List of PRRB Decisions

2004D11

Wed, 02 Nov 2005 10:48:00 EST

Decision #: 2004D11
Case #: 99-3324
Provider #: 42-7025
Issue: 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?

2004D12

Wed, 02 Nov 2005 10:49:00 EST

Decision #: 2004D12
Case #: 97-1685
Provider #: 23-0122
Issue: For proposes 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?

2004D14

Wed, 02 Nov 2005 10:51:00 EST

Decision #: 2004D14
Case #: 98-1861
Provider #: 34-0115
Issue: Was the Intermediary's determination disallowing the loss incurred on change of ownership proper?

2004D15

Wed, 02 Nov 2005 10:52:00 EST

Decision #: 2004D15
Case #: 97-2025
Provider #: 05-0373
Issue: 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

Wed, 02 Nov 2005 10:54:00 EST

Decision #: 2004D17
Case #: 00-2285
Provider #: 32-7125
Issue: Was the Intermediary's adjustment to the Provider's cost limits proper?

2005D20

Wed, 02 Nov 2005 10:57:00 EST

Decision #: 2005D20
Case #: 02-1342
Provider #: 15-0021
Issue: 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

Wed, 02 Nov 2005 10:58:00 EST

Decision #: 2005D21
Case #: 02-0028
Provider #: 18-5175
Issue: 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

Wed, 02 Nov 2005 11:20:00 EST

Decision #: 2005D23
Case #: 01-3385
Provider #: 53-7025
Issue: 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

Wed, 02 Nov 2005 11:23:00 EST

Decision #: 2005D26
Case #: 97-2174
Provider #: 38-0018
Issue: 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

Wed, 02 Nov 2005 11:27:00 EST

Decision #: 2005D30
Case #: 03-0901
Provider #: 19-4056
Issue: 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

Wed, 02 Nov 2005 11:30:00 EST

Decision #: 2004D31
Case #: 99-3760
Provider #: 39-7628
Issue: Was the Intermediary's adjustment applying Medicare's Physical Therapy Compensation Guidelines to the Provider's employee physical therapists proper?

2004D32

Wed, 02 Nov 2005 11:31:00 EST

Decision #: 2004D32
Case #: 98-2100
Provider #: 24-0063
Issue: 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

Wed, 02 Nov 2005 11:44:00 EST

Decision #: 2004D33
Case #: 99-3663G; 00-2170G
Provider #: Various
Issue: Should the provider's Federal Insurance Contributions Act (FICA) payroll costs be classified to the administrative and general cost center?

2004D34

Wed, 02 Nov 2005 11:45:00 EST

Decision #: 2004D34
Case #: 99-3196; 00-0018
Provider #: 39-7001
Issue: Were the Intermediary's adjustments applying Medicare's Physical Therapy Compensation Guidelines to the Provider's employee physical therapists proper?

2004D35

Wed, 02 Nov 2005 11:46:00 EST

Decision #: 2004D35
Case #: 96-0059; 96-0060
Provider #: 15-5383
Issue: Was the Provider entitled to an exemption from the routine cost limit as a "new" provider?

2004D36

Wed, 02 Nov 2005 11:47:00 EST

Decision #: 2004D36
Case #: 00-0386
Provider #: 39-0088
Issue: Was the Intermediary's denial of the Provider's loss on disposal of assets proper?

2004D37

Wed, 02 Nov 2005 11:48:00 EST

Decision #: 2004D37
Case #: 96-0720
Provider #: 18-0092
Issue: Whether non-acute care swing-bed days should be included in the Medicare proxy for the disproportionate share calculation ("DSH")?

2004D38

Wed, 02 Nov 2005 11:49:00 EST

Decision #: 2004D38
Case #: 02-1971
Provider #: 31-0067
Issue: Was the intermediary's determination of loss on consolidation proper?

2004D39

Wed, 02 Nov 2005 11:50:00 EST

Decision #: 2004D39
Case #: 96-0591; 97-2042
Provider #: 05-7252
Issue: Should denied Medicare visits be included in the "total visits" count for purposes of apportioning costs to the Medicare program?

2004D40

Wed, 02 Nov 2005 11:51:00 EST

Decision #: 2004D40
Case #: 02-0431; 02-0364
Provider #: 23-0075; 23-0004
Issue: 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

Wed, 02 Nov 2005 11:52:00 EST

Decision #: 2004D41
Case #: 98-3477G
Provider #: Various
Issue: Was the Intermediary's determination of the disproportionate share hospital (DSH) computation relating to state-only General Assistance Days Proper?

2004D42

Wed, 02 Nov 2005 11:53:00 EST

Decision #: 2004D42
Case #: 01-2416
Provider #: 05-4012
Issue: Did the Intermediary properly eliminate the Provider's Medicare bad debts due to the Provider allowing discounts to only non-Medicare patients?

2004D43

Wed, 02 Nov 2005 11:54:00 EST

Decision #: 2004D43
Case #: 00-3936; 00-3937
Provider #: 19-2531; 19-2509
Issue: Whether the Intermediary correctly disallowed Medicare bad debts related to amounts not included in the End-Stage Renal Dialysis (ESRD) Composite rate?

2004D44

Wed, 02 Nov 2005 11:55:00 EST

Decision #: 2004D44
Case #: 94-2187
Provider #: 23-0098
Issue: 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?

2004D45

Wed, 02 Nov 2005 11:56:00 EST

Decision #: 2004D45
Case #: 00-2151G
Provider #: Various
Issue: 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?

2004D46

Wed, 02 Nov 2005 11:57:00 EST

Decision #: 2004D46
Case #: 01-1540; 01-2860; 02-1247
Provider #: 23-7251
Issue: Was the Intermediary's adjustment to start-up costs proper?

2003D01

Wed, 02 Nov 2005 11:58:00 EST

Decision #: 2003D01
Case #: 99-0299; 99-3610
Provider #: 26-0094
Issue: 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

Wed, 02 Nov 2005 11:59:00 EST

Decision #: 2003D02
Case #: 99-3300
Provider #: 45-0272
Issue: 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

Wed, 02 Nov 2005 12:00:00 EST

Decision #: 2003D03
Case #: 01-0710G
Provider #: Various
Issue: 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

Wed, 02 Nov 2005 12:01:00 EST

Decision #: 2003D04
Case #: 01-0320
Provider #: 28-5149
Issue: Whether the provider's appeal of bad debts was derived from an intermediary determination or adverse finding?

2004D19

Wed, 02 Nov 2005 13:15:00 EST

Decision #: 2004D19
Case #: 99-0729; 01-0036
Provider #: 39-5432
Issue: 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

Wed, 02 Nov 2005 13:16:00 EST

Decision #: 2004D18
Case #: 01-1017
Provider #: 10-5930
Issue: Whether the Intermediary's adjustment reducing the adjusted hourly salary equivalency amount allowed for services of Physical Therapy Aides was proper?

2004D22

Wed, 02 Nov 2005 13:19:00 EST

Decision #: 2004D22
Case #: 03-0063; 03-0064
Provider #: 39-0026
Issue: 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

Wed, 02 Nov 2005 13:21:00 EST

Decision #: 2004D24
Case #: 98-0815
Provider #: 15-7046
Issue: 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

Wed, 02 Nov 2005 13:22:00 EST

Decision #: 2004D25
Case #: 96-1496; 98-0237
Provider #: 14-7135
Issue: 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

Wed, 02 Nov 2005 13:25:00 EST

Decision #: 2004D27
Case #: 95-2033R; 96-1979R; 97-1498R; 98-2049R
Provider #: 04-0036
Issue: 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

Wed, 02 Nov 2005 13:29:00 EST

Decision #: 2004D29
Case #: 96-2359; 01-0124
Provider #: 22-5681
Issue: Was the Intermediary's denial of the Provider's request for an exemption from Medicare's service cost limits proper?

2003D19

Wed, 02 Nov 2005 13:30:00 EST

Decision #: 2003D19
Case #: 99-0646
Provider #: 03-5145
Issue: Whether the Intermediary properly calculated the Provider's Medicare bad debts?

2003D21

Wed, 02 Nov 2005 13:33:00 EST

Decision #: 2003D21
Case #: 01-0153
Provider #: 06-7201
Issue: Was the Intermediary's adjustment to owner's compensation proper?

2003D22

Wed, 02 Nov 2005 13:34:00 EST

Decision #: 2003D22
Case #: 96-1531, 97-1417; 98-1063
Provider #: 20-0024
Issue: Is the Provider entitled to a TEFRA exception?

2003D23

Wed, 02 Nov 2005 13:35:00 EST

Decision #: 2003D23
Case #: 99-0160
Provider #: 45-0119
Issue: Was the Intermediary's determination of available beds for purposes of the disproportionate share payment calculation proper?

2003D06

Wed, 02 Nov 2005 13:37:00 EST

Decision #: 2003D06
Case #: 97-0061 & 97-0062
Provider #: 22-0156; 22-0111
Issue: 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

Wed, 02 Nov 2005 13:38:00 EST

Decision #: 2003D08
Case #: 00-3980
Provider #: 49-5281
Issue: Was the Intermediary's adjustment disallowing the allocation of general service costs to the ancillary cost centers proper?

2003D09

Wed, 02 Nov 2005 13:40:00 EST

Decision #: 2003D09
Case #: 00-3979
Provider #: 17-5185
Issue: Was the Intermediary's adjustment disallowing the allocation of general service costs to the ancillary cost centers proper?

2003D10

Wed, 02 Nov 2005 13:41:00 EST

Decision #: 2003D10
Case #: 00-3413
Provider #: 39-5460
Issue: 1. Was the Intermediary's reclassification of Staff Development Coordinator salaries proper?; 2. Was the Intermediary's reclassification of Social Services salaries proper?

2003D12

Wed, 02 Nov 2005 13:42:00 EST

Decision #: 2003D12
Case #: 97-1686
Provider #: 39-7006
Issue: Was the Intermediary's adjustment to rent paid by the Provider to a related party proper?

2003D18

Wed, 02 Nov 2005 13:43:00 EST

Decision #: 2003D18
Case #: 99-0321
Provider #: 06-3027
Issue: 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

Wed, 02 Nov 2005 13:44:00 EST

Decision #: 2003D17
Case #: 00-0544
Provider #: 05-0248
Issue: Was the Intermediary's adjustment to the residents count and Graduate Medical Education payments proper?

2003D16

Wed, 02 Nov 2005 13:45:00 EST

Decision #: 2003D16
Case #: 02-0721G
Provider #: 50-0023, 44-0131; 45-0059
Issue: 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

Wed, 02 Nov 2005 13:46:00 EST

Decision #: 2003D15
Case #: 96-1651
Provider #: 33-5758
Issue: 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

Wed, 02 Nov 2005 13:47:00 EST

Decision #: 2003D14
Case #: 96-1951
Provider #: 23-0167
Issue: 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

Wed, 02 Nov 2005 13:48:00 EST

Decision #: 2003D13
Case #: 96-0618G, 96-0619G; 96-0620G
Provider #: Various
Issue: 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

Wed, 02 Nov 2005 13:49:00 EST

Decision #: 2003D11
Case #: 00-2451
Provider #: 39-7279
Issue: Were the Intermediary's adjustments to physical therapy costs proper?

2003D25

Wed, 02 Nov 2005 13:50:00 EST

Decision #: 2003D25
Case #: 99-3866; 01-0764
Provider #: 39-5742
Issue: 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

Wed, 02 Nov 2005 14:02:00 EST

Decision #: 2003D26
Case #: 94-3266
Provider #: 05-0373
Issue: 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

Wed, 02 Nov 2005 14:13:00 EST

Decision #: 2003D27
Case #: 00-2949
Provider #: 49-7259
Issue: 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

Wed, 02 Nov 2005 14:15:00 EST

Decision #: 2003D41
Case #: 00-0346; 01-0210
Provider #: 39-5789
Issue: Was the Intermediary's adjustment to remove nursing administration statistics from the ancillary cost centers on worksheet B-1 proper?

2003D24

Wed, 02 Nov 2005 14:15:00 EST

Decision #: 2003D24
Case #: 98-0362G, 99-2356; 01-0053
Provider #: Various
Issue: Was the Intermediary's adjustment to deny the allocation of social service costs based on departmental gross charges proper?

2003D42

Wed, 02 Nov 2005 14:36:00 EST

Decision #: 2003D42
Case #: 02-1198
Provider #: 41-7001
Issue: Was the Intermediary's disallowance of the Provider's Spanish and Portuguese interpreter expenses proper?

2003D43

Wed, 02 Nov 2005 14:37:00 EST

Decision #: 2003D43
Case #: 97-3008
Provider #: 10-0055
Issue: Was the Intermediary's determination of obligated capital proper?

2003D44

Wed, 02 Nov 2005 14:38:00 EST

Decision #: 2003D44
Case #: 02-0901G
Provider #: Various
Issue: Was the Intermediary's disallowance of liabilities not liquidated timely on the Medicare cost report proper?

2003D45

Wed, 02 Nov 2005 14:39:00 EST

Decision #: 2003D45
Case #: 99-0722
Provider #: 05-7252
Issue: Whether the Intermediary's adjustment of Medicare visits to agree with Medicare's Provider Statistical and Reimbursement (PS&R)report were proper?

2003D28

Wed, 02 Nov 2005 14:40:00 EST

Decision #: 2003D28
Case #: 00-3416
Provider #: 14-7614
Issue: Was the Intermediary's adjustment to disallow accrued bonuses for employees proper?

2003D29

Wed, 02 Nov 2005 14:43:00 EST

Decision #: 2003D29
Case #: 01-1866
Provider #: 23-0205
Issue: Was the Intermediary's adjustment to DRG (Diagnostic Related Group) payments proper?

2003D30

Wed, 02 Nov 2005 14:48:00 EST

Decision #: 2003D30
Case #: 01-1525
Provider #: 31-7060
Issue: Was the Intermediary's adjustment to the Per Beneficiary Limit (PBL) calculation proper?

2003D31

Wed, 02 Nov 2005 14:49:00 EST

Decision #: 2003D31
Case #: 98-0507, 99-2398; 00-0946
Provider #: 36-0003
Issue: 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

Wed, 02 Nov 2005 14:50:00 EST

Decision #: 2003D32
Case #: 98-1282
Provider #: 67-7181
Issue: Was the Intermediary's Audit Adjustment #2 which disallowed $108,875 of Administrative and General Costs proper?

2003D33

Wed, 02 Nov 2005 14:51:00 EST

Decision #: 2003D33
Case #: 01-1779; 02-0270
Provider #: 18-3026
Issue: Was the all inclusive rate allocation Methodology proper?

2003D34

Wed, 02 Nov 2005 14:52:00 EST

Decision #: 2003D34
Case #: 99-2427G
Provider #: Various
Issue: Were the Intermediary's adjustment disallowing the Providers' claimed losses on disposal of assets due to a change of ownership proper?

2003D35

Wed, 02 Nov 2005 14:53:00 EST

Decision #: 2003D35
Case #: 99-2241G
Provider #: Various
Issue: Were the Intermediary's adjustment disallowing the Providers' claimed losses on disposal of assets due to a change of ownership proper?

2003D36

Wed, 02 Nov 2005 14:55:00 EST

Decision #: 2003D36
Case #: 98-1973
Provider #: 12-0006
Issue: Were the Intermediary's adjustment disproportionate share hospital payments proper?

2003D37

Wed, 02 Nov 2005 14:56:00 EST

Decision #: 2003D37
Case #: 94-2728
Provider #: 34-0141; 34-S141
Issue: Whether the Intermediary and HCFA properly determined that the Provider's request for an adjustment to the TEFRA limits was untimely?

2003D38

Wed, 02 Nov 2005 14:57:00 EST

Decision #: 2003D38
Case #: 01-1637
Provider #: 15-0102
Issue: 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

Wed, 02 Nov 2005 14:58:00 EST

Decision #: 2003D40
Case #: 01-2787
Provider #: 10-5858
Issue: 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

Wed, 02 Nov 2005 14:58:00 EST

Decision #: 2003D39
Case #: 97-2608
Provider #: 55-5405
Issue: Was the Intermediary's denial of the Provider's SNF routine service cost limit exception request proper?

2003D46

Wed, 02 Nov 2005 15:00:00 EST

Decision #: 2003D46
Case #: 00-1172
Provider #: 55-7008
Issue: Whether the Provider is entitled to an exception to the visit cost limits in accordance with Medicare regulations?

2003D47

Wed, 02 Nov 2005 15:01:00 EST

Decision #: 2003D47
Case #: 98-2105, 98-2106;98-2107
Provider #: 33-0261
Issue: Was the Intermediary's treatment of the Provider's increase in bed size of its exempt rehabilitation unit proper?

2003D48

Wed, 02 Nov 2005 15:10:00 EST

Decision #: 2003D48
Case #: 99-2780, 99-2781, 01-1334, 01-1335; 02-0450
Provider #: 39-7015
Issue: Was the Intermediary's adjustment to home office costs proper?

2003D49

Wed, 02 Nov 2005 15:11:00 EST

Decision #: 2003D49
Case #: 02-1970
Provider #: 14-0167
Issue: Is the Provider entitled to status as a Medicare Dependent hospital ("MDH") for the period of October 1, 2001 through January 14, 2002?

2003D50

Wed, 02 Nov 2005 15:12:00 EST

Decision #: 2003D50
Case #: 00-0961G
Provider #: Various
Issue: Was the Intermediary's adjustment to restorative nurses aides proper?

2003D51

Wed, 02 Nov 2005 15:13:00 EST

Decision #: 2003D51
Case #: 01-3608G
Provider #: Various
Issue: Was the Intermediary's adjustment to restorative nurses aides proper?

2003D52

Wed, 02 Nov 2005 15:14:00 EST

Decision #: 2003D52
Case #: 01-2455
Provider #: N/A
Issue: Were the Intermediary's adjustments reclassifying the Medical Director cost proper?

2003D54

Wed, 02 Nov 2005 15:15:00 EST

Decision #: 2003D54
Case #: 01-2453
Provider #: 05-6323
Issue: Was the Intermediary's adjustment reclassifying Medical Director cost proper?

2003D55

Wed, 02 Nov 2005 15:16:00 EST

Decision #: 2003D55
Case #: 01-2262
Provider #: 55-5336
Issue: 1. Was the Intermediary's adjustment to advertising costs proper?; 2. Was the Intermediary's adjustments reclassifying Medical Director cost proper?

2003D56

Wed, 02 Nov 2005 15:18:00 EST

Decision #: 2003D56
Case #: 99-3820
Provider #: 40-0098
Issue: 1. Was the Intermediary's adjustment to interest expense proper?; 2. Was the Intermediary's adjustment to deferred organizational cost proper?

2003D57

Wed, 02 Nov 2005 15:19:00 EST

Decision #: 2003D57
Case #: 99-3821
Provider #: 40-0098
Issue: Was the Intermediary's adjustment to bad debts proper?

2003D58

Wed, 02 Nov 2005 15:20:00 EST

Decision #: 2003D58
Case #: 95-0590
Provider #: 40-0016
Issue: Was the Center for Medicare & Medicaid Services' denial of the Provider's exception request proper?

2003D59

Wed, 02 Nov 2005 15:22:00 EST

Decision #: 2003D59
Case #: 00-1344
Provider #: 40-0079
Issue: Was the Intermediary's adjustment to the disproportionate share, (DSH) computation proper?

2003D60

Wed, 02 Nov 2005 15:23:00 EST

Decision #: 2003D60
Case #: 00-0064
Provider #: 46-7051
Issue: 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

Wed, 02 Nov 2005 15:24:00 EST

Decision #: 2003D61
Case #: 01-0627
Provider #: 23-3519
Issue: Was HCFA's (the Center for Medicare & Medicaid Services') determination concerning the exception request under the prospective payment system proper?

2003D62

Wed, 02 Nov 2005 15:25:00 EST

Decision #: 2003D62
Case #: 99-0584
Provider #: 39-0080
Issue: Was the Intermediary's determination of loss on sale of assets proper?

2003D63

Wed, 02 Nov 2005 15:26:00 EST

Decision #: 2003D63
Case #: 99-2054, 99-2307G; 01-0337
Provider #: Various
Issue: 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

Wed, 02 Nov 2005 15:27:00 EST

Decision #: 2003D64
Case #: 98-2851
Provider #: 17-0087
Issue: Was the Intermediary's determination of loss on consolidation proper?

2003D65

Wed, 02 Nov 2005 15:28:00 EST

Decision #: 2003D65
Case #: 95-2104G, 95-1244G; 96-2516G
Provider #: Various
Issue: Whether the Intermediary correctly applied the Medicare lower of cost or charges limit in determining payments to the Providers?

2003D66

Wed, 02 Nov 2005 15:29:00 EST

Decision #: 2003D66
Case #: 99-4073
Provider #: 49-5280
Issue: Was the Intermediary's adjustment disallowing Medicare Part A and Part B bad debts proper?

2005D18

Tue, 15 Nov 2005 10:36:00 EST

Decision #: 2005D18
Case #: 98-2318
Provider #: 15-5400
Issue: 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

Tue, 15 Nov 2005 10:38:00 EST

Decision #: 2004D02
Case #: 99-3609; 00-3050; 01-2972
Provider #: 22-4022
Issue: Were the Intermediary's adjustments to physician stand-by costs in the routine area correct?

2004D03

Tue, 15 Nov 2005 10:40:00 EST

Decision #: 2004D03
Case #: 99-3323
Provider #: 42-7010
Issue: 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

Tue, 15 Nov 2005 10:40:00 EST

Decision #: 2004D04
Case #: 00-2255; 01-2782
Provider #: 17-8012
Issue: Whether the Intermediary's adjustment to include private duty nursing costs on the Medicare cost report was correct?

2002D18

Wed, 30 Nov 2005 10:49:00 EST

Decision #: 2002D18
Case #: 96-1254; 96-1443
Provider #: 06-7032
Issue: 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

Wed, 30 Nov 2005 10:51:00 EST

Decision #: 2002D19
Case #: 99-0233
Provider #: 13-0024
Issue: Was the Intermediary's adjustment to emergency room ("ER") physicians' availability costs proper?

2002D30

Wed, 30 Nov 2005 12:54:00 EST

Decision #: 2002D30
Case #: 95-1515, 95-2428, 99-3520, 99-3125
Provider #: 05-0366
Issue: 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

Wed, 30 Nov 2005 12:57:00 EST

Decision #: 2002D31
Case #: 97-0135
Provider #: 01-5426
Issue: Was the Centers for Medicare & Medicaid Services' (Formerly the Health Care Financing Administration) denial of a new provider exemption proper?

2002D32

Wed, 30 Nov 2005 13:00:00 EST

Decision #: 2002D32
Case #: 00-3418G
Provider #: Various
Issue: Was the Intermediary's adjustment to the non-qualified deferred compensation plan proper?

2002D33

Wed, 30 Nov 2005 13:03:00 EST

Decision #: 2002D33
Case #: 91-0550G
Provider #: Various
Issue: Was the Intermediary's adjustment to Indirect Medical Education costs proper?

2002D34

Wed, 30 Nov 2005 13:04:00 EST

Decision #: 2002D34
Case #: 89-1181R
Provider #: 05-0230
Issue: 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

Wed, 30 Nov 2005 13:35:00 EST

Decision #: 2002D35
Case #: 00-3147; 00-3150
Provider #: 23-6554
Issue: Did the Intermediary properly adjust the provider's bad debt expense?

2002D36

Wed, 30 Nov 2005 13:38:00 EST

Decision #: 2002D36
Case #: 97-1761
Provider #: 14-7525
Issue: 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

Wed, 30 Nov 2005 13:44:00 EST

Decision #: 2002D38
Case #: 98-1171
Provider #: 06-7239
Issue: Was the Intermediary's determination of legal fees proper?

2002D39

Wed, 30 Nov 2005 13:47:00 EST

Decision #: 2002D39
Case #: 97-0403
Provider #: 39-5066
Issue: Was the Intermediary's adjustment to Medicare patient days proper?

2002D40

Wed, 30 Nov 2005 13:49:00 EST

Decision #: 2002D40
Case #: 96-2090R
Provider #: 39-5863
Issue: 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

Wed, 30 Nov 2005 13:51:00 EST

Decision #: 2002D41
Case #: 99-0286R
Provider #: 31-7062
Issue: Was the interest paid on working capital loans from the Friend Center Fund and commercial banks necessary and allowable?

2002D42

Wed, 30 Nov 2005 13:53:00 EST

Decision #: 2002D42
Case #: 99-0417
Provider #: 37-5262
Issue: Was the Intermediary's methodology used in settling a low utilization cost report proper?

2002D43

Wed, 30 Nov 2005 13:56:00 EST

Decision #: 2002D43
Case #: 98-2295; 99-2144
Provider #: 15-2009
Issue: 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

Wed, 30 Nov 2005 13:58:00 EST

Decision #: 2002D44
Case #: 97-3201
Provider #: 20-0009
Issue: Was it proper for the Intermediary to deny the Provider's TEFRA exception request for untimely filing?

2002D45

Thu, 01 Dec 2005 08:24:00 EST

Decision #: 2002D45
Case #: 97-2659
Provider #: 21-5302
Issue: Did the Provider meet the regulatory requirements for approval of the new provider exemption?

2002D46

Thu, 01 Dec 2005 08:37:00 EST

Decision #: 2002D46
Case #: 98-0460
Provider #: 05-0211
Issue: 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

Thu, 01 Dec 2005 08:50:00 EST

Decision #: 2002D47
Case #: 00-3139; 01-2861
Provider #: 23-0115
Issue: Was the Intermediary's denial of the Provider's request for additional payment for decreased discharges proper?

2002D48

Thu, 01 Dec 2005 08:56:00 EST

Decision #: 2002D48
Case #: 96-2035, 96-2036, 96-2037; 96-2038
Provider #: 22-5673
Issue: 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

Thu, 01 Dec 2005 09:06:00 EST

Decision #: 2002D49
Case #: 98-0489
Provider #: 22-0036
Issue: Was the Intermediary's adjustment (denial) of the transitional care unit new provider exemption proper?

2002D50

Thu, 01 Dec 2005 09:08:00 EST

Decision #: 2002D50
Case #: 96-1033
Provider #: 50-5025
Issue: 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

Thu, 01 Dec 2005 13:05:00 EST

Decision #: 2001D12
Case #: 97-0744; 99-0318
Provider #: 10-7281
Issue: 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.)

2001D21

Thu, 01 Dec 2005 14:14:00 EST

Decision #: 2001D21
Case #: 97-1287
Provider #: 37-0161
Issue: Were the Intermediary's adjustments reducing the loss on asset disposal proper?

2001D55

Fri, 02 Dec 2005 13:09:00 EST

Decision #: 2001D55
Case #: 91-2902M & 95-1677
Provider #: 39-0156
Issue: 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

Fri, 02 Dec 2005 13:37:00 EST

Decision #: 2000D02
Case #: 96-1218
Provider #: 44-0008
Issue: Was the Intermediary's reclassification of home health agency costs proper?

2000D15

Mon, 05 Dec 2005 14:23:00 EST

Decision #: 2000D15
Case #: 94-1517
Provider #: 10-0129
Issue: 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

Mon, 05 Dec 2005 14:25:00 EST

Decision #: 2000D16
Case #: 97-0080
Provider #: 05-7299
Issue: 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

Mon, 05 Dec 2005 14:30:00 EST

Decision #: 2000D17
Case #: 92-1549
Provider #: 26-0104
Issue: Was the computation and allocation of the cashiering, accounts receivable, and collections cost center done correctly and done in accordance with the regulations?

2000D18

Mon, 05 Dec 2005 15:02:00 EST

Decision #: 2000D18
Case #: 94-1750
Provider #: 45-0698
Issue: 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

Mon, 05 Dec 2005 15:07:00 EST

Decision #: 2000D19
Case #: 95-0072
Provider #: 38-0007
Issue: Was the Intermediary's or HCFA's determination regarding the Provider's TEFRA exception request proper?

2000D20

Mon, 05 Dec 2005 15:13:00 EST

Decision #: 2000D20
Case #: 94-2879
Provider #: 33-3028
Issue: Was HCFA's partial denial of the Provider's request for a TEFRA target rate adjustment proper?

2000D21

Mon, 05 Dec 2005 15:16:00 EST

Decision #: 2000D21
Case #: 95-0897
Provider #: 31-0002
Issue: Was the Intermediary's failure to apply updated reasonable compensation equivalent limits proper?

2005D02

Wed, 14 Dec 2005 09:51:00 EST

Decision #: 2005D02
Case #: 96-2577G
Provider #: Various
Issue: 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

Wed, 14 Dec 2005 10:04:00 EST

Decision #: 2005D03
Case #: 96-0211, 97-1061R, 98-2080R
Provider #: 26-0015
Issue: 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

Wed, 14 Dec 2005 10:05:00 EST

Decision #: 2005D04
Case #: 01-1458
Provider #: 20-0033
Issue: Was CMS' denial of the Provider's end stage renal disease (ESRD) composite rate exception request correct?

2005D05

Wed, 14 Dec 2005 10:06:00 EST

Decision #: 2005D05
Case #: 94-3085
Provider #: 05-0295
Issue: 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

Wed, 14 Dec 2005 10:07:00 EST

Decision #: 2005D06
Case #: 97-0592, 98-1495
Provider #: 23-0077
Issue: 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

Wed, 14 Dec 2005 10:09:00 EST

Decision #: 2005D07
Case #: 00-0374
Provider #: 52-5478
Issue: 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

Wed, 14 Dec 2005 10:10:00 EST

Decision #: 2005D08
Case #: 00-1542, 01-1278, 03-0040
Provider #: 10-0070
Issue: Were the Intermediary's adjustments to interest expense relating to the acquisition of medical records and an assembled work force proper?

2005D09

Wed, 14 Dec 2005 10:11:00 EST

Decision #: 2005D09
Case #: 99-1467
Provider #: 05-0420
Issue: 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

Wed, 14 Dec 2005 10:14:00 EST

Decision #: 2005D10
Case #: 02-0355
Provider #: 19-7210
Issue: 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

Wed, 14 Dec 2005 10:16:00 EST

Decision #: 2005D11
Case #: 00-3166, 00-3167, 00-3119
Provider #: 03-0023, 03-7047
Issue: Whether the Intermediary's denial of a request for exception to the Home Health Agency (HHA) per visit cost limits was proper?

2005D12

Wed, 14 Dec 2005 10:17:00 EST

Decision #: 2005D12
Case #: 99-0452G
Provider #: Various
Issue: Whether the Intermediary properly processed the Providers' TEFRA exception request?

2005D13

Wed, 14 Dec 2005 10:18:00 EST

Decision #: 2005D13
Case #: 02-0078
Provider #: 19-7585
Issue: Whether the Intermediary denial of the Provider's request for exception to its per-visit cost limits was proper?

2005D14

Wed, 14 Dec 2005 10:19:00 EST

Decision #: 2005D14
Case #: 00-0945
Provider #: 15-5258
Issue: 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

Wed, 14 Dec 2005 10:20:00 EST

Decision #: 2005D15
Case #: 02-0020
Provider #: 05-6092
Issue: Whether the Intermediary's denial of the Provider's Routine Cost Limit (RCL) exception request was proper?

2005D16

Wed, 14 Dec 2005 10:34:00 EST

Decision #: 2005D16
Case #: Various
Provider #: Various
Issue: 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

Wed, 14 Dec 2005 10:35:00 EST

Decision #: 2005D17
Case #: 02-0013, 02-0319
Provider #: 04-3816
Issue: Was the Intermediary's adjustment to physician/owners compensation proper?

2004D05

Wed, 14 Dec 2005 10:41:00 EST

Decision #: 2004D05
Case #: 01-0741
Provider #: 23-2557
Issue: 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

Wed, 14 Dec 2005 10:42:00 EST

Decision #: 2004D06
Case #: 01-0742
Provider #: 23-2553
Issue: 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?

2004D09

Wed, 14 Dec 2005 10:44:00 EST

Decision #: 2004D09
Case #: 03-0665
Provider #: 37-5109
Issue: 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?

2004D07

Wed, 14 Dec 2005 10:44:00 EST

Decision #: 2004D07
Case #: 01-0743
Provider #: 23-2315
Issue: 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?

2004D08

Wed, 14 Dec 2005 10:44:00 EST

Decision #: 2004D08
Case #: 03-0666
Provider #: 37-5109
Issue: Does the Board have jurisdiction over the recoupment of overpayments appealed from a letter from the Centers for Medicare and Medicaid Services?

2005D29

Wed, 14 Dec 2005 16:47:00 EST

Decision #: 2005D29
Case #: 95-0468
Provider #: 05-0076
Issue: Was the Intermediary's partial denial of the Provider's End Stage Renal Disease (ESRD) exception request proper?

2004D01

Wed, 14 Dec 2005 16:54:00 EST

Decision #: 2004D01
Case #: 01-1470; 01-1534G; 01-1539G
Provider #: Various
Issue: 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

Wed, 14 Dec 2005 16:55:00 EST

Decision #: 2003D07
Case #: 00-3976
Provider #: 17-5218
Issue: Was the Intermediary's adjustment disallowing the allocation of general service costs to the ancillary cost centers proper?

2005D31

Wed, 14 Dec 2005 16:57:00 EST

Decision #: 2005D31
Case #: 01-1679
Provider #: 48-0001
Issue: 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

Wed, 14 Dec 2005 16:58:00 EST

Decision #: 2005D32
Case #: 94-3299, 96-0845, 98-2163
Provider #: 31-0111
Issue: Whether the Intermediary failed to properly classify certain projects as old capital.

2005D01

Wed, 14 Dec 2005 16:59:00 EST

Decision #: 2005D01
Case #: 02-0212, 02-0213,02-0214 et al
Provider #: 40-7019;40-7013;40-7017;et al
Issue: Whether the Providers' receivable financing was a loan or a sale of assets?

2005D27

Thu, 15 Dec 2005 10:44:00 EST

Decision #: 2005D27
Case #: 02-1008
Provider #: 25-0019
Issue: Was the Intermediary's disallowance of Medicare bad debts proper?

2004D20

Thu, 15 Dec 2005 10:44:00 EST

Decision #: 2004D20
Case #: 98-1344; 99-1718; 00-2691
Provider #: 51-0001
Issue: Was the Intermediary's adjustment to bond interest proper?

2005D28

Thu, 15 Dec 2005 10:44:00 EST

Decision #: 2005D28
Case #: 97-1566
Provider #: 04-0062
Issue: Was the Centers for Medicare and Medicaid Service's denial of the Provider's request for new provider exemption proper?

2005D25

Thu, 15 Dec 2005 10:44:00 EST

Decision #: 2005D25
Case #: 99-1213
Provider #: 67-7455
Issue: 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

Thu, 15 Dec 2005 10:44:00 EST

Decision #: 2005D24
Case #: 02-0183
Provider #: 19-7545
Issue: 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?

2004D13

Thu, 15 Dec 2005 10:44:00 EST

Decision #: 2004D13
Case #: 01-0881GE
Provider #: Various
Issue: 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.

2003D20

Thu, 15 Dec 2005 10:44:00 EST

Decision #: 2003D20
Case #: 99-4064
Provider #: 52-0089
Issue: Was the Intermediary's determination of the TEFRA exception request proper?

2003D05

Thu, 15 Dec 2005 10:44:00 EST

Decision #: 2003D05
Case #: 00-3145
Provider #: 05-8017
Issue: Was the Intermediary's adjustment of start-up costs proper?

2004D16

Thu, 15 Dec 2005 10:44:00 EST

Decision #: 2004D16
Case #: 00-0411; 00-2594
Provider #: 45-0061
Issue: Was the Intermediary's adjustment excluding observation bed days from the determination of the Provider's disproportionate share hospital adjustment proper?

2004D28

Thu, 15 Dec 2005 10:44:00 EST

Decision #: 2004D28
Case #: 04-1640; 04-1641
Provider #: 50-3300
Issue: 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?

2004D26

Thu, 15 Dec 2005 10:44:00 EST

Decision #: 2004D26
Case #: 01-0883
Provider #: 20-0018
Issue: Was CMS' denial of end stage renal disease composite rate exception request correct based on applicable Medicare law?

2004D30

Thu, 15 Dec 2005 10:44:00 EST

Decision #: 2004D30
Case #: 01-0937
Provider #: 23-7252
Issue: Was the Intermediary's adjustment to the single business tax proper?

2005D22

Thu, 15 Dec 2005 10:44:00 EST

Decision #: 2005D22
Case #: 01-0700
Provider #: 15-5228
Issue: Whether the Intermediary's adjustment to disallow a portion of the owner's compensation was proper?

2004D23

Thu, 15 Dec 2005 10:44:00 EST

Decision #: 2004D23
Case #: 97-2439
Provider #: 19-0160
Issue: Was the Provider's routine cost limit determined in accordance with Medicare law, regulations, and program instructions?

2005D19

Thu, 15 Dec 2005 10:44:00 EST

Decision #: 2005D19
Case #: 01-0261
Provider #: 19-7558
Issue: Was the Intermediary's adjustment to disallow accrued salaries proper?

2004D10

Thu, 15 Dec 2005 10:44:00 EST

Decision #: 2004D10
Case #: 00-2699; 00-2700
Provider #: 15-7193; 15-7318
Issue: 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?

2004D21

Thu, 15 Dec 2005 10:44:00 EST

Decision #: 2004D21
Case #: 99-1424
Provider #: 04-0048
Issue: Was the Intermediary's determination of the loss on disposal of assets proper?

2005D34

Fri, 03 Feb 2006 10:59:00 EST

Decision #: 2005D34
Case #: 98-1658
Provider #: 45-0124
Issue: Whether the Intermediary properly applied the "Pickle Amendment" in calculating the Provider's Disproportionate Share Hospital (DSH) adjustment.

2005D35

Fri, 03 Feb 2006 11:10:00 EST

Decision #: 2005D35
Case #: 99-1345
Provider #: 55-7729
Issue: Whether the liabilities claimed by the Provider are reimbursable under the Medicare principles.

2005D36

Fri, 03 Feb 2006 11:30:00 EST

Decision #: 2005D36
Case #: 02-0216; 02-0217
Provider #: 03-0064
Issue: 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

Fri, 03 Feb 2006 13:22:00 EST

Decision #: 2005D37
Case #: 01-2620
Provider #: 14-7112
Issue: Were the Intermediary adjustments applying Medicare's salary equivalency guidelines to services performed by Provider's employee physical and occupational therapists proper?

2005D38

Fri, 03 Feb 2006 13:27:00 EST

Decision #: 2005D38
Case #: 02-2031
Provider #: 45-2049
Issue: Whether the Intermediary erred in denying the Provider a continuous improvement bonus ("CIB") for fiscal year ending August 31, 1999.

2003D53

Fri, 03 Feb 2006 14:08:00 EST

Decision #: 2003D53
Case #: 99-2359
Provider #: 05-5039
Issue: 1. Was the Intermediary's adjustment to advertising costs proper?; 2. Was the Intermediary's adjustment to tax penalties proper?

2005D40

Mon, 06 Feb 2006 14:11:00 EST

Decision #: 2005D40
Case #: 00-2981
Provider #: 41-5122
Issue: 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

Mon, 06 Feb 2006 14:19:00 EST

Decision #: 2005D41
Case #: 99-4038
Provider #: 36-0066
Issue: 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

Mon, 06 Feb 2006 14:24:00 EST

Decision #: 2005D42
Case #: 01-3257
Provider #: 33-0215
Issue: 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

Mon, 06 Feb 2006 14:28:00 EST

Decision #: 2005D43
Case #: 00-0909G
Provider #: Various
Issue: 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

Mon, 06 Feb 2006 14:33:00 EST

Decision #: 2005D44
Case #: 99-4061
Provider #: 50-5504
Issue: 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

Mon, 06 Feb 2006 14:37:00 EST

Decision #: 2005D45
Case #: 02-1213
Provider #: 22-0163
Issue: 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

Tue, 07 Feb 2006 15:05:00 EST

Decision #: 2005D46
Case #: 98-2583
Provider #: 50-0124; 50-5492
Issue: Was the Provider entitled to a "new provider" exemption from Medicare's routime cost limits for its hospital-based skilled nursing facility (SNF)?

2005D47

Tue, 07 Feb 2006 15:12:00 EST

Decision #: 2005D47
Case #: 02-2129; 04-1734
Provider #: 05-0281
Issue: 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

Tue, 07 Feb 2006 15:18:00 EST

Decision #: 2005D48
Case #: 95-0777
Provider #: 33-0225
Issue: Whether the Intermediary's application of the reasonable compensation equivalent limits was proper.

2005D49

Tue, 07 Feb 2006 15:22:00 EST

Decision #: 2005D49
Case #: Various
Provider #: 36-0125; 36-0187; 36-0027; 36-0009; 36-0068
Issue: Whether the Intermediary improperly excluded patient days related to Ohio's Hospital Care Assurance Program (HCAP) in the providers' disproportionate share calculations.

2005D50

Tue, 07 Feb 2006 15:30:00 EST

Decision #: 2005D50
Case #: 89-1584
Provider #: 45-0101
Issue: 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

Tue, 07 Feb 2006 15:35:00 EST

Decision #: 2005D51
Case #: 98-2210
Provider #: 10-5319A
Issue: 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

Tue, 07 Feb 2006 15:39:00 EST

Decision #: 2005D52
Case #: 99-1511G
Provider #: Various
Issue: 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

Fri, 10 Feb 2006 12:10:00 EST

Decision #: 2005D39
Case #: 99-2779; 02-1243
Provider #: 36-0242
Issue: Whether the Intermediary's adjustment to disallow the interest paid to the Ohio State University Hospitals was proper.

2005D53

Fri, 10 Feb 2006 12:17:00 EST

Decision #: 2005D53
Case #: 97-1198; 99-0246; 99-0247
Provider #: 05-0357
Issue: 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

Fri, 10 Feb 2006 12:29:00 EST

Decision #: 2005D54
Case #: 03-0045; 03-0046
Provider #: 45-0130
Issue: 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

Fri, 10 Feb 2006 12:33:00 EST

Decision #: 2005D55
Case #: 00-3322
Provider #: 39-0263
Issue: Whether the Intermediary's adjustment disallowing the Provider's loss on sale of assets is proper?

2005D56

Fri, 10 Feb 2006 12:36:00 EST

Decision #: 2005D56
Case #: 99-3095
Provider #: 45-0272
Issue: 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

Mon, 13 Feb 2006 11:23:00 EST

Decision #: 2005D57
Case #: 99-3096
Provider #: 45-0272
Issue: 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

Mon, 13 Feb 2006 11:30:00 EST

Decision #: 2005D58
Case #: 99-0832
Provider #: 45-0272
Issue: 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

Mon, 13 Feb 2006 11:33:00 EST

Decision #: 2005D59
Case #: 01-0728
Provider #: 45-0272
Issue: 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

Mon, 13 Feb 2006 11:35:00 EST

Decision #: 2005D60
Case #: 02-1126
Provider #: 33-3531
Issue: 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

Wed, 15 Feb 2006 14:57:00 EST

Decision #: 2005D61
Case #: 99-1543; 00-1001
Provider #: 39-7573
Issue: Whether the Intermediary's adjustments applying the physical therapy salary guidelines to fee-for-service employee compensation was proper.

2005D62

Wed, 15 Feb 2006 15:03:00 EST

Decision #: 2005D62
Case #: 01-0077
Provider #: 25-5234
Issue: Whether the Intermediary's adjustment removing the Provider's 'grossing up' of costs and charges for drugs charged to patients was proper.

2005D63

Wed, 15 Feb 2006 15:06:00 EST

Decision #: 2005D63
Case #: 98-1913
Provider #: 06-7188
Issue: 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

Wed, 15 Feb 2006 15:11:00 EST

Decision #: 2005D64
Case #: 98-1922
Provider #: 05-6169
Issue: Whether the Intermediary's adjustment to allow only a 15% increase in the therapy rate for physical therapy supervisors was proper.

2005D65

Wed, 15 Feb 2006 15:15:00 EST

Decision #: 2005D65
Case #: 00-3600
Provider #: 45-7661
Issue: Whether the Intermediary properly disallowed interest expense incurred in connection with the Provider's deferred compensation plan.

2005D66

Wed, 15 Feb 2006 15:19:00 EST

Decision #: 2005D66
Case #: 00-3299
Provider #: 19-7213
Issue: 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.

2002D23

Sat, 18 Feb 2006 00:00:00 EST

Decision #: 2002D23
Case #: 96-1189; 97-0797R
Provider #: 24-0038
Issue: Whether state-funded days may qualify as Medicaid-eligible days for purposes of the Provider's disproportionate share calculation?

2002D29

Sat, 18 Feb 2006 00:00:00 EST

Decision #: 2002D29
Case #: 98-0452
Provider #: 16-0026
Issue: Did the Provider qualify for a payment adjustment due to a decline in its discharges for fiscal year ending June 30, 1995?

2002D20

Sat, 18 Feb 2006 00:00:00 EST

Decision #: 2002D20
Case #: 98-2883
Provider #: 06-5332
Issue: Were the Intermediary's adjustments to the Provider's depreciation expense related to the sale and leaseback of the facility proper?

2002D37

Sat, 18 Feb 2006 00:00:00 EST

Decision #: 2002D37
Case #: 94-3225G, 94-1910G, 93-0483G, 93-0284G, 94-0209G, 95-1245G, 96-0976G, 98-0179
Provider #: Various
Issue: 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.

2002D24

Sat, 18 Feb 2006 00:00:00 EST

Decision #: 2002D24
Case #: 01-0198
Provider #: 42-5018
Issue: 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?

2002D22

Sat, 18 Feb 2006 00:00:00 EST

Decision #: 2002D22
Case #: 01-0199
Provider #: 42-5112
Issue: 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?

2002D21

Sat, 18 Feb 2006 00:00:00 EST

Decision #: 2002D21
Case #: 96-1820
Provider #: 44-7442
Issue: Was the Intermediary's adjustment to the Provider's cost report to remove legal fees proper?

2002D26

Sat, 18 Feb 2006 00:00:00 EST

Decision #: 2002D26
Case #: 96-0623
Provider #: 23-0227
Issue: 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.

2002D28

Sat, 18 Feb 2006 00:00:00 EST

Decision #: 2002D28
Case #: 96-1240
Provider #: 05-0224
Issue: 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?

2002D27

Sat, 18 Feb 2006 00:00:00 EST

Decision #: 2002D27
Case #: 99-3872
Provider #: 55-7633
Issue: 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?

2002D25

Sat, 18 Feb 2006 00:00:00 EST

Decision #: 2002D25
Case #: 01-0200
Provider #: 42-5102
Issue: 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?

2005D67

Tue, 21 Feb 2006 13:50:00 EST

Decision #: 2005D67
Case #: 98-2026
Provider #: 41-0007
Issue: 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

Tue, 21 Feb 2006 14:01:00 EST

Decision #: 2005D69
Case #: 01-3317
Provider #: 39-7086
Issue: Whether the Intermediary's adjustment of accounting fees was proper.

2005D70

Tue, 21 Feb 2006 14:05:00 EST

Decision #: 2005D70
Case #: 98-1725; 99-2325; 02-1682
Provider #: 21-7084
Issue: 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)).

2002D15

Wed, 22 Feb 2006 00:00:00 EST

Decision #: 2002D15
Case #: 97-1432
Provider #: 20-0066
Issue: 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?

2002D17

Wed, 22 Feb 2006 00:00:00 EST

Decision #: 2002D17
Case #: 00-1736
Provider #: 39-7095
Issue: 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?

2002D16

Wed, 22 Feb 2006 00:00:00 EST

Decision #: 2002D16
Case #: 98-2627
Provider #: 39-0073
Issue: 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?

2002D13

Wed, 22 Feb 2006 00:00:00 EST

Decision #: 2002D13
Case #: 01-3205G
Provider #: 50-0023; 44-0131; 45-0059
Issue: 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.

2002D11

Wed, 22 Feb 2006 00:00:00 EST

Decision #: 2002D11
Case #: 98-1968
Provider #: 33-5521
Issue: Was the Intermediary's adjustment to unpaid interest expense proper?

2002D10

Wed, 22 Feb 2006 00:00:00 EST

Decision #: 2002D10
Case #: 97-3094
Provider #: 06-7199
Issue: Was the Intermediary's adjustment disallowing yellow page advertisement expense proper?

2002D12

Wed, 22 Feb 2006 00:00:00 EST

Decision #: 2002D12
Case #: 00-0479
Provider #: 15-7425
Issue: Was the Intermediary's adjustment reclassifying a portion of the Hospice Director's salary proper?

2002D14

Wed, 22 Feb 2006 00:00:00 EST

Decision #: 2002D14
Case #: 94-3354; 95-1196
Provider #: 05-0040
Issue: 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?

2002D03

Mon, 13 Mar 2006 00:00:00 EST

Decision #: 2002D03
Case #: 98-3317G; 98-2888G
Provider #: 03-0002, 03-0065, 03-0001, 03-0089
Issue: Was the Intermediary's adjustment to home office interest expense proper?

2002D01

Mon, 13 Mar 2006 00:00:00 EST

Decision #: 2002D01
Case #: 00-1056, 99-3600, 00-1057
Provider #: 45-0352
Issue: Were the Intermediary's adjustments to the number of available beds for disproportionate share (DSH) qualification purposes proper?

2002D08

Mon, 13 Mar 2006 00:00:00 EST

Decision #: 2002D08
Case #: 97-1048
Provider #: 42-0030
Issue: 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?

2002D07

Mon, 13 Mar 2006 00:00:00 EST

Decision #: 2002D07
Case #: 98-0490
Provider #: 49-0009
Issue: Was the Intermediary's computation of the Provider's graduate medical education cost proper?

2002D05

Mon, 13 Mar 2006 00:00:00 EST

Decision #: 2002D05
Case #: 96-0550
Provider #: 19-5258
Issue: Was the Intermediary's denial of a routine cost limit exemption as a new provider proper?

2002D02

Mon, 13 Mar 2006 00:00:00 EST

Decision #: 2002D02
Case #: 97-1280G
Provider #: Various
Issue: Did the Intermediary properly reimburse the Provider for drugs and medical supplies purchased from a related party?

2002D06

Mon, 13 Mar 2006 00:00:00 EST

Decision #: 2002D06
Case #: 98-0511
Provider #: 03-5145
Issue: Did the Intermediary calculate the provider's bad debts properly?

2002D09

Mon, 13 Mar 2006 00:00:00 EST

Decision #: 2002D09
Case #: 00-1180
Provider #: 06-7256
Issue: 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?

2002D04

Mon, 13 Mar 2006 00:00:00 EST

Decision #: 2002D04
Case #: 95-0620
Provider #: 36-0163
Issue: Was the Intermediary's adjustment with respect to parking garage revenues proper?

2001D52

Tue, 14 Mar 2006 00:00:00 EST

Decision #: 2001D52
Case #: 97-2064R, 97-2148R, 98-0474 (On the Record)
Provider #: 43-0077
Issue: 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?

2001D54

Tue, 14 Mar 2006 00:00:00 EST

Decision #: 2001D54
Case #: 97-1736
Provider #: 44-0161
Issue: 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

Tue, 14 Mar 2006 00:00:00 EST

Decision #: 2001D53
Case #: 96-0180
Provider #: 33-0285
Issue: Did the Intermediary use the correct reasonable compensation equivalent ('RCE') limits to disallow a portion of the Provider's hospital-based physicians' compensation?

2001D51

Tue, 14 Mar 2006 00:00:00 EST

Decision #: 2001D51
Case #: 96-0166
Provider #: 04-3001
Issue: 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?

2001D50

Tue, 14 Mar 2006 00:00:00 EST

Decision #: 2001D50
Case #: 98-0787
Provider #: 36-0006
Issue: 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?

2001D47

Thu, 16 Mar 2006 00:00:00 EST

Decision #: 2001D47
Case #: 96-0225
Provider #: 14-7525
Issue: Was the compensation paid to HCC's owner reasonable?

2001D44

Thu, 16 Mar 2006 00:00:00 EST

Decision #: 2001D44
Case #: 97-1917
Provider #: 37-7093
Issue: Was the Intermediary' adjustment to physical therapy labor costs proper?

2001D40

Thu, 16 Mar 2006 00:00:00 EST

Decision #: 2001D40
Case #: 97-0843
Provider #: 01-0079
Issue: Was the Intermediary's disallowance of the Provider's Medicare Part B bad debts for deductibles and coinsurance proper?

2001D41

Thu, 16 Mar 2006 00:00:00 EST

Decision #: 2001D41
Case #: 96-0102
Provider #: 17-0001
Issue: Did HCFA properly determine that the SNF routine cost limits exception request was not timely filed?

2001D49

Thu, 16 Mar 2006 00:00:00 EST

Decision #: 2001D49
Case #: 95-1217
Provider #: 36-0017
Issue: 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?

2001D48

Thu, 16 Mar 2006 00:00:00 EST

Decision #: 2001D48
Case #: 00-1179
Provider #: 25-7305
Issue: 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?

2001D42

Thu, 16 Mar 2006 00:00:00 EST

Decision #: 2001D42
Case #: 95-1143
Provider #: 33-0285
Issue: 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?

2001D46

Thu, 16 Mar 2006 00:00:00 EST

Decision #: 2001D46
Case #: 99-2365G
Provider #: 06-7032; 06-7201
Issue: Were the Intermediary's adjustments to physical therapy costs proper?

2001D45

Thu, 16 Mar 2006 00:00:00 EST

Decision #: 2001D45
Case #: 98-0095
Provider #: 05-7465
Issue: Was the Intermediary's adjustment reclassifying the community liaison's compensation to a non-reimbursable cost center proper?

2001D43

Thu, 16 Mar 2006 00:00:00 EST

Decision #: 2001D43
Case #: 89-1522R
Provider #: 05-0327
Issue: Was the Provider's computation of the self-disallowance amount of investment income offset against interest expense proper?

2005D68

Sat, 18 Mar 2006 00:00:00 EST

Decision #: 2005D68
Case #: 99-2385
Provider #: 15-5281
Issue: 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.

2001D31

Sat, 18 Mar 2006 00:00:00 EST

Decision #: 2001D31
Case #: 00-0573G
Provider #: Various
Issue: 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?

2001D36

Sat, 18 Mar 2006 00:00:00 EST

Decision #: 2001D36
Case #: 97-0475
Provider #: 36-0003
Issue: 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?

2001D37

Sat, 18 Mar 2006 00:00:00 EST

Decision #: 2001D37
Case #: 94-2298, 95-1213, 96-0132, 96-2235, 98-0023, 99-0057, 98-2943
Provider #: 34-0054
Issue: Was the Intermediary's adjustment to the disproportionate share amount proper?

2001D38

Sat, 18 Mar 2006 00:00:00 EST

Decision #: 2001D38
Case #: 98-2619
Provider #: 01-5049
Issue: 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?

2001D33

Sat, 18 Mar 2006 00:00:00 EST

Decision #: 2001D33
Case #: 00-1745
Provider #: 14-5736
Issue: 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?

2001D32

Sat, 18 Mar 2006 00:00:00 EST

Decision #: 2001D32
Case #: 97-2651, 97-2652, 97-2653, 97-2654
Provider #: 50-0012; 50-5481
Issue: 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)?

2001D35

Sat, 18 Mar 2006 00:00:00 EST

Decision #: 2001D35
Case #: 96-0343
Provider #: 36-0003
Issue: 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?

2001D39

Sat, 18 Mar 2006 00:00:00 EST

Decision #: 2001D39
Case #: 00-2472
Provider #: 21-7008
Issue: 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?

2001D34

Sat, 18 Mar 2006 00:00:00 EST

Decision #: 2001D34
Case #: 95-1001G
Provider #: 01-0055, 01-7013, 01-7020, 01-7048, 01-7072
Issue: 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?

2001D30

Sat, 18 Mar 2006 00:00:00 EST

Decision #: 2001D30
Case #: 97-0160
Provider #: 10-4549
Issue: Was the Intermediary's adjustments to the Provider's therapy costs proper?

2006D20

Wed, 22 Mar 2006 14:18:00 EST

Decision #: 2006D20
Case #: 96-1822; 97-1579; 98-1827; 99-2061
Provider #: 22-0077
Issue: 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.

2001D29

Wed, 29 Mar 2006 00:00:00 EST

Decision #: 2001D29
Case #: 97-0159
Provider #: 10-4549
Issue: Was the Intermediary's adjustments to the Provider's therapy costs proper?

2001D28

Wed, 29 Mar 2006 00:00:00 EST

Decision #: 2001D28
Case #: 97-2018; 99-0881
Provider #: 39-5742
Issue: 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?

2001D24

Wed, 29 Mar 2006 00:00:00 EST

Decision #: 2001D24
Case #: 97-1699
Provider #: 33-0154
Issue: Was the Intermediary's adjustment disallowing certain expenses of compensating hospital based physicians pursuant to the 1984 Reasonable Compensation Equivalency limits proper?

2001D25

Wed, 29 Mar 2006 00:00:00 EST

Decision #: 2001D25
Case #: 99-3163
Provider #: 14-7017
Issue: 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?

2001D22

Wed, 29 Mar 2006 00:00:00 EST

Decision #: 2001D22
Case #: 98-0229
Provider #: 14-7483
Issue: Was the Intermediary's adjustment to skilled nursing and HHA visits proper?

2001D27

Wed, 29 Mar 2006 00:00:00 EST

Decision #: 2001D27
Case #: 99-0095
Provider #: 26-7262
Issue: Was the Intermediary's adjustment to remove excess key employee compensation proper?

2001D23

Wed, 29 Mar 2006 00:00:00 EST

Decision #: 2001D23
Case #: 94-1039; 94-1040
Provider #: 23-0001
Issue: 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?

2001D20

Wed, 29 Mar 2006 00:00:00 EST

Decision #: 2001D20
Case #: 96-1308
Provider #: 45-7751
Issue: 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

Wed, 29 Mar 2006 00:00:00 EST

Decision #: 2001D26
Case #: 96-1477, 97-1703, 97-2763
Provider #: 29-0007
Issue: 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?

2001D11

Sat, 01 Apr 2006 00:00:00 EST

Decision #: 2001D11
Case #: 95-2183; 97-3095
Provider #: 36-0051
Issue: Did the Intermediary use the correct reasonable compensation equivalent ("RCE") limits to disallow a portion of the Provider's hospital-based physicians' compensation?

2001D10

Sat, 01 Apr 2006 00:00:00 EST

Decision #: 2001D10
Case #: 93-1355
Provider #: 45-0388
Issue: 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?

2001D16

Sat, 01 Apr 2006 00:00:00 EST

Decision #: 2001D16
Case #: 95-2234, 97-0068, 97-2678
Provider #: 22-7029
Issue: 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)

2001D19

Sat, 01 Apr 2006 00:00:00 EST

Decision #: 2001D19
Case #: 91-1844
Provider #: 05-0457
Issue: Did the Intermediary properly adjust outpatient surgery, anesthesia and supply charges?

2001D17

Sat, 01 Apr 2006 00:00:00 EST

Decision #: 2001D17
Case #: 97-2425
Provider #: 05-0455
Issue: 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.)

2001D14

Sat, 01 Apr 2006 00:00:00 EST

Decision #: 2001D14
Case #: 95-1296
Provider #: 33-0106
Issue: Did the Intermediary use the correct reasonable compensation equivalent ("RCE") limits to disallow a portion of the Provider's hospital-based only physicians' compensation?

2001D13

Sat, 01 Apr 2006 00:00:00 EST

Decision #: 2001D13
Case #: 95-2033, 96-1979, 97-1498, 98-2049
Provider #: 04-0036
Issue: Were the Intermediary's adjustments disallowing pass-through cost reimbursement of nursing education costs proper?

2001D18

Sat, 01 Apr 2006 00:00:00 EST

Decision #: 2001D18
Case #: 99-2430; 00-0769
Provider #: 17-7087
Issue: 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?

2001D15

Sat, 01 Apr 2006 00:00:00 EST

Decision #: 2001D15
Case #: 94-0463
Provider #: 24-0053
Issue: ere the Intermediary's adjustments to SNF routine cost limits proper?

2001D02

Mon, 24 Apr 2006 00:00:00 EST

Decision #: 2001D02
Case #: 96-0423G, 99-0448G, 99-2082G
Provider #: 05-5916, 05-5053, 05-6261, 55-5658
Issue: Were the Intermediary's adjustments to disallow costs related to the Provider's airplane proper

2001D09

Mon, 24 Apr 2006 00:00:00 EST

Decision #: 2001D09
Case #: 92-0111
Provider #: 51-0039
Issue: 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?

2001D05

Mon, 24 Apr 2006 00:00:00 EST

Decision #: 2001D05
Case #: 97-0693
Provider #: 05-0390
Issue: Was the Intermediary's determination of inpatient and outpatient Medicare bad debts proper?

2001D03

Mon, 24 Apr 2006 00:00:00 EST

Decision #: 2001D03
Case #: 92-1220; 93-0473
Provider #: 05-0025
Issue: Was the Intermediary's adjustment to the number of available beds for indirect medical education ad

2001D07

Mon, 24 Apr 2006 00:00:00 EST

Decision #: 2001D07
Case #: 97-2509
Provider #: 14-5111
Issue: Was the Intermediary's adjustment to the routine cost limit proper?

2001D01

Mon, 24 Apr 2006 00:00:00 EST

Decision #: 2001D01
Case #: 99-1249
Provider #: 14-5335
Issue: Is the Provider entitled to an exception to the skilled nursing facility routine service cost limits for fiscal year ending 1995?

2001D06

Mon, 24 Apr 2006 00:00:00 EST

Decision #: 2001D06
Case #: 97-0139R
Provider #: 39-5095
Issue: Was the Intermediary's reclassification of employment taxes proper?

2001D08

Mon, 24 Apr 2006 00:00:00 EST

Decision #: 2001D08
Case #: 94-3107
Provider #: 33-0058
Issue: Was HCFA's denial of the Provider's ESRD composite payment rate exception proper?

2001D04

Mon, 24 Apr 2006 00:00:00 EST

Decision #: 2001D04
Case #: 98-0627
Provider #: 15-4014
Issue: 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?

2005D71

Mon, 24 Apr 2006 14:17:00 EST

Decision #: 2005D71
Case #: 02-0399, 02-1946
Provider #: 15-0029
Issue: Were the Intermediary's adjustments to the count of full-time equivalent interns and residents proper?

2005D72

Mon, 24 Apr 2006 14:26:00 EST

Decision #: 2005D72
Case #: 99-2472
Provider #: 05-0603
Issue: 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

Mon, 24 Apr 2006 14:32:00 EST

Decision #: 2006D01
Case #: 98-0502
Provider #: 24-0010
Issue: 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

Mon, 24 Apr 2006 14:37:00 EST

Decision #: 2006D02
Case #: 02-1686
Provider #: 23-0020
Issue: 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

Mon, 24 Apr 2006 14:41:00 EST

Decision #: 2006D03
Case #: 02-1765, 02-1766, 02-1767, 03-0825
Provider #: 31-4013
Issue: Whether the Intermediary's adjustments to disallow reimbursement for physicians' professioanl services on a reasonable cost basis was proper.

2006D04

Mon, 24 Apr 2006 15:10:00 EST

Decision #: 2006D04
Case #: 99-1295
Provider #: 15-5478
Issue: Was the Intermediary's adjustment to owners' compensation proper?

2006D05

Mon, 24 Apr 2006 15:13:00 EST

Decision #: 2006D05
Case #: 94-2729
Provider #: 14-0119
Issue: 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

Wed, 26 Apr 2006 10:46:00 EST

Decision #: 2006D07
Case #: 99-3690G
Provider #: Various
Issue: 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

Wed, 26 Apr 2006 10:54:00 EST

Decision #: 2006D08
Case #: 03-0009G
Provider #: Various
Issue: Whether the Intermediary's adjustments reallocating key employee and owners' bonuses were proper.

2006D09

Wed, 26 Apr 2006 10:58:00 EST

Decision #: 2006D09
Case #: 04-0412
Provider #: 26-0039
Issue: Whether the Intermediary's computation of the adjustment due the Provider for a decrease in discharges experienced in FY 2000 was correct.

2006D10

Wed, 26 Apr 2006 11:02:00 EST

Decision #: 2006D10
Case #: 03-1555, 04-0387
Provider #: 45-0162
Issue: Whether or not Highland Medical Center has 100 or more available beds for Medicare disproportionate share adjustment qualification and payment purposes.

2000D06

Thu, 27 Apr 2006 00:00:00 EST

Decision #: 2000D06
Case #: 96-0053G
Provider #: 46-5067, 46-5068, 49-5049, 46-5075
Issue: Did the Intermediary improperly disallow the time studies the Providers used for allocation of nursing administration, medical records and social services?

2000D05

Thu, 27 Apr 2006 00:00:00 EST

Decision #: 2000D05
Case #: 94-0327
Provider #: 14-0032
Issue: Was the Health Care Financing Administration's ("HCFA") denial of the Provider's request for classification as a sole community hospital proper?

2000D04

Thu, 27 Apr 2006 00:00:00 EST

Decision #: 2000D04
Case #: 94-0426, 94-0429
Provider #: 03-0002
Issue: Must the Provider have a written agreement with its related facilities in order to have the resident rotations included in its GME count?

2000D01

Thu, 27 Apr 2006 00:00:00 EST

Decision #: 2000D01
Case #: 97-0602
Provider #: 07-7133
Issue: Was the Intermediary's adjustment to disallow franchise fees correct?

2000D03

Thu, 27 Apr 2006 00:00:00 EST

Decision #: 2000D03
Case #: 97-2434
Provider #: 05-0109
Issue: Did the Intermediary properly implement PRRB Decision No. 96-D35?

2000D07

Thu, 27 Apr 2006 00:00:00 EST

Decision #: 2000D07
Case #: 94-2649
Provider #: 45-0037
Issue: 1. Was the HHA cafeteria allocation statistic proper?; 2. Were the HHA administrative costs proper?

2000D11

Fri, 28 Apr 2006 00:00:00 EST

Decision #: 2000D11
Case #: 96-0498
Provider #: 16-0045
Issue: 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

Fri, 28 Apr 2006 00:00:00 EST

Decision #: 2000D12
Case #: 95-0068
Provider #: 38-0024
Issue: Was the Intermediary's or HCFA's determination regarding the Provider's TEFRA exception request proper?

2000D08

Fri, 28 Apr 2006 00:00:00 EST

Decision #: 2000D08
Case #: 95-0527
Provider #: 36-0163
Issue: Was the denial of Provider's End Stage Renal Disease ("ESRD") composite rate exception request based on atypical service intensity/patient mix proper?

2000D09

Fri, 28 Apr 2006 00:00:00 EST

Decision #: 2000D09
Case #: 98-1081
Provider #: 06-7201
Issue: Were the Intermediary's adjustments to owners' compensation proper?

2000D10

Fri, 28 Apr 2006 00:00:00 EST

Decision #: 2000D10
Case #: 94-3018, 94-3019, 94-3020, 94-3021, 95-2194
Provider #: 39-5580
Issue: 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?

2000D14

Fri, 28 Apr 2006 00:00:00 EST

Decision #: 2000D14
Case #: 95-1201
Provider #: 03-0024
Issue: 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?

2000D13

Fri, 28 Apr 2006 00:00:00 EST

Decision #: 2000D13
Case #: 94-0718
Provider #: 31-0001
Issue: 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?

2006D15

Tue, 09 May 2006 00:00:00 EST

Decision #: 2006D15
Case #: 02-1526
Provider #: 19-7060
Issue: Whether the Intermediary's disallowance of medical director fees was proper.

2006D14

Tue, 09 May 2006 00:00:00 EST

Decision #: 2006D14
Case #: 03-0176
Provider #: 07-5407
Issue: Whether the Intermediary properly denied the Provider's new provider exemption request.

2006D12

Tue, 09 May 2006 00:00:00 EST

Decision #: 2006D12
Case #: 99-3024
Provider #: 24-0093
Issue: 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.

2006D13

Tue, 09 May 2006 00:00:00 EST

Decision #: 2006D13
Case #: 01-2940
Provider #: 05-0145
Issue: 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.

2006D11

Tue, 09 May 2006 00:00:00 EST

Decision #: 2006D11
Case #: 02-0812
Provider #: 05-0069
Issue: 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.

1999D001

Wed, 10 May 2006 14:26:00 EST

Decision #: 1999D001
Case #: 93-0824+
Provider #: 18-0124
Issue: Was the Intermediary's adjustment toMedicare bad debts proper?

1999D002

Wed, 10 May 2006 14:32:00 EST

Decision #: 1999D002
Case #: 92-1027
Provider #: 50-0054
Issue: 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

Wed, 10 May 2006 14:42:00 EST

Decision #: 1999D003
Case #: 95-2373
Provider #: 10-7281
Issue: 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

Wed, 10 May 2006 15:06:00 EST

Decision #: 1999D004
Case #: 95-0907
Provider #: 31-0073
Issue: Was the Intermediary's calculation of the Provider's disproportionate share hospital adjustment proper?

1999D005

Thu, 11 May 2006 14:13:00 EST

Decision #: 1999D005
Case #: 94-2470
Provider #: 39-4023
Issue: 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

Thu, 11 May 2006 15:15:00 EST

Decision #: 1999D006
Case #: 93-1518+/C
Provider #: 51-0007
Issue: 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

Thu, 11 May 2006 15:30:00 EST

Decision #: 1999D008
Case #: 96-0640
Provider #: 21-5264
Issue: 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

Thu, 11 May 2006 15:38:00 EST

Decision #: 1999D009
Case #: 94-2203
Provider #: 11-6571
Issue: Was the Intermediary's adjustment to bad debt proper?

1999D010

Thu, 11 May 2006 15:43:00 EST

Decision #: 1999D010
Case #: 89-1103
Provider #: 05-0128
Issue: 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

Wed, 17 May 2006 14:56:00 EST

Decision #: 1999D011
Case #: 97-0831
Provider #: 40-7014
Issue: Was the Intermediary's audit adjustment to durable medidcal equipment ("DME") bad debts proper?

1999D012

Wed, 17 May 2006 15:01:00 EST

Decision #: 1999D012
Case #: 93-0451, 93-1941
Provider #: 44-7425
Issue: Was the Intermediary's adjustment of management fees proper?

1999D013

Wed, 17 May 2006 15:05:00 EST

Decision #: 1999D013
Case #: 91-2935M
Provider #: 07-0016
Issue: 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

Wed, 17 May 2006 15:12:00 EST

Decision #: 1999D014
Case #: 94-3074, 95-2199
Provider #: 14-0088
Issue: 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

Wed, 17 May 2006 15:21:00 EST

Decision #: 1999D015
Case #: 94-0030
Provider #: 23-6563
Issue: 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

Thu, 18 May 2006 13:55:00 EST

Decision #: 1999D016
Case #: 92-1962G
Provider #: Various
Issue: Should the revised Dallas-Fort Worth wage indexes be effective October 1, 1991?

1999D017

Thu, 18 May 2006 14:08:00 EST

Decision #: 1999D017
Case #: 91-2308, 94-2352, 94-1066
Provider #: 26-0021
Issue: 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

Thu, 18 May 2006 14:14:00 EST

Decision #: 1999D018
Case #: 94-2471
Provider #: 39-0142
Issue: Was the Intermediary's methodology for determining physicians'Part A costs (reasonable compensation equivalents) proper?

1999D019

Thu, 18 May 2006 15:08:00 EST

Decision #: 1999D019
Case #: 95-1242+, 95-1242C
Provider #: 39-0118
Issue: Was the Intermediary's determination regarding the Provider's prospective payment system capital rate proper?

1999D020

Thu, 18 May 2006 15:13:00 EST

Decision #: 1999D020
Case #: 91-1734
Provider #: 50-0025
Issue: Was the Intermediary's adjustment to bad debts proper?

1999D007

Thu, 18 May 2006 15:23:00 EST

Decision #: 1999D007
Case #: 94-1896, 95-1021
Provider #: 19-0158
Issue: Was the Provider entitled to be reimbursed for the costs incured in connection with an abandoned hospital expansion project?

1999D022

Mon, 22 May 2006 14:26:00 EST

Decision #: 1999D022
Case #: 93-1886
Provider #: 05-5837
Issue: Is the Provider entitled to the full exception request to the , which is sought from HCFA?

1999D023

Mon, 22 May 2006 14:34:00 EST

Decision #: 1999D023
Case #: 93-0178, 93-0518, 92-1084
Provider #: 10-4013
Issue: 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

Mon, 22 May 2006 14:40:00 EST

Decision #: 1999D024
Case #: 93-0688, 94-0445, 94-2071
Provider #: 45-0007
Issue: 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

Mon, 22 May 2006 14:48:00 EST

Decision #: 1999D025
Case #: 94-2452
Provider #: 11-3027
Issue: Were the sale and lease of the Provider Transactions between related organations?

2006D16

Fri, 26 May 2006 14:40:00 EST

Decision #: 2006D16
Case #: 04-0426
Provider #: 05-0122
Issue: Whether the Intermediary's disallowance of the Provider's inpatient and outpatient Medicare bad debts was proper?

2006D17

Fri, 26 May 2006 14:48:00 EST

Decision #: 2006D17
Case #: 99-3635
Provider #: 22-5387
Issue: 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

Fri, 26 May 2006 15:10:00 EST

Decision #: 2006D18
Case #: 00-0548, 00-0609
Provider #: 49-7033
Issue: Was the Intermediary's adjustment applying Medicare's Physical Therapy Compensation Guidelines to the Provider's employee physical therapists proper?

2006D19

Fri, 26 May 2006 15:19:00 EST

Decision #: 2006D19
Case #: 04-0133
Provider #: 03-0101
Issue: 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

Tue, 27 Jun 2006 00:00:00 EST

Decision #: 2006D06
Case #: 97-2444, 98-2580, 99-3445, 99-3383G, 00-1426
Provider #: 37-7120, 37-7417
Issue: 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

Wed, 05 Jul 2006 15:53:00 EST

Decision #: 1999D021
Case #: 91-2474M
Provider #: 22-0104
Issue: 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

Wed, 05 Jul 2006 16:03:00 EST

Decision #: 1999D026
Case #: 94-1159
Provider #: 39-0142
Issue: 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

Fri, 14 Jul 2006 15:20:00 EST

Decision #: 2006D21
Case #: 01-0546G
Provider #: Various
Issue: Whether the Intermediary appropriately denied the Provider's requests for an exception to the Medicare allowable hourly salary equivalency amount for physical therapy.

2006D22

Fri, 14 Jul 2006 15:25:00 EST

Decision #: 2006D22
Case #: 01-0820
Provider #: 14-0052
Issue: 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

Fri, 14 Jul 2006 15:28:00 EST

Decision #: 2006D23
Case #: 00-2689
Provider #: 39-0102
Issue: 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

Fri, 14 Jul 2006 15:32:00 EST

Decision #: 2006D24
Case #: 03-0259; 03-0260
Provider #: 31-6597; 31-6625
Issue: Whether the Intermediary's adjustments were proper that disallowed the Providers' claimed Medicare Bad Debts, disallowed in a prior year period.

2006D25

Fri, 14 Jul 2006 15:36:00 EST

Decision #: 2006D25
Case #: 01-1397; 01-1398
Provider #: 21-7118
Issue: 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

Fri, 14 Jul 2006 15:41:00 EST

Decision #: 2006D26
Case #: 02-0632
Provider #: 30-0003
Issue: 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

Fri, 14 Jul 2006 15:44:00 EST

Decision #: 2006D27
Case #: 00-1020
Provider #: 03-0030
Issue: 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

Fri, 14 Jul 2006 15:47:00 EST

Decision #: 2006D28
Case #: 04-0783; 04-0819
Provider #: 14-0007; 04-0093
Issue: 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

Fri, 14 Jul 2006 15:51:00 EST

Decision #: 2006D29
Case #: 97-1202; 99-2900
Provider #: 33-0059
Issue: 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

Fri, 14 Jul 2006 15:55:00 EST

Decision #: 2006D30
Case #: 00-3284; 00-3619; 01-0598
Provider #: 19-5301; 19-5302; 19-5304
Issue: Whether the Intermediary's adjustments to reduce the Providers' outpatient therpay costs by 10 percent were proper?

2006D31

Fri, 14 Jul 2006 15:59:00 EST

Decision #: 2006D31
Case #: 93-1227+; 93-1227C
Provider #: 05-0040
Issue: 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

Fri, 14 Jul 2006 16:01:00 EST

Decision #: 2006D32
Case #: 01-2850
Provider #: 37-0078
Issue: 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

Mon, 17 Jul 2006 14:50:00 EST

Decision #: 1999D27
Case #: 94-2772
Provider #: 45-0035
Issue: Was the denial of the Provider's request for an adjustment to the TEFRA limits because of untimely filing, proper?

1999D28

Mon, 17 Jul 2006 14:57:00 EST

Decision #: 1999D28
Case #: 94-0152
Provider #: 39-0158
Issue: 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

Wed, 26 Jul 2006 14:40:00 EST

Decision #: 1999D29
Case #: 92-0668
Provider #: 34-0113
Issue: Did the Intermediary properly reopen the Provider's cost report and recoup an overpayment made to the Provider?

1999D30

Wed, 26 Jul 2006 15:00:00 EST

Decision #: 1999D30
Case #: 93-1376G
Provider #: Various
Issue: Was the Intermediary's classification of the Louisianna franchise tax as an operating cost rather than a capital cost proper?

1999D31

Tue, 01 Aug 2006 11:03:00 EST

Decision #: 1999D31
Case #: 93-1475
Provider #: 05-0329
Issue: 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

Tue, 01 Aug 2006 11:28:00 EST

Decision #: 1999D32
Case #: 97-1195; 97-1192; 95-1564; 97-1191
Provider #: 23-7201
Issue: 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

Tue, 01 Aug 2006 11:35:00 EST

Decision #: 2006D33
Case #: 00-2873; 00-2874; 01-1931
Provider #: 09-7000
Issue: Whether the Intermediary's adjustment applying Medicare's Physical Therapy Compensation Guidelines to the Provider's employee physical therapists was proper.

2006D34

Tue, 01 Aug 2006 13:52:00 EST

Decision #: 2006D34
Case #: 95-0315G
Provider #: 45-4069; 45-3038
Issue: 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

Tue, 01 Aug 2006 13:57:00 EST

Decision #: 2006D35
Case #: 01-0991
Provider #: 14-4646
Issue: 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

Fri, 04 Aug 2006 10:55:00 EST

Decision #: 2006D36
Case #: 02-2110G
Provider #: Various
Issue: 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

Fri, 04 Aug 2006 11:01:00 EST

Decision #: 2006D37
Case #: 02-0140
Provider #: 07-0007
Issue: Whether the Intermediary's adjustment to disallow the Connecticut Sales Tax was proper.

2006D38

Fri, 04 Aug 2006 11:05:00 EST

Decision #: 2006D38
Case #: 98-1822
Provider #: 07-0028
Issue: Whether the Intermediary's adjustment to disallow the Connecticut Sales Tax was proper.

2006D39

Fri, 04 Aug 2006 11:14:00 EST

Decision #: 2006D39
Case #: 01-2871
Provider #: 05-0327
Issue: 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

Fri, 04 Aug 2006 11:20:00 EST

Decision #: 2006D40
Case #: 01-2872
Provider #: 05-2550
Issue: 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

Mon, 07 Aug 2006 14:36:00 EST

Decision #: 1999D33
Case #: 91-2887
Provider #: 14-0087
Issue: Was the Intermediary's netting of the balance due to Edgewood Hospital of liabilities owed to the program by Edgewood Medical Center proper?

1999D34

Mon, 07 Aug 2006 14:42:00 EST

Decision #: 1999D34
Case #: 97-0354G
Provider #: Various
Issue: Did the Providers properly classify workers' compensation costs under the category of administrative and general costs instead of employees benefits costs?

1999D35

Mon, 07 Aug 2006 14:49:00 EST

Decision #: 1999D35
Case #: 89-1782R
Provider #: 33-0041
Issue: Were the Intermediary's adjustments reclassifying the lease rental costs reported as capital costs proper?

1999D36

Tue, 08 Aug 2006 11:33:00 EST

Decision #: 1999D36
Case #: 91-1440
Provider #: 05-0194
Issue: Was the Intermediary's adjustment modifying the disproportionate share adjustment amount proper?

1999D37

Tue, 08 Aug 2006 11:37:00 EST

Decision #: 1999D37
Case #: 84-0407; 88-1478
Provider #: 26-6512
Issue: 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

Tue, 08 Aug 2006 13:19:00 EST

Decision #: 1999D38
Case #: 96-2150
Provider #: 22-5664
Issue: Was the Provider entitled to an exemption from the skilled nursing facility routine service cost limits as a "new provider"?

1999D39

Tue, 08 Aug 2006 13:24:00 EST

Decision #: 1999D39
Case #: 93-1522
Provider #: 05-4003
Issue: 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

Tue, 08 Aug 2006 13:29:00 EST

Decision #: 1999D40
Case #: 88-0373
Provider #: 06-0098
Issue: Was the DRG amount, other than outlier payments, calculated correctly under Medicare law and PPS regulations?

1999D41

Wed, 09 Aug 2006 14:20:00 EST

Decision #: 1999D41
Case #: 96-2199
Provider #: 16-0088
Issue: 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

Wed, 09 Aug 2006 15:01:00 EST

Decision #: 1999D42
Case #: 92-0215; 94-0239
Provider #: 05-0226
Issue: Was the Intermediary's adjustment to offset investment income earned from a related organization proper?

1999D43

Wed, 09 Aug 2006 15:08:00 EST

Decision #: 1999D43
Case #: 89-0910
Provider #: 05-0153
Issue: 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

Wed, 09 Aug 2006 15:14:00 EST

Decision #: 1999D44
Case #: 96-0529
Provider #: 52-5394
Issue: Were the Intermediary's adjustments to ancillary cost centers proper?

1999D45

Wed, 09 Aug 2006 15:17:00 EST

Decision #: 1999D45
Case #: 98-0105
Provider #: 23-6616
Issue: Was the Intermediary's adjustment to owner's compensation Proper?

1999D46

Wed, 09 Aug 2006 15:22:00 EST

Decision #: 1999D46
Case #: 95-1043
Provider #: 39-5481
Issue: 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

Wed, 09 Aug 2006 15:28:00 EST

Decision #: 1999D47
Case #: 95-0931
Provider #: 01-0139
Issue: Was the Provider's request for an exception to its TEFRA target rate proper?

1999D48

Wed, 09 Aug 2006 15:35:00 EST

Decision #: 1999D48
Case #: 95-0492E; 97-0952E;97-2389E
Provider #: 20-7026
Issue: 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

Fri, 11 Aug 2006 10:31:00 EST

Decision #: 1999D49
Case #: 93-1505
Provider #: 22-0077
Issue: Was the Intermediary's disallowance of Medicare bad debts proper?

1999D51

Fri, 11 Aug 2006 11:20:00 EST

Decision #: 1999D51
Case #: 94-0198
Provider #: 01-0079
Issue: Was the Intermediary's attempt to recover Disproportionate Share Hospital (DSH) payments from the Provider for FYs 89 and 90 proper?

1999D52

Fri, 11 Aug 2006 11:25:00 EST

Decision #: 1999D52
Case #: 94-2925
Provider #: 28-0034
Issue: 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

Fri, 11 Aug 2006 11:38:00 EST

Decision #: 1999D53
Case #: 94-1156
Provider #: 39-4023
Issue: Was the Intermediary's application of the 1984 Reasonable Compensation Equivalent (RCE) limits proper?

1999D54

Fri, 11 Aug 2006 13:37:00 EST

Decision #: 1999D54
Case #: 97-3024
Provider #: 55-7160
Issue: Was the Intermediary's adjustment reclassifying non-allowable costs of community liason employees to a non-reimbursable cost center proper?

1999D55

Fri, 11 Aug 2006 13:52:00 EST

Decision #: 1999D55
Case #: 94-2504
Provider #: 04-0022
Issue: Were the Intermediary's adjustments disallowing the pass-through of nursing education costs proper?

1999D56

Fri, 11 Aug 2006 13:57:00 EST

Decision #: 1999D56
Case #: 96-0174G
Provider #: Various
Issue: 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

Fri, 11 Aug 2006 14:18:00 EST

Decision #: 1999D57
Case #: 95-1188R
Provider #: 050235; 55-5046
Issue: Was the Intermediary's denial of the Provider's Routine Cost Limits exception proper?

1999D58

Fri, 11 Aug 2006 14:23:00 EST

Decision #: 1999D58
Case #: 95-0308R
Provider #: 05-0235; 55-5046
Issue: Was the Intermediary's denial of the Provider's Routine Cost Limit exception proper?

1999D59

Fri, 11 Aug 2006 14:29:00 EST

Decision #: 1999D59
Case #: 97-0139
Provider #: 39-5095
Issue: 1. Was the Intermediary's reclassification of employment taxes proper?; 2. Was the Intermediary's adjustment to owner's compensation proper?

1999D60

Mon, 14 Aug 2006 16:36:00 EST

Decision #: 1999D60
Case #: 96-2056
Provider #: 23-7141
Issue: 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

Tue, 15 Aug 2006 14:10:00 EST

Decision #: 1999D61
Case #: 97-2340
Provider #: 01-5049
Issue: 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

Tue, 15 Aug 2006 14:22:00 EST

Decision #: 1999D62
Case #: 96-0122
Provider #: 38-5161
Issue: Was the Intermediary's adjustment limiting contracted occupational therapy and speech therapy costs to $104 per hour proper?

1999D63

Tue, 15 Aug 2006 14:28:00 EST

Decision #: 1999D63
Case #: 94-3180
Provider #: 36-0085
Issue: Was the Intermediary's adjustment to the outlier payments proper?

1999D64

Tue, 15 Aug 2006 14:33:00 EST

Decision #: 1999D64
Case #: 96-1263
Provider #: 52-5419
Issue: 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

Wed, 16 Aug 2006 11:05:00 EST

Decision #: 1999D65
Case #: 94-3026
Provider #: 19-7317
Issue: Was the Intermediary's adjustment to Worksheet A-8-3 proper?

1999D66

Wed, 16 Aug 2006 11:09:00 EST

Decision #: 1999D66
Case #: 98-0211GE
Provider #: Various
Issue: Did the Intermediary properly determine that the Providers had less than 100 "beds" for the fiscal years in question?

1999D67

Wed, 16 Aug 2006 11:19:00 EST

Decision #: 1999D67
Case #: 96-0869
Provider #: 19-0207
Issue: 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

Wed, 16 Aug 2006 11:33:00 EST

Decision #: 1999D68
Case #: 98-2042; 98-2046
Provider #: 33-7005; 33-7002
Issue: 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

Wed, 16 Aug 2006 13:18:00 EST

Decision #: 1999D69
Case #: 97-0503
Provider #: 21-5282
Issue: 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

Wed, 16 Aug 2006 13:45:00 EST

Decision #: 1999D71
Case #: 96-1086
Provider #: 44-0182
Issue: 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

Wed, 16 Aug 2006 13:49:00 EST

Decision #: 1999D72
Case #: 97-2381
Provider #: 26-7140
Issue: 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

Thu, 17 Aug 2006 14:29:00 EST

Decision #: 1998D001
Case #: 92-1498
Provider #: 14-0179
Issue: 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

Thu, 17 Aug 2006 14:46:00 EST

Decision #: 1998D002
Case #: 91-1163E; 92-0895
Provider #: 24-0036
Issue: 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

Thu, 17 Aug 2006 14:51:00 EST

Decision #: 1998D003
Case #: 91-0133
Provider #: 03-4001
Issue: 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

Thu, 17 Aug 2006 14:57:00 EST

Decision #: 1998D004
Case #: 91-1441
Provider #: 06-0015
Issue: Was the Intermediary's adjustment reclassifying air ambulance lease rental payments from capital costs to operating expenses proper?

1998D005

Fri, 18 Aug 2006 13:28:00 EST

Decision #: 1998D005
Case #: 96-2054
Provider #: 45-7789
Issue: Was the Intermediary's adjustment shifting nursing and home health aide costs to a privite duty nursing cost center proper?

1998D006

Fri, 18 Aug 2006 13:33:00 EST

Decision #: 1998D006
Case #: 93-0228
Provider #: 24-0053
Issue: Did the Intermediary properly disallow the physician's Part A compensation?

1998D007

Fri, 18 Aug 2006 13:43:00 EST

Decision #: 1998D007
Case #: 94-3386
Provider #: 33-7243
Issue: Was the Intermediary's adjustment reversing the direct assignment of the New York sub-unit costs proper?

1998D008

Fri, 18 Aug 2006 13:48:00 EST

Decision #: 1998D008
Case #: 91-2866M
Provider #: 33-0214
Issue: Were the Intermediary's adjustments to the graduate medical education ("GME") base year costs proper?

1998D013

Mon, 21 Aug 2006 14:43:00 EST

Decision #: 1998D013
Case #: 96-2058
Provider #: 10-5883
Issue: Is the Provider exempt from the skilled nursing facility ("SNF") routine cost limits as a "new provider"?

1998D014

Mon, 21 Aug 2006 14:48:00 EST

Decision #: 1998D014
Case #: 92-0430
Provider #: 10-5201
Issue: Was the Health Care Financing Administration's (HCFA) denial of the Provider's exception request proper?

1998D016

Tue, 22 Aug 2006 16:43:00 EST

Decision #: 1998D016
Case #: 85-1109
Provider #: 39-0079
Issue: Were the Intermediary's adjustments to the Provider's interest expense to account for the hospital's 1983 advance refunding of debt proper?

1998D017

Tue, 22 Aug 2006 16:49:00 EST

Decision #: 1998D017
Case #: 89-0303
Provider #: 39-0079
Issue: Were the Intermediary's adjustments to the Provider's interest expense to account for the hospital's 1983 advance refunding of debt proper?

1998D018

Tue, 22 Aug 2006 16:52:00 EST

Decision #: 1998D018
Case #: 93-1769
Provider #: 05-5632
Issue: 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

Fri, 25 Aug 2006 00:00:00 EST

Decision #: 1999D70
Case #: 92-0110G
Provider #: Various
Issue: 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

Mon, 28 Aug 2006 00:00:00 EST

Decision #: 1999D50
Case #: 95-0523; 96-0510
Provider #: 52-7143
Issue: Were the Intermediary's adjustments to reclassify certain costs and visits from skilled nursing to either other visits or private duty visits proper?

1998D019

Mon, 28 Aug 2006 13:53:00 EST

Decision #: 1998D019
Case #: 91-2800M
Provider #: 05-0239
Issue: 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

Mon, 28 Aug 2006 14:02:00 EST

Decision #: 1998D020
Case #: 91-2842M
Provider #: 05-0103
Issue: 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

Tue, 29 Aug 2006 10:15:00 EST

Decision #: 1998D011
Case #: 95-0380
Provider #: 52-6514
Issue: Was the Intermediary's modification of cost reporting form 2088-79 for the calculation of reimbursable cost proper?

1998D021

Tue, 29 Aug 2006 10:22:00 EST

Decision #: 1998D021
Case #: 89-2023
Provider #: 05-0179
Issue: Was the Intermediary's adjustment to the amortization of the loss on the sale of Turlock Community Hospital proper?

1998D015

Tue, 29 Aug 2006 14:54:00 EST

Decision #: 1998D015
Case #: 91-2414M
Provider #: 24-0053
Issue: 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

Wed, 30 Aug 2006 13:02:00 EST

Decision #: 1998D022
Case #: 93-1156
Provider #: 38-0018
Issue: Was the Provider's request to reopen the calculation of the disproportionate share adjustment to exclude employee self-insured days proper?

1998D023

Wed, 30 Aug 2006 13:07:00 EST

Decision #: 1998D023
Case #: 95-1661
Provider #: 06-6549
Issue: Does the Provider Reimbursement Review Board have jurisdiction over Provider extension locations that are not surveyed for purposes of certification?

1998D024

Thu, 31 Aug 2006 15:12:00 EST

Decision #: 1998D024
Case #: 92-0662
Provider #: 47-4001
Issue: 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

Thu, 31 Aug 2006 15:19:00 EST

Decision #: 1998D025
Case #: 95-0308
Provider #: 05-0235
Issue: Was the Intermediary';s denial of the Provider';s Routine Cost Limit exception proper?

1998D009

Sat, 02 Sep 2006 00:00:00 EST

Decision #: 1998D009
Case #: 92-1679
Provider #: 39-0142
Issue: Was the Intermediary';s application of the 1984 Reasonable Compensation Equivalent (RCE) limits proper?

1998D010

Sat, 02 Sep 2006 00:00:00 EST

Decision #: 1998D010
Case #: 93-1749
Provider #: 10-6639
Issue: Was the Provider entitled to the lower of cost or charges (LCC) carryforward which was generated under the prior ownership?

1998D012

Sat, 02 Sep 2006 00:00:00 EST

Decision #: 1998D012
Case #: 86-0429
Provider #: 05-0289
Issue: Was the Intermediary';s denial of the full TEFRA incentive payment to the Provider proper?

1998D026

Wed, 06 Sep 2006 10:49:00 EST

Decision #: 1998D026
Case #: 91-2673M
Provider #: 39-0028
Issue: 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

Mon, 23 Oct 2006 15:17:00 EST

Decision #: 2006D41
Case #: 00-3942
Provider #: 14-7589
Issue: 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

Tue, 24 Oct 2006 10:29:00 EST

Decision #: 2006D42
Case #: 00-3347
Provider #: 34-6538
Issue: 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

Tue, 24 Oct 2006 11:02:00 EST

Decision #: 2006D43
Case #: 04-0025
Provider #: 17-0032
Issue: Whether the Provider was improperly denied a Medicare low-volume adjustment.

2006D44

Mon, 30 Oct 2006 10:49:00 EST

Decision #: 2006D44
Case #: 04-0643
Provider #: 01-0092
Issue: 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

Mon, 30 Oct 2006 10:53:00 EST

Decision #: 2006D45
Case #: 02-0224
Provider #: 39-0256
Issue: 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

Tue, 31 Oct 2006 14:43:00 EST

Decision #: 2006D46
Case #: 03-0940
Provider #: 33-0078
Issue: Whether the Intermediary properly calculated the Provider's indirect medical education (IME) reimbursement for its fiscal year ending December 31, 1999.

2006D47

Tue, 31 Oct 2006 14:46:00 EST

Decision #: 2006D47
Case #: 03-1587; 03-1592
Provider #: 14-0119
Issue: 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

Wed, 01 Nov 2006 16:40:00 EST

Decision #: 2006D48
Case #: 98-2103; 99-1746; 00-2563; 03-0127; 03-0484; 03-1471; 03-1472
Provider #: 09-0007
Issue: Whether the Intermediary properly adjusted the Provider's available beds for the purpose of determining the amount of its indirect medical education payment.

2006D49

Wed, 01 Nov 2006 16:45:00 EST

Decision #: 2006D49
Case #: 96-2013G
Provider #: 07-5234; 07-5210
Issue: Whether the Intermediary's adjustments to disallow rental expense as a cost incurred with a related organization were proper.

2006D50

Mon, 06 Nov 2006 11:05:00 EST

Decision #: 2006D50
Case #: 01-1326G
Provider #: 07-5234; 07-5210; 07-5198
Issue: Whether the Intermediary's adjustments to disallow rental expense as a cost incurred with a related organization were proper.

2006D51

Mon, 06 Nov 2006 11:10:00 EST

Decision #: 2006D51
Case #: 02-1212
Provider #: 52-0087
Issue: 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

Thu, 09 Nov 2006 11:08:00 EST

Decision #: 2006D52
Case #: 04-0565
Provider #: 50-1304
Issue: 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

Thu, 09 Nov 2006 11:12:00 EST

Decision #: 2006D53
Case #: 96-0480
Provider #: 26-0104
Issue: 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

Tue, 14 Nov 2006 14:49:00 EST

Decision #: 2006D54
Case #: 02-1420
Provider #: 10-0122
Issue: 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

Tue, 14 Nov 2006 14:52:00 EST

Decision #: 2006D55
Case #: 98-0580; 98-0463
Provider #: 14-5314
Issue: 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

Mon, 04 Dec 2006 11:35:00 EST

Decision #: 2006D56
Case #: 04-0660
Provider #: 05-0444
Issue: 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

Mon, 04 Dec 2006 11:40:00 EST

Decision #: 2006D57
Case #: 05-0051
Provider #: 51-5028
Issue: 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

Mon, 04 Dec 2006 11:44:00 EST

Decision #: 2006D58
Case #: 03/0895
Provider #: 34-0168
Issue: Whether the Intermediary's disallowance of Medicare bad debts claimed by the Provider was justified.

2007D01

Thu, 07 Dec 2006 10:54:00 EST

Decision #: 2007D01
Case #: 97-0174
Provider #: 16-0024
Issue: Was the Intermediary's disallowance of the loss on disposal of assets resulting from a merger proper?

2007D02

Thu, 07 Dec 2006 10:58:00 EST

Decision #: 2007D02
Case #: 03-0482G
Provider #: 31-0108; 31-0039; 31-0005
Issue: 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

Thu, 07 Dec 2006 10:59:00 EST

Decision #: 2007D03
Case #: 04-0372
Provider #: 33-7089
Issue: 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

Thu, 07 Dec 2006 11:02:00 EST

Decision #: 2007D04
Case #: 99-1159; 01-2664; 02-0866
Provider #: 20-0024
Issue: Whether the Intermediary's denial of the Provider's request for an adjustment to its TEFRA target amount was proper.

2000D22

Thu, 07 Jun 2007 11:07:00 EST

Decision #: 2000D22
Case #: 96-1930; 97-1708; 98-2034
Provider #: 34-0061
Issue: 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

Thu, 07 Jun 2007 11:14:00 EST

Decision #: 2000D23
Case #: 96-1736
Provider #: 31-0062
Issue: 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

Thu, 07 Jun 2007 11:25:00 EST

Decision #: 2000D24
Case #: 94-0302G; 94-0304G
Provider #: Various
Issue: Were the Intermediary's adjustments to the Providers' home office cost statementsproper?

2000D25

Thu, 07 Jun 2007 11:29:00 EST

Decision #: 2000D25
Case #: 95-0326
Provider #: 50-0057
Issue: Were HCFA's determinations of the Provider's ESRD exception requests proper?

2000D26

Thu, 07 Jun 2007 11:37:00 EST

Decision #: 2000D26
Case #: 95-1566
Provider #: 31-0075
Issue: Was the Intermediary's failure to apply updated reasonable compensation equivalents limits proper?

2000D27

Fri, 08 Jun 2007 13:21:00 EST

Decision #: 2000D27
Case #: 96-0036
Provider #: 36-0085
Issue: Was the Intermediary's adjustment to the outlier payments proper?

2000D28

Fri, 08 Jun 2007 13:31:00 EST

Decision #: 2000D28
Case #: 91-2846M
Provider #: 33-0354
Issue: 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

Fri, 08 Jun 2007 13:35:00 EST

Decision #: 2000D29
Case #: 91-2887
Provider #: 14-0087
Issue: Was the Intermediary's netting of the balance due to Edgewater Hospital of liabilities owed to the program by Edgewater Medical Center proper?

2000D30

Fri, 08 Jun 2007 13:41:00 EST

Decision #: 2000D30
Case #: 95-0459
Provider #: 05-0684
Issue: Was the Intermediary's elimination of square footage statistics for the fourth floor storage area correct?

2000D31

Fri, 08 Jun 2007 13:56:00 EST

Decision #: 2000D31
Case #: 96-2587
Provider #: 34-7021
Issue: Was the Intermediary's adjustment disallowing the Provider's employee recruitment expense proper?

2000D32

Fri, 08 Jun 2007 14:00:00 EST

Decision #: 2000D32
Case #: 98-0448
Provider #: 24-0053
Issue: Was the Intermediary's disallowance of the physician Part A compensation due to inadequate physician time studies proper?

2000D33

Fri, 08 Jun 2007 14:06:00 EST

Decision #: 2000D33
Case #: 97-2391
Provider #: 33-0158
Issue: Were the Intermediary's adjustments to the reasonable compensation equivalent ("";RCE"";) limits proper?

2000D34

Mon, 11 Jun 2007 13:44:00 EST

Decision #: 2000D34
Case #: 97-2064
Provider #: 43-0077
Issue: Was the Intermediary's classification of School of Nursing Joint Education Program cost proper?

2000D35

Mon, 11 Jun 2007 13:48:00 EST

Decision #: 2000D35
Case #: 97-2148
Provider #: 43-0077
Issue: 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?

2000D36

Mon, 11 Jun 2007 13:53:00 EST

Decision #: 2000D36
Case #: 97-0795
Provider #: 01-7009
Issue: Was the Intermediary's adjustment calculation proper to bring the expenses of Healthstar, Inc., a related party, to the cost of ownership?

2000D37

Mon, 11 Jun 2007 13:58:00 EST

Decision #: 2000D37
Case #: 95-2401; 95-2402; 95-2403
Provider #: 39-0029
Issue: 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?

2000D38

Mon, 11 Jun 2007 14:05:00 EST

Decision #: 2000D38
Case #: 98-0273
Provider #: 45-6689
Issue: Was the Intermediary's adjustment to the accrued salaries proper?

2000D39

Mon, 11 Jun 2007 14:10:00 EST

Decision #: 2000D39
Case #: 91-2592M; 94-0951; 94-0952; 94-0953; 94-1386
Provider #: 49-0063
Issue: 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?

2000D40

Mon, 11 Jun 2007 14:23:00 EST

Decision #: 2000D40
Case #: 95-0535
Provider #: 52-0098
Issue: Was HCFA's denial of the Provider's request for an exception rate for self-dialysis training using an accelerated method proper?

2000D41

Mon, 11 Jun 2007 14:27:00 EST

Decision #: 2000D41
Case #: 96-2423
Provider #: 33-0048
Issue: 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?

2000D42

Tue, 12 Jun 2007 15:38:00 EST

Decision #: 2000D42
Case #: 95-0577
Provider #: 39-0049
Issue: Was HCFA's denial of the Provider's request for an exception to the renal dialysis composite rate based on atypical service intensity proper?

2000D43

Tue, 12 Jun 2007 15:45:00 EST

Decision #: 2000D43
Case #: 96-0527
Provider #: 01-0068
Issue: Was the Intermediary's adjustment disallowing portions of compensation paid to physicians based on the application of the 1984 reasonable compensation equivalents ("";RCE"";) proper?

2000D44

Tue, 12 Jun 2007 15:51:00 EST

Decision #: 2000D44
Case #: 94-0616
Provider #: 14-0087
Issue: Was the Intermediary's calculation of the Provider's disproportionate share ajustment ("";DSH"";) proper?

2000D45

Tue, 12 Jun 2007 15:58:00 EST

Decision #: 2000D45
Case #: 94-0614
Provider #: 14-0087
Issue: Was the Intermediary's calculation of the Provider's disproportionate share ("";DSH"";) adjustment proper?

2000D46

Tue, 12 Jun 2007 16:03:00 EST

Decision #: 2000D46
Case #: 97-2385
Provider #: 36-6007
Issue: 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)?

2000D47

Tue, 12 Jun 2007 16:07:00 EST

Decision #: 2000D47
Case #: 96-0644
Provider #: 24-0063
Issue: Was the Intermediary's adjustment to disallow the Minnesota Care Tax proper?

2000D48

Tue, 12 Jun 2007 16:11:00 EST

Decision #: 2000D48
Case #: 96-0861
Provider #: 24-2004
Issue: Was the Intermediary's adjustment to disallow the Minnesota Care Tax proper?

2000D50

Tue, 12 Jun 2007 16:14:00 EST

Decision #: 2000D50
Case #: 96-0918
Provider #: 51-0001
Issue: Was the Intermediary's adjustment reclassifying the depreciable assets as "";new""; capital proper?

2000D49

Tue, 12 Jun 2007 16:23:00 EST

Decision #: 2000D49
Case #: 96-0804
Provider #: 24-0003
Issue: Was the Intermediary's adjustment to disallow the Minnesota Care Tax proper?

2000D52

Wed, 13 Jun 2007 16:35:00 EST

Decision #: 2000D52
Case #: 96-2570
Provider #: 16-0059
Issue: Was the Intermediary's adjustment disallowing the Provider's loss on the sale of its assets proper?

2000D53

Wed, 13 Jun 2007 16:40:00 EST

Decision #: 2000D53
Case #: 88-0649
Provider #: 22-3026; 22-5190
Issue: 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

Wed, 13 Jun 2007 16:46:00 EST

Decision #: 2000D54
Case #: 96-2623
Provider #: 05-0559
Issue: 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

Thu, 21 Jun 2007 11:14:00 EST

Decision #: 2000D51
Case #: 95-2202
Provider #: 33-0399
Issue: Was the Intermediary's adjustment reducing the allowable cost to charge retio that should be applied to outpatient charges proper?

2000D55

Fri, 22 Jun 2007 11:10:00 EST

Decision #: 2000D55
Case #: 97-1810
Provider #: 10-7123
Issue: Was the Intermediary's adjustment to the Provider's visit statistic proper?

2000D56

Fri, 22 Jun 2007 11:15:00 EST

Decision #: 2000D56
Case #: 96-1215
Provider #: 44-0072
Issue: 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

Fri, 22 Jun 2007 11:24:00 EST

Decision #: 2000D58
Case #: 96-2027; 97-2271
Provider #: 53-0002
Issue: 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

Fri, 22 Jun 2007 11:29:00 EST

Decision #: 2000D57
Case #: 96-0939
Provider #: 05-0267
Issue: 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

Fri, 22 Jun 2007 11:55:00 EST

Decision #: 2000D59
Case #: 96-2619
Provider #: 03-5104
Issue: Was the Intermediary's adjustment disallowing indigent Part B bad debts proper?

2007D35

Mon, 25 Jun 2007 11:32:00 EST

Decision #: 2007D35
Case #: 95-0795; 97-1098; 00-3556G; 01-2892G; 01-2936G; 01-2937G; 02-1810G; 03-1423G
Provider #: Various
Issue: 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

Mon, 25 Jun 2007 11:39:00 EST

Decision #: 2007D36
Case #: 98-2095
Provider #: 33-7019
Issue: 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

Mon, 25 Jun 2007 11:43:00 EST

Decision #: 2007D37
Case #: 00-0774
Provider #: 53-7025
Issue: 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

Mon, 25 Jun 2007 13:07:00 EST

Decision #: 2007D38
Case #: 00-01032; 01-2147
Provider #: 24-5610
Issue: Whether the denial of the Provider's request for a new provider exemption from the skilled nursing facility routine cost limits was proper.

2007D39

Mon, 25 Jun 2007 13:13:00 EST

Decision #: 2007D39
Case #: 04-0644
Provider #: 23-0230
Issue: 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

Mon, 25 Jun 2007 13:18:00 EST

Decision #: 2007D40
Case #: 04-2269
Provider #: 05-0150
Issue: 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

Mon, 25 Jun 2007 13:25:00 EST

Decision #: 2000D60
Case #: 95-0079; 95-2394; 96-0287
Provider #: 26-7002
Issue: 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

Mon, 25 Jun 2007 13:33:00 EST

Decision #: 2000D61
Case #: 96-2534
Provider #: 23-0132
Issue: Was the denial of the TEFRA exception request proper?

2000D63

Mon, 25 Jun 2007 13:41:00 EST

Decision #: 2000D63
Case #: 97-0643; 98-0770; 99-3555; 99-0613
Provider #: 55-7253
Issue: 1. Was the Intermediary's adjustment to Physical Therapy costs proper?; 2. Was the Intermediary's adjustment to owner's compensation proper?

2000D64

Mon, 25 Jun 2007 13:46:00 EST

Decision #: 2000D64
Case #: 96-0847
Provider #: 24-0106
Issue: Was the Intermediary's adjustment offsetting the Provider-paid surcharge (tax) to the Minnesota Medicaid Program proper?

2000D65

Mon, 25 Jun 2007 13:58:00 EST

Decision #: 2000D65
Case #: 91-2887R
Provider #: 14-0087
Issue: Was the Intermediary's netting of the balance due to Edgewater Hospital of liabilities owed to the program by Edgewater Medical Center proper?

2000D66

Tue, 26 Jun 2007 15:32:00 EST

Decision #: 2000D66
Case #: 92-0209; 94-2362; 98-0428; 99-0130; 99-0131
Provider #: 01-0068
Issue: Was the Intermediary's adjustment disallowing portions of compensation paid to physicians based on the application of the 1984 reasonable compensation equivalents proper?

2000D67

Tue, 26 Jun 2007 15:39:00 EST

Decision #: 2000D67
Case #: 94-0654
Provider #: 45-0358
Issue: Was the Intermediary's adjustment reclassifying costs related to equipment which was part of a aupply purchase agreement proper?

2000D68

Tue, 26 Jun 2007 16:05:00 EST

Decision #: 2000D68
Case #: 99-0286
Provider #: 31-7062
Issue: 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

Tue, 26 Jun 2007 16:14:00 EST

Decision #: 2000D69
Case #: 90-1357
Provider #: 05-0076
Issue: 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

Tue, 26 Jun 2007 16:18:00 EST

Decision #: 2000D70
Case #: 97-0407
Provider #: 36-0125; 36-6048
Issue: 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

Wed, 27 Jun 2007 13:01:00 EST

Decision #: 2000D62
Case #: 92-0668R
Provider #: 34-0113
Issue: Did the Intermediary properly reopen the Provider's cost report and recoup an overpayment made to the Provider?

2000D71

Wed, 27 Jun 2007 13:07:00 EST

Decision #: 2000D71
Case #: 95-1279; 95-1280
Provider #: 13-0037
Issue: Were the Intermediary's adjustments disallowing costs associated with the Certified Nurse Anesthetist proper?

2000D72

Wed, 27 Jun 2007 13:22:00 EST

Decision #: 2000D72
Case #: 93-1920; 94-0007
Provider #: 05-0226
Issue: 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

Wed, 27 Jun 2007 13:29:00 EST

Decision #: 2000D73
Case #: 94-1477; 94-1520
Provider #: 45-0023
Issue: Were the Intermediary's initial, amended and reopening adjustments to interest expense and bond related cost proper?

2000D74

Wed, 27 Jun 2007 14:28:00 EST

Decision #: 2000D74
Case #: 88-1494G; 88-1495G; 88-1496G
Provider #: Various
Issue: 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

Wed, 27 Jun 2007 14:35:00 EST

Decision #: 2000D75
Case #: 93-0073G; 92-1509G; 93-0888G
Provider #: Various
Issue: 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?

2000D76

Thu, 28 Jun 2007 15:25:00 EST

Decision #: 2000D76
Case #: 98-0455
Provider #: 26-7281
Issue: 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

Thu, 28 Jun 2007 15:36:00 EST

Decision #: 2000D77
Case #: 97-2085
Provider #: 05-7470
Issue: Was the Intermediary's disallowance of interest expense proper?

2000D78

Thu, 28 Jun 2007 15:40:00 EST

Decision #: 2000D78
Case #: 98-2068G
Provider #: 05-7470; 55-7643; 55-7625
Issue: Was the Intermediary's disallowance of interst expense proper?

2000D79

Thu, 28 Jun 2007 15:44:00 EST

Decision #: 2000D79
Case #: 98-1396G
Provider #: Various
Issue: Was the Intermediary's adjustment to worker's compensation expense proper?

2000D80

Thu, 28 Jun 2007 15:48:00 EST

Decision #: 2000D80
Case #: 96-0184G
Provider #: Various
Issue: 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

Thu, 28 Jun 2007 15:53:00 EST

Decision #: 2000D81
Case #: 96-2281G
Provider #: Various
Issue: 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?

2000D82

Fri, 06 Jul 2007 13:36:00 EST

Decision #: 2000D82
Case #: 96-2052
Provider #: 52-5504
Issue: Was the Intermediary's recalculation of the Provider's gross-up method proper?

2000D83

Fri, 06 Jul 2007 13:40:00 EST

Decision #: 2000D83
Case #: Various
Provider #: Various
Issue: Was the Intermediary's inclusion of maintenance treatments in the Provider's cost aportionment statistics for Medicare reimbursement proper?

2000D84

Fri, 06 Jul 2007 13:45:00 EST

Decision #: 2000D84
Case #: 95-0711
Provider #: 52-0094
Issue: 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

Fri, 06 Jul 2007 13:53:00 EST

Decision #: 2000D85
Case #: 96-2085
Provider #: 05-0090
Issue: Was the Intermediary's calculation of the Skilled Nursing Facility (SNF) Routine Cost Limits (RCL) proper?

2000D86

Fri, 06 Jul 2007 13:59:00 EST

Decision #: 2000D86
Case #: 97-2707
Provider #: 45-0717
Issue: 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

Mon, 09 Jul 2007 16:01:00 EST

Decision #: 2000D87
Case #: 95-0634
Provider #: 05-0017
Issue: Was HCFA's denial of the Provider's routine cost limit (RCL) exception request proper?

2000D88

Mon, 09 Jul 2007 16:06:00 EST

Decision #: 2000D88
Case #: 99-3515G
Provider #: Various
Issue: 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

Mon, 09 Jul 2007 16:11:00 EST

Decision #: 2000D89
Case #: 97-2390
Provider #: 52-0109
Issue: Were the Intermediary's adjustments offsetting investment income related to the sale of HMO stock proper?

2000D90

Mon, 09 Jul 2007 16:16:00 EST

Decision #: 2000D90
Case #: 97-2601
Provider #: 20-0016
Issue: Was the Intermediary's denial of the Provider's request for a sole community hospital decreased volume adjustment proper?

2007D41

Thu, 12 Jul 2007 15:06:00 EST

Decision #: 2007D41
Case #: 04-0805
Provider #: 05-4135
Issue: 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

Thu, 12 Jul 2007 15:10:00 EST

Decision #: 2007D42
Case #: 00-1882G
Provider #: Various
Issue: 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

Thu, 12 Jul 2007 15:13:00 EST

Decision #: 2007D43
Case #: 98-1942
Provider #: 44-0048
Issue: 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

Thu, 12 Jul 2007 15:16:00 EST

Decision #: 2007D44
Case #: 01-2519
Provider #: 45-0039
Issue: 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

Thu, 12 Jul 2007 15:20:00 EST

Decision #: 2007D45
Case #: 02-0162
Provider #: 10-5990
Issue: 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.

2007D46

Tue, 31 Jul 2007 13:22:00 EST

Decision #: 2007D46
Case #: 97-1239; 97-1240
Provider #: 21-5279; 21-5280
Issue: 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.

2007D47

Tue, 31 Jul 2007 13:30:00 EST

Decision #: 2007D47
Case #: 05-0658
Provider #: 45-7789
Issue: 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.

2007D48

Tue, 31 Jul 2007 13:36:00 EST

Decision #: 2007D48
Case #: 05-0310
Provider #: 23-2029
Issue: 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).

2007D49

Tue, 31 Jul 2007 13:42:00 EST

Decision #: 2007D49
Case #: 01-1010
Provider #: 38-0033
Issue: 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.

2007D50

Tue, 31 Jul 2007 14:00:00 EST

Decision #: 2007D50
Case #: 00-1757; 00-1859; 01-0958; 03-0180; 04-0110
Provider #: 44-0049
Issue: Whether the Intermediary's adjustment to the Provider's per resident amount (PRA) was proper.

2007D51

Fri, 24 Aug 2007 15:59:00 EST

Decision #: 2007D51
Case #: 01-0883
Provider #: 20-0018
Issue: 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

Fri, 24 Aug 2007 16:08:00 EST

Decision #: 2007D52
Case #: 02-0530G
Provider #: Various
Issue: 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

Fri, 24 Aug 2007 16:12:00 EST

Decision #: 2007D53
Case #: 00-1081
Provider #: 08-0003
Issue: Whether the Intermediary's application of the reasonable compensation equivalent (RCE) limits was proper.

2007D54

Fri, 24 Aug 2007 16:15:00 EST

Decision #: 2007D54
Case #: 00-1411
Provider #: 39-0128
Issue: 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

Fri, 24 Aug 2007 16:18:00 EST

Decision #: 2007D55
Case #: 02-1565; 03-0517; 04-0338
Provider #: 23-0070
Issue: 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

Fri, 24 Aug 2007 16:38:00 EST

Decision #: 2007D56
Case #: 04-0823
Provider #: 35-0070
Issue: Whether the Provider is entitled to Transitional Outpatient Payments (TOPs).

2007D57

Fri, 24 Aug 2007 16:42:00 EST

Decision #: 2007D57
Case #: 00-2326
Provider #: 14-0088
Issue: 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

Fri, 24 Aug 2007 16:45:00 EST

Decision #: 2007D58
Case #: 03/0759
Provider #: 22-0089
Issue: Whether the Provider's Notice of Program Reimbursement (NPR) dated September 24, 2002 was an original or a revised NPR.

2007D60

Fri, 07 Sep 2007 11:32:00 EST

Decision #: 2007D60
Case #: 04-1341; 04-1369
Provider #: 65-0001
Issue: Whether the Intermediary's adjustment disallowing the Provider's claimed withholding tax expense was proper.

2007D59

Fri, 07 Sep 2007 11:36:00 EST

Decision #: 2007D59
Case #: 05-1792
Provider #: 05-0260
Issue: 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.

2007D61

Fri, 07 Sep 2007 13:14:00 EST

Decision #: 2007D61
Case #: 96-1582
Provider #: 33-0059
Issue: 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.

2007D62

Fri, 07 Sep 2007 13:21:00 EST

Decision #: 2007D62
Case #: 96-2468
Provider #: 05-0279
Issue: Whether the Intermediary's determination of non-allowable physician office and vacant space costs was proper.

2007D63

Fri, 07 Sep 2007 13:26:00 EST

Decision #: 2007D63
Case #: 03-0721; 04-0473
Provider #: 23-0059
Issue: 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?

2007D64

Fri, 07 Sep 2007 13:33:00 EST

Decision #: 2007D64
Case #: 04-0831; 04-0833
Provider #: 08-5034
Issue: 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.

2007D65

Fri, 07 Sep 2007 13:39:00 EST

Decision #: 2007D65
Case #: 03-0132
Provider #: 44-0048
Issue: 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.

2007D66

Fri, 07 Sep 2007 13:43:00 EST

Decision #: 2007D66
Case #: 01-3169; 03-1194
Provider #: 23-5472; 23-0121
Issue: 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.

2009D25

Thu, 25 Jun 2009 09:43:00 EST

Decision #: 2009D25
Case #: 00-3473G
Provider #: Various
Issue: 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.

2009D22

Tue, 30 Jun 2009 15:19:00 EST

Decision #: 2009D22
Case #: 99-1340
Provider #: 39-0028
Issue: 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

Tue, 30 Jun 2009 15:30:00 EST

Decision #: 2009D23
Case #: 99-0584R (on Remand)
Provider #: 39-0080
Issue: Whether the Jeanes Hospital merger was a bona fide sale.

2009D24

Tue, 30 Jun 2009 15:34:00 EST

Decision #: 2009D24
Case #: 99-2786
Provider #: 22-0118
Issue: Whether the Intermediary's disallowance of the Provider's claim for a loss in connection with its October 1, 1996 statutory merger was proper.

2009D26

Mon, 13 Jul 2009 13:51:00 EST

Decision #: 2009D26
Case #: Various
Provider #: Various
Issue: 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.

2009D27

Mon, 13 Jul 2009 13:56:00 EST

Decision #: 2009D27
Case #: 05-1370
Provider #: 52-0051
Issue: 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).

2009D28

Mon, 03 Aug 2009 16:44:00 EST

Decision #: 2009D28
Case #: 04-0597G; 05-0663G; 06-0682G; 03-0282G; 04-0598G
Provider #: Various
Issue: Whether paid lunch period time should be added to hours used to calculate the Providers' hourly wage rates.

2009D29

Mon, 03 Aug 2009 16:49:00 EST

Decision #: 2009D29
Case #: 98-0892
Provider #: 17-0122
Issue: 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.

2009D30

Mon, 03 Aug 2009 16:52:00 EST

Decision #: 2009D30
Case #: 04-2128G
Provider #: Various
Issue: 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.

2009D31

Mon, 03 Aug 2009 16:55:00 EST

Decision #: 2009D31
Case #: 05-2010
Provider #: 45-0299
Issue: 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.

2009D32

Mon, 03 Aug 2009 16:59:00 EST

Decision #: 2009D32
Case #: 05-1133; 06-0127
Provider #: 05-0234
Issue: 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.

2009D33

Mon, 03 Aug 2009 17:03:00 EST

Decision #: 2009D33
Case #: 06-0814
Provider #: 45-0296
Issue: 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.

2008D26

Thu, 06 Aug 2009 14:04:00 EST

Decision #: 2008D26
Case #: 02-0326; 03-0730; 04-1130
Provider #: 05-0327
Issue: 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.

2008D27

Thu, 06 Aug 2009 14:05:00 EST

Decision #: 2008D27
Case #: 05-1219
Provider #: 17-1302
Issue: Was the Intermediary's adjustment to the provider's claimed owner's compensation proper?

2008D28

Thu, 06 Aug 2009 14:05:00 EST

Decision #: 2008D28
Case #: 02-0463
Provider #: 03-7205
Issue: 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.

2008D29

Thu, 06 Aug 2009 14:06:00 EST

Decision #: 2008D29
Case #: 05-0133G; 05-243G
Provider #: Various
Issue: 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.

2008D30

Thu, 06 Aug 2009 14:06:00 EST

Decision #: 2008D30
Case #: 02-0050; 02-0615
Provider #: 14-4036
Issue: 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)

2008D31

Fri, 14 Aug 2009 15:08:00 EST

Decision #: 2008D31
Case #: 02-0705
Provider #: 05-0241
Issue: 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.

2008D33

Fri, 14 Aug 2009 15:09:00 EST

Decision #: 2008D33
Case #: 98-0019; 02-0785
Provider #: 22-5682
Issue: 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.

2008D32

Fri, 14 Aug 2009 15:09:00 EST

Decision #: 2008D32
Case #: 03-0778; 04-0914
Provider #: 23-0216
Issue: 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)

2007D70

Fri, 14 Aug 2009 15:10:00 EST

Decision #: 2007D70
Case #: 00-3349
Provider #: 34-6538
Issue: 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)

2008D38

Fri, 14 Aug 2009 15:11:00 EST

Decision #: 2008D38
Case #: 00-1454
Provider #: 39-0067
Issue: Whether the Intermediary's adjustments disallowing the loss on disposal of depreciable assets through consolidation were proper.

2008D37

Fri, 14 Aug 2009 15:11:00 EST

Decision #: 2008D37
Case #: 04-1083; 04-1091; 04-1093; 04-1950
Provider #: 22-0033
Issue: 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.

2008D39

Fri, 14 Aug 2009 15:11:00 EST

Decision #: 2008D39
Case #: 00-1456
Provider #: 39-0098
Issue: Whether the Intermediary's adjustments disallowing the loss on disposal of depreciable assets through consolidation were proper.

2008D40

Fri, 14 Aug 2009 15:12:00 EST

Decision #: 2008D40
Case #: 06-0987
Provider #: 27-1328
Issue: Whether the Intermediary's adjustment to Certified Registered Nurse Anesthetist (CRNA) cost was proper.

2008D41

Mon, 17 Aug 2009 14:20:00 EST

Decision #: 2008D41
Case #: 06-0614
Provider #: 23-0097
Issue: Whether the Intermediary correctly limited the Provider's ambulance reimbursement to its charges.

2008D42

Mon, 17 Aug 2009 14:21:00 EST

Decision #: 2008D42
Case #: 04-0393G
Provider #: 23-0412; 23-0270; 23-0176
Issue: 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.

2008D43

Mon, 17 Aug 2009 14:21:00 EST

Decision #: 2008D43
Case #: 04-1792; 05-2073; 05-2074; 05-2154; 06-0010; 06-0300
Provider #: 37-0078
Issue: Whether the Intermediary properly adjusted the Provider's indirect medical education full-time equivalent (FTE) cap?

2008D45

Mon, 17 Aug 2009 14:22:00 EST

Decision #: 2008D45
Case #: 05-1891; 05-1887; 04-1831; 05-0731; 06-1938
Provider #: 14-0228
Issue: 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.

2008D44

Mon, 17 Aug 2009 14:22:00 EST

Decision #: 2008D44
Case #: 03-1643
Provider #: 37-0190
Issue: Whether the Intermediary properly treated the Provider as an acute care prospective payment system (PPS) facility instead of an excluded cancer hospital.

2008D06

Mon, 17 Aug 2009 14:23:00 EST

Decision #: 2008D06
Case #: 99-3140
Provider #: 05-0369
Issue: 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

Mon, 17 Aug 2009 14:23:00 EST

Decision #: 2007D77
Case #: 00-3356
Provider #: 44-6530
Issue: 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)

2007D78

Mon, 17 Aug 2009 14:24:00 EST

Decision #: 2007D78
Case #: 02-0328; 03-0383; 04-0283; 05-1327
Provider #: 05-0396
Issue: 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

Tue, 18 Aug 2009 14:28:00 EST

Decision #: 2008D01
Case #: 05-0686
Provider #: 15-0011
Issue: Whether the recission of the hospital's approved request for Sole Community Hospital (SCH) status was proper.

2008D02

Tue, 18 Aug 2009 14:29:00 EST

Decision #: 2008D02
Case #: 01-1674G
Provider #: Various
Issue: 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.

2008D08

Tue, 18 Aug 2009 14:29:00 EST

Decision #: 2008D08
Case #: 04-1796
Provider #: 22-0070
Issue: 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.

2008D03

Tue, 18 Aug 2009 14:29:00 EST

Decision #: 2008D03
Case #: 01-2270; 02-1573; 03-1015
Provider #: 10-0032
Issue: 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.

2008D07

Tue, 18 Aug 2009 14:30:00 EST

Decision #: 2008D07
Case #: 03-1056
Provider #: 52-0051
Issue: 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.

2008D05

Tue, 18 Aug 2009 14:30:00 EST

Decision #: 2008D05
Case #: 06-1478
Provider #: 31-5381
Issue: Whether the Intermediary properly adjusted Medicare bad debts.

2007D76

Thu, 20 Aug 2009 11:21:00 EST

Decision #: 2007D76
Case #: 00-3355
Provider #: 42-6548
Issue: 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)

2008D04

Wed, 26 Aug 2009 10:41:00 EST

Decision #: 2008D04
Case #: 04-1796
Provider #: 22-0070
Issue: 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.

2008D10

Wed, 26 Aug 2009 10:42:00 EST

Decision #: 2008D10
Case #: 02-0363
Provider #: 31-0001
Issue: Whether the Intermediary's adjustments to the Provider's direct graduate medical education and indirect medical education full-time equivalent counts were proper.

2008D09

Wed, 26 Aug 2009 10:42:00 EST

Decision #: 2008D09
Case #: 03-0811
Provider #: 04-0091
Issue: Whether the Provider's Disproportionate Share Hospital (DSH) adjustment was correctly calculated.

2008D11

Wed, 26 Aug 2009 10:42:00 EST

Decision #: 2008D11
Case #: 03-1549
Provider #: 31-0001
Issue: 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.

2008D35

Wed, 26 Aug 2009 10:43:00 EST

Decision #: 2008D35
Case #: 05-2054
Provider #: 36-0112
Issue: 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.

2008D12

Wed, 26 Aug 2009 10:43:00 EST

Decision #: 2008D12
Case #: 04-1491; 04-1495; 04-1496
Provider #: 18-0080
Issue: Whether the Intermediary properly adjusted Medicare bad debts accounts considered indigent by the Provider.

2008D36

Wed, 26 Aug 2009 10:44:00 EST

Decision #: 2008D36
Case #: 99-3519M
Provider #: 05-0625
Issue: 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.

2008D34

Wed, 26 Aug 2009 10:44:00 EST

Decision #: 2008D34
Case #: 02-1010; 02-0892; 02-1663; 02-2148; 30-0597; 03-1011; 04-0021; 04-0022
Provider #: 23-0053
Issue: 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.

2009D01

Wed, 26 Aug 2009 10:45:00 EST

Decision #: 2009D01
Case #: 96-1627G
Provider #: 39-0001
Issue: 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.

2009D02

Fri, 28 Aug 2009 09:58:00 EST

Decision #: 2009D02
Case #: 04-0596G
Provider #: Various
Issue: 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.

2009D03

Fri, 28 Aug 2009 09:59:00 EST

Decision #: 2009D03
Case #: 04-2130G
Provider #: 50-0024
Issue: 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

Fri, 28 Aug 2009 09:59:00 EST

Decision #: 2009D04
Case #: 04-1915
Provider #: 03-0023
Issue: Whether the Intermediary properly calculated and applied the Provider's ambulance cost per trip limit.

2009D06

Fri, 28 Aug 2009 10:00:00 EST

Decision #: 2009D06
Case #: 04-1790G
Provider #: 03-0002; 03-0065; 03-0018
Issue: 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

Fri, 28 Aug 2009 10:00:00 EST

Decision #: 2009D05
Case #: 06-1300; 06-1301; 06-1307
Provider #: 03-0103
Issue: Whether the Intermediary used proper cost to charge ratios in calculating the Provider's outlier payments.

2009D09

Fri, 28 Aug 2009 10:01:00 EST

Decision #: 2009D09
Case #: 07-1153
Provider #: 27-1325
Issue: Whether the Intermediary's disallowance of the Provider's certified registered nurse anesthetist (CRNA) on-call costs was proper.

2009D08

Fri, 28 Aug 2009 10:01:00 EST

Decision #: 2009D08
Case #: 98-3176G
Provider #: 05-0008; 05-0058; 05-0132; 05-0152; 05-0655
Issue: 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

Fri, 28 Aug 2009 10:01:00 EST

Decision #: 2009D07
Case #: 05-1420G
Provider #: Various
Issue: Whether the Intermediary's adjustment to utilization review costs was proper.

2007D05

Tue, 08 Sep 2009 16:05:00 EST

Decision #: 2007D05
Case #: 02-1833G
Provider #: Various
Issue: 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.

2007D06

Tue, 08 Sep 2009 16:06:00 EST

Decision #: 2007D06
Case #: 04-0575
Provider #: 17-0086
Issue: 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.

2007D07

Tue, 08 Sep 2009 16:06:00 EST

Decision #: 2007D07
Case #: 01-1443; 01-1444
Provider #: 45-0011
Issue: 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.

2007D08

Tue, 08 Sep 2009 16:07:00 EST

Decision #: 2007D08
Case #: 05-0448
Provider #: 25-0085
Issue: 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.

2007D10

Tue, 08 Sep 2009 16:07:00 EST

Decision #: 2007D10
Case #: 04-0209
Provider #: 13-0029
Issue: 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

Tue, 08 Sep 2009 16:07:00 EST

Decision #: 2007D09
Case #: 01-3592G; 02-2153G; 03-0960G
Provider #: Various
Issue: 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.

2007D12

Tue, 08 Sep 2009 16:08:00 EST

Decision #: 2007D12
Case #: 03-1464
Provider #: 05-0308
Issue: 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.

2009D10

Thu, 10 Sep 2009 11:09:00 EST

Decision #: 2009D10
Case #: 07-1969G
Provider #: 19-5350; 11-5612; 15-5473; 11-5535
Issue: 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.

2009D12

Thu, 10 Sep 2009 11:10:00 EST

Decision #: 2009D12
Case #: 08-2907G
Provider #: Various
Issue: 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

Thu, 10 Sep 2009 11:10:00 EST

Decision #: 2009D11
Case #: 05-1360G; 05-1362G; 05-1363G; 05-1527G
Provider #: Various
Issue: 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"";.

2009D13

Thu, 10 Sep 2009 11:11:00 EST

Decision #: 2009D13
Case #: 02-0488; 03-1001
Provider #: 05-4144
Issue: Whether the Intermediary's determination of the Provider's direct graduate medical education (DGME) payment was proper.

2005D33

Mon, 28 Sep 2009 15:30:00 EST

Decision #: 2005D33
Case #: 03-0055
Provider #: 05-8034
Issue: Was the Intermediary's adjustment to start-up costs proper?

2009D34

Mon, 28 Sep 2009 15:32:00 EST

Decision #: 2009D34
Case #: 99-1786; 99-2499; 00-2047; 01-1820
Provider #: 22-0042; 22-5699
Issue: 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).

2009D35

Mon, 28 Sep 2009 15:38:00 EST

Decision #: 2009D35
Case #: 04-2261G
Provider #: Various
Issue: 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).

2009D36

Mon, 28 Sep 2009 15:42:00 EST

Decision #: 2009D36
Case #: 06-1080G; 06-1081G
Provider #: Various
Issue: Whether the Intermediary"";s adjustments to the Provider's reimbursable capital cost after denying "";new hospital""; status was proper.

2009D38

Mon, 28 Sep 2009 15:49:00 EST

Decision #: 2009D38
Case #: 06-0316G; 06-0317G; 06-0318G; 06-0319G
Provider #: Various
Issue: 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.

2009D37

Tue, 29 Sep 2009 09:47:00 EST

Decision #: 2009D37
Case #: 98-3491
Provider #: 39-0160; 39-5580
Issue: 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.

2007D11

Wed, 30 Sep 2009 14:05:00 EST

Decision #: 2007D11
Case #: 97-2446
Provider #: 05-0597
Issue: Whether the Intermediary's determination of reimbursable Medicare bad debts for beneficiaries without Medicaid eligibility (non-crossover beneficiaries) was proper.

2007D13

Fri, 09 Oct 2009 15:01:00 EST

Decision #: 2007D13
Case #: 97-2986
Provider #: 14-0119
Issue: 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?

2007D67

Fri, 09 Oct 2009 15:03:00 EST

Decision #: 2007D67
Case #: 03-0522G
Provider #: Various
Issue: 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).

2007D14

Fri, 09 Oct 2009 15:05:00 EST

Decision #: 2007D14
Case #: 00-3662G; 00-3663G; 00-3664G; 02-0983G; 04-0180G; 04-0443G
Provider #: Various
Issue: 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.

2007D15

Fri, 09 Oct 2009 15:05:00 EST

Decision #: 2007D15
Case #: 00-1836
Provider #: 21-7134
Issue: Whether the Intermediary's adjustment to disallow the cost of accrued compensatory time was proper.

2007D17

Fri, 09 Oct 2009 15:06:00 EST

Decision #: 2007D17
Case #: 97-2936
Provider #: 05-0279
Issue: 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

Fri, 09 Oct 2009 15:06:00 EST

Decision #: 2007D16
Case #: 03-0818
Provider #: 05-0578
Issue: Whether the Intermediary properly increased the number of available beds used to determine the Provider's indirect medical education (IME) payment.

2007D18

Fri, 09 Oct 2009 15:07:00 EST

Decision #: 2007D18
Case #: 02-2080
Provider #: 45-0688
Issue: Whether the Intermediary's determination of allowable Medicare bad debts based upon collection effort was proper.

2007D20

Wed, 14 Oct 2009 14:23:00 EST

Decision #: 2007D20
Case #: 03-0573
Provider #: 36-0141
Issue: 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

Wed, 14 Oct 2009 14:23:00 EST

Decision #: 2007D19
Case #: 99-3470; 99-3471
Provider #: 39-0037; 39-0036
Issue: 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.

2007D21

Wed, 14 Oct 2009 14:24:00 EST

Decision #: 2007D21
Case #: 03-0268; 03-0269
Provider #: 05-0045
Issue: Whether the Intermediary's adjustments disallowing the Provider's regular Medicare bad debts were proper.

2007D23

Wed, 14 Oct 2009 14:24:00 EST

Decision #: 2007D23
Case #: 01-2214
Provider #: 22-0060
Issue: 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

Wed, 14 Oct 2009 14:24:00 EST

Decision #: 2007D22
Case #: 01-0654; 02-0235
Provider #: 01-7009
Issue: Whether the relevant claims were timely filed by Alacare under 42 C.F.R. Section 424.44.

1998D027

Wed, 14 Oct 2009 14:25:00 EST

Decision #: 1998D027
Case #: 95-1188
Provider #: 05-0235
Issue: Was the Intermediary's denial of the Provider's Routine Cost Limit exception proper?

2007D24

Wed, 14 Oct 2009 14:25:00 EST

Decision #: 2007D24
Case #: 03-1199G
Provider #: Various
Issue: Whether the Intermediary should include all MediKan patient days, primary and secondary, in the Providers' disproportionate share hospital (DSH) calculation.

1998D028

Wed, 14 Oct 2009 14:26:00 EST

Decision #: 1998D028
Case #: 87-0480E
Provider #: 33-0085
Issue: Was the Intermediary's denial of the Provider's request for rural referral center status for the fiscal year ended December 3, 1986 proper?

1998D029

Wed, 14 Oct 2009 14:26:00 EST

Decision #: 1998D029
Case #: 89-1782
Provider #: 33-0041
Issue: Were the Intermediary's adjustments reclassifying the lease rental costs reported as capital costs proper?

1998D032

Thu, 15 Oct 2009 11:33:00 EST

Decision #: 1998D032
Case #: 95-0495
Provider #: 39-0181
Issue: Was the Intermediary's adjustment disallowing the Provider's claimed loss on disposal proper?

1998D030

Thu, 15 Oct 2009 11:33:00 EST

Decision #: 1998D030
Case #: 90-2029
Provider #: 05-0388
Issue: Was the Intermediary's adjustment disallowing the costs associated with the repossessed equipment proper?

1998D031

Thu, 15 Oct 2009 11:33:00 EST

Decision #: 1998D031
Case #: 91-2986M
Provider #: 33-0153
Issue: Were the Intermediary's adjustments made foe graduate medical education (GME) settlement purposes proper?

1998D034

Thu, 15 Oct 2009 11:34:00 EST

Decision #: 1998D034
Case #: 97-1914
Provider #: 11-6670
Issue: 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?

1998D033

Thu, 15 Oct 2009 11:34:00 EST

Decision #: 1998D033
Case #: 95-2125
Provider #: 53-7025
Issue: Did the Intermediary properly disallow a portion of the owner's compensation?

1998D035

Thu, 15 Oct 2009 11:34:00 EST

Decision #: 1998D035
Case #: 93-2004
Provider #: 10-0114
Issue: 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?

1998D037

Thu, 15 Oct 2009 11:35:00 EST

Decision #: 1998D037
Case #: 93-0145
Provider #: 52-0091
Issue: Was the Intermediary's denial of sole community status under 42 C.F.R. Section 412.92 proper?

1998D036

Thu, 15 Oct 2009 11:35:00 EST

Decision #: 1998D036
Case #: 93-0337
Provider #: 05-0034
Issue: Was the Provider's request for an adjustment to the TEFRA target amount for the 1989 fiscal year filed on a timely basis?

1998D039

Thu, 15 Oct 2009 11:36:00 EST

Decision #: 1998D039
Case #: 97-0111G; 97-0112G
Provider #: Various
Issue: Were the Intermediary's adjustments to occupational therapy and speech therapy costs proper?

1998D038

Thu, 15 Oct 2009 11:36:00 EST

Decision #: 1998D038
Case #: 95-2447
Provider #: 17-7215
Issue: 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?

1998D040

Thu, 15 Oct 2009 11:36:00 EST

Decision #: 1998D040
Case #: 96-2419
Provider #: 52-5569
Issue: 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

Thu, 15 Oct 2009 11:37:00 EST

Decision #: 1998D042
Case #: 93-0048
Provider #: 05-0102
Issue: Was the Intermediary's adjustment disallowing Medicare bad debts proper?

1998D041

Fri, 16 Oct 2009 14:15:00 EST

Decision #: 1998D041
Case #: 93-0590
Provider #: 36-0062
Issue: Was the Intermediary's adjustment offsetting employee benefits proper?

1998D043

Fri, 16 Oct 2009 14:15:00 EST

Decision #: 1998D043
Case #: 92-0033
Provider #: 50-0044
Issue: Was the Intermediary's denial of the Provider's request for an adjustment to its TEFRA target rate for its rehabilitation unit proper?

1998D045

Fri, 16 Oct 2009 14:16:00 EST

Decision #: 1998D045
Case #: 92-0507
Provider #: 05-0457
Issue: Did the Intermediary properly adjust outpatient surgery, anesthesia and supply charges?

1998D044

Fri, 16 Oct 2009 14:16:00 EST

Decision #: 1998D044
Case #: 96-0320
Provider #: 14-7273
Issue: Was the Intermediary's adjustment reducing allowable owner's compensation correct?

1998D048

Fri, 16 Oct 2009 14:17:00 EST

Decision #: 1998D048
Case #: 97-0050G
Provider #: Various
Issue: Did the Intermediary properly adjust the Provider's occupational and speech therapy costs?

1998D047

Fri, 16 Oct 2009 14:17:00 EST

Decision #: 1998D047
Case #: 96-2128
Provider #: 39-0023
Issue: 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?

1998D046

Fri, 16 Oct 2009 14:17:00 EST

Decision #: 1998D046
Case #: 92-1582
Provider #: 39-6563
Issue: Was the Intermediary's adjustment to the Provider's reasonable costs proper?

1998D049

Fri, 16 Oct 2009 14:18:00 EST

Decision #: 1998D049
Case #: 91-2824M
Provider #: 14-0180
Issue: 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

Fri, 16 Oct 2009 14:24:00 EST

Decision #: 1998D050
Case #: 94-2093G; 94-2094G; 94-2095G; 96-1323G; 96-1325G
Provider #: Various
Issue: 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?

1998D051

Mon, 19 Oct 2009 14:41:00 EST

Decision #: 1998D051
Case #: 95-2407G
Provider #: Various
Issue: 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?

1998D054

Mon, 19 Oct 2009 14:42:00 EST

Decision #: 1998D054
Case #: 91-1799
Provider #: 41-0005
Issue: 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?

1998D052

Mon, 19 Oct 2009 14:42:00 EST

Decision #: 1998D052
Case #: 92-1562
Provider #: 45-0068
Issue: 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?

1998D053

Mon, 19 Oct 2009 14:42:00 EST

Decision #: 1998D053
Case #: 96-0229
Provider #: 45-7663
Issue: 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?

1998D055

Mon, 19 Oct 2009 14:43:00 EST

Decision #: 1998D055
Case #: 93-0846
Provider #: 36-5746
Issue: Was the Intermediary's adjustment of the nursing cost proper?

2007D68

Mon, 19 Oct 2009 14:46:00 EST

Decision #: 2007D68
Case #: 99-2630; 00-3142;01-1808; 02-1095; 03-1383; 01-2158
Provider #: 24-0063; 24-0210
Issue: 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

Mon, 19 Oct 2009 14:47:00 EST

Decision #: 2007D71
Case #: 00-3350
Provider #: 34-6538
Issue: 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

Mon, 19 Oct 2009 14:47:00 EST

Decision #: 2007D69
Case #: 00-3348
Provider #: 34-6538
Issue: 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)

2007D73

Mon, 19 Oct 2009 14:48:00 EST

Decision #: 2007D73
Case #: 00-3352
Provider #: 42-6548
Issue: 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)

2007D72

Mon, 19 Oct 2009 14:48:00 EST

Decision #: 2007D72
Case #: 00-3351
Provider #: 34-6538
Issue: 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)

2007D75

Mon, 19 Oct 2009 14:48:00 EST

Decision #: 2007D75
Case #: 00-3353
Provider #: 42-6548
Issue: 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?

2008D17

Mon, 19 Oct 2009 14:49:00 EST

Decision #: 2008D17
Case #: 04-0088G
Provider #: Various
Issue: 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.

2008D13

Mon, 19 Oct 2009 14:49:00 EST

Decision #: 2008D13
Case #: 00-1904G
Provider #: Various
Issue: Whether the Intermediary's calculation of the disproportionate share hospital (DSH) payment was proper.

2008D14

Mon, 19 Oct 2009 14:50:00 EST

Decision #: 2008D14
Case #: 01-0215
Provider #: 39-5526
Issue: 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?

2008D16

Mon, 19 Oct 2009 14:50:00 EST

Decision #: 2008D16
Case #: 89-1584
Provider #: 45-0101
Issue: 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.

2008D19

Tue, 20 Oct 2009 12:53:00 EST

Decision #: 2008D19
Case #: 04-1995G
Provider #: 35-0002; 35-0015
Issue: 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.

2007D74

Tue, 20 Oct 2009 12:54:00 EST

Decision #: 2007D74
Case #: 00-3354
Provider #: 42-6548
Issue: 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)

2009D14

Tue, 20 Oct 2009 12:54:00 EST

Decision #: 2009D14
Case #: 04-1293
Provider #: 08-5029
Issue: 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.

2009D17

Tue, 20 Oct 2009 12:55:00 EST

Decision #: 2009D17
Case #: 09-0764G; 09-1053GC
Provider #: Various
Issue: 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?

2009D15

Tue, 20 Oct 2009 12:55:00 EST

Decision #: 2009D15
Case #: 92-1212; 92-1522
Provider #: 45-0196
Issue: 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.

2009D16

Tue, 20 Oct 2009 12:55:00 EST

Decision #: 2009D16
Case #: 05-1296G; 05-1315G; 05-2197G; 06-1668G
Provider #: 07-0010; 07-0022; 07-0018
Issue: 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.

1998D059

Tue, 20 Oct 2009 12:57:00 EST

Decision #: 1998D059
Case #: 93-1280
Provider #: 40-0098
Issue: 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

Tue, 20 Oct 2009 12:57:00 EST

Decision #: 1998D057
Case #: 94-1800C
Provider #: 29-0021
Issue: 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?

1998D060

Tue, 20 Oct 2009 12:58:00 EST

Decision #: 1998D060
Case #: 89-1568
Provider #: 37-0094
Issue: Was the Intermediary's offset of investment income earned on the Provider's funded depreciation account against interest expense proper?

1998D061

Tue, 20 Oct 2009 12:58:00 EST

Decision #: 1998D061
Case #: 91-2894M; 92-1709; 94-1277; 94-1278; 94-1702; 94-2063
Provider #: 36-0152
Issue: 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?

1998D063

Wed, 21 Oct 2009 11:00:00 EST

Decision #: 1998D063
Case #: 96-0535
Provider #: 18-0127
Issue: Were the Intermediary's adjustments to Medicare bad debts proper?

1998D062

Wed, 21 Oct 2009 11:00:00 EST

Decision #: 1998D062
Case #: 94-3278
Provider #: 23-0132
Issue: Was the denial of the TEFRA exception request proper?

2009D20

Wed, 21 Oct 2009 11:02:00 EST

Decision #: 2009D20
Case #: 04-1997G
Provider #: Various
Issue: 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.

2009D18

Wed, 21 Oct 2009 11:02:00 EST

Decision #: 2009D18
Case #: 09-0801 thru 09-0810; 09-0815; 09-0816
Provider #: 05-0126
Issue: 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

Wed, 21 Oct 2009 11:02:00 EST

Decision #: 2009D19
Case #: 05-1873; 05-1879; 05-1880; 05-1881
Provider #: 24-0036
Issue: 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

Wed, 21 Oct 2009 11:03:00 EST

Decision #: 2009D21
Case #: 09-0380GC
Provider #: Various
Issue: 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

Wed, 21 Oct 2009 11:04:00 EST

Decision #: 1998D058
Case #: 85-0058
Provider #: 33-0136
Issue: 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

Wed, 21 Oct 2009 11:04:00 EST

Decision #: 1998D064
Case #: 96-0340
Provider #: 36-5946
Issue: Was HCFA's denial of the Provider's request for an exemption fron the routine cost limit ("";RCL"";) as a new provider proper?

1998D065

Wed, 21 Oct 2009 11:04:00 EST

Decision #: 1998D065
Case #: 96-1352; 96-1353
Provider #: 14-7472
Issue: Were the Intermediary's adjustments to disallow legal fees deemed not related to patient care proper?

1998D066

Wed, 21 Oct 2009 11:05:00 EST

Decision #: 1998D066
Case #: 94-0070
Provider #: 36-0054
Issue: Does the Provider meet the criteria for receiving disproportionate share payments based on application of undisputed facts?

1998D068

Wed, 21 Oct 2009 11:05:00 EST

Decision #: 1998D068
Case #: 92-1805; 93-0196; 94-0366; 95-0672; 96-0750; 97-0104
Provider #: 14-7407
Issue: 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?

1998D067

Wed, 21 Oct 2009 11:05:00 EST

Decision #: 1998D067
Case #: 94-1389E; 94-1390E; 94-1525E
Provider #: 39-4001
Issue: Did the Intermediary err in reopening the Provider's cost reports to calculate Graduate Medical Education reimbursement?

1998D069

Fri, 23 Oct 2009 10:48:00 EST

Decision #: 1998D069
Case #: 90-0989
Provider #: 41-0001
Issue: Was the Health Care Financing Administration's ( 'HCFA' ) denial of the Provider's request for reconsideration of the TEFRA exception request proper?

1998D056

Fri, 23 Oct 2009 10:48:00 EST

Decision #: 1998D056
Case #: 93-0509
Provider #: 05-0381
Issue: Was the Intermediary's refusal to reopen the Provider's cost reports an abuse of discretion?

1998D071

Fri, 23 Oct 2009 10:49:00 EST

Decision #: 1998D071
Case #: 95-2007
Provider #: 05-0457
Issue: Was the Intermediary's refusal to reopen the Provider's cost report an abuse of discretion?

1998D070

Fri, 23 Oct 2009 10:49:00 EST

Decision #: 1998D070
Case #: 94-1740
Provider #: 05-0183
Issue: 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?

1998D072

Fri, 23 Oct 2009 10:49:00 EST

Decision #: 1998D072
Case #: 90-1070
Provider #: 04-0062
Issue: 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

Fri, 23 Oct 2009 10:50:00 EST

Decision #: 1998D073
Case #: 91-2671M
Provider #: 23-0032
Issue: 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

Fri, 23 Oct 2009 10:50:00 EST

Decision #: 1998D074
Case #: 93-0513
Provider #: 11-0198
Issue: Was the Intermediary's elimination of space rental costs proper?

1998D076

Fri, 23 Oct 2009 10:51:00 EST

Decision #: 1998D076
Case #: 94-0353
Provider #: 23-0032
Issue: Was the Intermediary's denial of the Provider's request to revise the 1985 base year average per resisent amount proper?

1998D079

Fri, 23 Oct 2009 10:51:00 EST

Decision #: 1998D079
Case #: 95-0436
Provider #: 05-0183
Issue: 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?

1998D077

Fri, 23 Oct 2009 10:51:00 EST

Decision #: 1998D077
Case #: 94-2804
Provider #: 45-0137
Issue: 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?

1998D080

Fri, 23 Oct 2009 10:52:00 EST

Decision #: 1998D080
Case #: 93-0054
Provider #: 15-4033
Issue: 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?

1998D075

Mon, 26 Oct 2009 11:13:00 EST

Decision #: 1998D075
Case #: 88-1339
Provider #: 10-0060
Issue: Did the Intermediary correctly apply the lower of cost or charge limit?

1998D078

Mon, 26 Oct 2009 11:13:00 EST

Decision #: 1998D078
Case #: 91-1509
Provider #: 05-0040
Issue: 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

Mon, 26 Oct 2009 11:14:00 EST

Decision #: 1998D081
Case #: 92-2398
Provider #: 42-T078
Issue: Was HCFA's denial of the Provider's request for an adjustment to its TEFRA target rate for certain costs proper?

1998D082

Mon, 26 Oct 2009 11:14:00 EST

Decision #: 1998D082
Case #: 94-2577
Provider #: 17-0086
Issue: Was the Intermediary's reopening of the Medicare cost report to reduce reimbursement for indirect medical education ("";IME"";) expense proper?

1998D085

Mon, 26 Oct 2009 11:15:00 EST

Decision #: 1998D085
Case #: 96-0378
Provider #: 05-0281; 55-5294
Issue: Should the Provider's Medicaid patient days in its "";subacute unit""; be included in calculating the disproportionate share hospital ("";DSH"";) adjustment?

1998D084

Mon, 26 Oct 2009 11:15:00 EST

Decision #: 1998D084
Case #: 96-0066G
Provider #: Various
Issue: Was the Intermediary's inclusion of neonatal intensive care unit ("";NICU"";) beds in the indirect medical education ("";IME"";) calculation proper?

1998D083

Mon, 26 Oct 2009 11:15:00 EST

Decision #: 1998D083
Case #: 92-1569
Provider #: 05-0191
Issue: Was the Provider's request for an adjustment to the TEFRA limits for the fiscal year ended June 30, 1989 timely?

2007D25

Mon, 26 Oct 2009 11:16:00 EST

Decision #: 2007D25
Case #: 06-0110G; 06-0111G
Provider #: 67-7270: 37-7097
Issue: 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

Thu, 29 Oct 2009 14:07:00 EST

Decision #: 2009D39
Case #: 04-1799G
Provider #: Various
Issue: 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

Thu, 29 Oct 2009 14:12:00 EST

Decision #: 2009D40
Case #: 05-1291; 05-1292; 05-1293
Provider #: 10-4504; 10-4561; 10-4560
Issue: Whether the Intermediary's adjustments reflected in the revised Notices of Program Reimbursement (NPR), that reduced allowable home office costs, were proper.

2009D41

Thu, 29 Oct 2009 14:17:00 EST

Decision #: 2009D41
Case #: 05-0350; 06-0452
Provider #: 33-0004
Issue: 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

Thu, 29 Oct 2009 14:20:00 EST

Decision #: 2009D42
Case #: Various
Provider #: 26-2011; 26-2010
Issue: 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

Thu, 29 Oct 2009 14:24:00 EST

Decision #: 2010D01
Case #: 01-2484
Provider #: 06-0024
Issue: 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

Thu, 29 Oct 2009 14:28:00 EST

Decision #: 2010D02
Case #: 06-1078G; 06-1079G
Provider #: Various
Issue: Whether the Intermediary's adjustments to the Provider's reimbursable capital costs after denying "";new hospital""; status was proper.

2010D03

Thu, 29 Oct 2009 14:32:00 EST

Decision #: 2010D03
Case #: 07-0793G
Provider #: Various
Issue: 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

Mon, 02 Nov 2009 14:24:00 EST

Decision #: 2007D26
Case #: 04-1774
Provider #: 42-0023
Issue: 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.

2007D29

Mon, 02 Nov 2009 14:25:00 EST

Decision #: 2007D29
Case #: 02-0361G
Provider #: Various
Issue: 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.

2007D28

Mon, 02 Nov 2009 14:25:00 EST

Decision #: 2007D28
Case #: 03-0513; 04-0456
Provider #: 44-0070
Issue: 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.

2007D27

Mon, 02 Nov 2009 14:25:00 EST

Decision #: 2007D27
Case #: 04-0552
Provider #: 24-0001
Issue: 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.

2007D32

Mon, 02 Nov 2009 14:26:00 EST

Decision #: 2007D32
Case #: 00-2803
Provider #: 52-0174
Issue: Whether the Intermediary's determining disallow post-retirement health benefits costs for a terminated provider was proper.

2007D31

Mon, 02 Nov 2009 14:26:00 EST

Decision #: 2007D31
Case #: 01-3521G
Provider #: 31-0015; 31-0051
Issue: Whether the cost report instructions improperly apply the indirect medical education (IME) full-time equivalent (FTE) cap to discharges prior to October 1, 1997.

2007D30

Mon, 02 Nov 2009 14:26:00 EST

Decision #: 2007D30
Case #: 99-2858
Provider #: 17-0122
Issue: 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

2007D33

Mon, 02 Nov 2009 14:27:00 EST

Decision #: 2007D33
Case #: 04-2009
Provider #: 45-1320
Issue: 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

Mon, 02 Nov 2009 14:28:00 EST

Decision #: 2007D34
Case #: 06-0456
Provider #: 05-0222
Issue: 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.

1998D087

Tue, 03 Nov 2009 11:08:00 EST

Decision #: 1998D087
Case #: 97-0682G
Provider #: Various
Issue: Were the Intermediary's adjustments to occupational and speech therapy costs proper?

1998D086

Tue, 03 Nov 2009 11:08:00 EST

Decision #: 1998D086
Case #: 94-3045
Provider #: 33-2546
Issue: Was the Intermediary's denial of the Provider's request for an exception to its End-Stage Renal Disease ("";ESRD"";) composite rate proper?

1998D088

Tue, 03 Nov 2009 11:09:00 EST

Decision #: 1998D088
Case #: 90-1201;91-1310
Provider #: 45-0021
Issue: 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

Tue, 03 Nov 2009 11:09:00 EST

Decision #: 1998D089
Case #: 91-2907M
Provider #: 39-0196
Issue: 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?:

1998D092

Tue, 03 Nov 2009 11:10:00 EST

Decision #: 1998D092
Case #: 95-0303
Provider #: 05-4078
Issue: Was the Intermediary's adjustment to the property tax expense proper?

1998D091

Tue, 03 Nov 2009 11:10:00 EST

Decision #: 1998D091
Case #: 95-1921
Provider #: 05-0468
Issue: Should the Provider's Medicaid patient days in its "";subacute unit""; be included in calculating disproportionate share hospital ("";DSH"";) adjustment?

1998D090

Tue, 03 Nov 2009 11:10:00 EST

Decision #: 1998D090
Case #: 92-0948
Provider #: 50-0064
Issue: 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?

1998D093

Tue, 03 Nov 2009 11:11:00 EST

Decision #: 1998D093
Case #: 92-0591
Provider #: 16-0083
Issue: Was the Intermediary's allowcation of the Provider's physician billing costs proper?