; 10-1216GC; 10-1217GC; 05-1862G; 10-1218GC; 10-1219GC; 10-1220GC; 10-1221GC; 10-1222GC; 10-1223GC; 10-1224GC; 06-1816G; 10-1225GC; 10-1226GC; 10-1227GC; 10-1228GC; 10-1229GC; 10-1230GC; 10-1231GC; 12-1232GC; 07-1466G; 09-2301G; 09-0811GC; 11-0082GC; 10-1090GC; 11-0081GC; 10-0183GC; 11-0079GC; 11-0080GC; 10-1095GC | 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 the Social Security Act, as amended. |
2012D18 | 08-1404 | 36-0152 | Did the Intermediary properly disallow Medicare bad debt expense- specifically, did the Intermediary correctly disallow those claims from the sample review where the Provider was unable to produce all of the documentation from the patient file used to substantiate the indigency determination. |
2012D19 | 02-0387GC | Various | Whether the Intermediary's adjustments to the Laundry and Linen and the Central Service and Supply statistics were proper. |
2012D20 | 08-1417 | 14-0124 | Whether the Intermediary's exclusion of the physician malpractice expense from Worksheets A-8-2 and D-9 of the cost report was proper. |
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