The process of submitting an appeal to the Provider Reimbursement Review Board (“Board” or “PRRB”) begins with filing the Medicare Cost Report. Effective with cost report periods ending on or after December 31, 2008, in order for the PRRB to have jurisdiction over a disputed issue, Medicare regulations require that a provider either include a claim for reimbursement of cost on its cost report or self-disallow the cost by filing a cost report under “protest”. The procedures for filing a cost report under “protest” can be found in the Provider Reimbursement Manual, Part II § 115. These procedures require a provider to identify the disputed item and amount for each issue in footnotes to the cost report settlement worksheet. The provider should use a “reasonable methodology” to estimate the reimbursement effect for each disputed item. The cumulative effect on reimbursement should be reported on the protested line – CMS 2252-10, worksheet E Part A, line 75 and a statement disclosing the fact that the cost report is being filed under protest should be included in the cover letter submitted with the cost report.
After the cost report is filed and the Medicare Administrative Contractor (MAC) has finalized the audit adjustments, a Notice of Program Reimbursement (NPR) will be issued to the provider. A provider has 180 days from the NPR date to file a request for hearing to the Board. The Board must determine whether it has jurisdiction to grant a hearing on each specific matter at issue in the hearing request. Establishing jurisdiction before the Board and the federal courts is an integral prerequisite to effectively pursuing the Medicare Part A appeals process.
As you may be aware, BESLER Consulting, through The Law Office of Joseph D. Glazer, P.C., filed a case against the Department of Health and Human Services (“DHHS”) and the Board challenging certain practices of the defendants that we believe are not compliant with the Freedom of Information Act (“FOIA”). For a number of reasons, BESLER agreed to dismiss that case. BESLER applauds the DHHS and the Board for putting jurisdictional decisions online for all parties to review. That type of openness and transparency was the goal of our lawsuit, and we are thankful that the DHHS and Board are taking this important step.
The Board regularly issues jurisdictional decisions in addition to published substantive decisions.
The Board now publishes these jurisdictional decisions on their website at: