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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