Blog, Reimbursement

Top Questions from the Guide to Appeals Webinar

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Kristin DeGroat, BESLER's Compliance & General Counsel
Christina Brown, BESLER's Director of Reimbursement ServicesLooking for more information about Guide to Appeals? BESLER’s Director of Reimbursement Services Christina Brown, BESLER’s Compliance Officer Kristin DeGroat & Leslie Goldsmith, Partner at Bass, Berry & Sim, answers your questions from the recent webinar. 

To watch BESLER’s Guide to Appeals Webinar, click HERE

    1. What is the earliest the MAC can start auditing the cost report? Is there a certain amount of time that you have to refile?

      Per CMS, “Once the cost report is deemed ‘receivable,’ the MAC will perform the acceptability review within 30 days.” Once accepted, there is no regulatory requirement that outlines the earliest an audit can start.

    2. Can you reopen and appeal an issue at the same time?

      The regulations permit it, however many MACs refuse to reopen a cost report for an issue that is under appeal. If you need additional guidance, feel free to reach out.

    3. Should outside legal counsel be used for all PRRB appeals?

      It is helpful to enlist the help of counsel that is familiar with the intricate PRRB rules, but it is not required.

    4. What is the advantage of filing an appeal based on untimely finalization? Does it prompt the MAC to settle the report?

      It may help you get your issue to the court at an earlier date. It does not prompt the MAC to settle the report.

    5. For support, can you include PHI?

      No. If PHI is required, there is a specific process to submit redacted information.

    6. If you are using a consultant to file an appeal, do they have to be registered for the electronic filing?


    7. Does the timeline for untimely finalization start over if an amended cost report is filed, or is the timely settlement based on the original filing date?

      The timeline starts over for an amended cost report.

    8. If the MAC hasn’t made any adjustments related to the Section 1115 Waiver Day issue, can’t you just include above the line and avoid the Protested line issue?

      If you know that it is contrary to CMS policy to allow the cost, you should claim it as a protested amount and not as an allowable cost.

    9. For Bad Debts, we bill Medicaid for Ded/coins, but the MAC is removing bad debt because Medicaid 835 RA has denied code COA. Why is that correct? I thought that as long as the hospital billed Medicaid and received no payment, bad debt should be allowed.

      This is a provider specific question that requires provider specific analysis. Feel free to contact our Reimbursement Services department for further assistance.

    10. Can Charity based on presumptive indigence be claimed as Medicare Bad Debt?


    11. Can you provide the specific documentation to support the Hershey calculation changes for all open cost reports? Thank you.


    12. For bad debts’ Timely Billing rule, can hospitals exclude time its performing an internal review of payment from the 120 day count?


    13. Do Home Office allocations included in A&G and Employee Benefits Step Down allocations disqualify NAHE programs based on the Direct Control requirements?

      We have heard that there are providers getting disallowances on this basis.  Whether these disallowances are appropriate requires a detailed provider specific analysis.

    14. Once a position paper is submitted, will the provider be notified when the MAC responds?


    15. Are there any special considerations we should be aware of when we have an outstanding appeal with an auditor that is auditing a subsequent cost report? (We have an appeal on a 2018 & 2019 cost report and the same auditor is auditing our 2020 cost report currently.) 
      This is a provider specific question that requires provider specific analysis. If you need additional guidance, feel free to reach out.

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