Provider Reimbursement Review Board Issues Rules Governing Medicare Part A Appeals And Extends Due Dates For Position Papers
On August 8, 2008, the Provider Reimbursement Review Board
(PRRB) issued Rules (Board Rules) on the Medicare Part A appeal
process and procedures at the PRRB. The Board Rules supersede
and replace the PRRB's previous appeal guidelines, which
were referred to as "Instructions." The Board Rules
are effective on August 21, 2008, and apply to appeals pending
on that date.
On August 13, 2008, the PRRB issued an Alert regarding the
automatic extension of position paper due dates. The Alert
states that if a party received an acknowledgment letter from
the PRRB prior to August 21, 2008, which set preliminary or
final position paper due dates that fall on or after September
1, 2008, the provider's preliminary position paper would be
extended by four months from the original due date. The Alert
also states that the parties may disregard any final position
paper due dates set in acknowledgment letters issued before
August 21, 2008. The due dates for final position papers will
be reset by the PRRB when it issues its notice of the hearing
date.
Board Rules
The Board Rules follow upon, but are distinct from, the
regulations governing the Part A appeal process at the PRRB
that were issued by the Centers for Medicare & Medicaid
Services (CMS) on May 23, 2008. The CMS Regulations, which were
published in the Federal Register and are part of the
Code of Federal Regulations, also are generally effective on
August 21, 2008. We discussed the CMS Regulations in our
newsletter entitled "CMS Implements Restrictive Rules for
Medicare Part A Appeals," which is available at
http://www.foley.com/publications/pub_detail.aspx?pubid=5067.
The PRRB's issuance of its appeal guidelines under the
designation of "Rules" rather than
"Instructions" is likely to create significant
confusion between the regulations that were issued by CMS and
the Board Rules. In the past, it was easier to distinguish
between the different sets of rules because the PRRB's
rules were referred to as Instructions.
We discuss below some of the most significant changes in the
Board Rules from the provider's perspective.
Filing of Appeals
Under the Board Rules, filing individual provider appeals
will be more burdensome than in the past. To file an individual
appeal, the provider must submit the following:
A completed Model Form A, the Individual Appeal Request
Form. Model Form A is one of the model forms issued in
connection with the Board Rules; these model forms are
available on the PRRB's Web site.
The supporting documentation listed in Model Form
A.
For each appeal issue, the provider must submit a
calculation or...
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