Medicare Cost Report Appeals and Reopenings

HRS has extensive experience with appeals processing and utilizes both in-house and top industry counsel to properly represent our clients at a peak level. Initial Hearing Requests before the Provider Reimbursement Review Board require experience and precision to perfect an appeal regarding a provider’s dissatisfaction with a Medicare contractor’s final determination or the direction of the Centers for Medicare & Medicaid Services (CMS). With the appeal in place, HRS may file both Preliminary Providers Position and Final Providers Position briefings while also attempting to gain an Administrative Resolution through mediated proceedings with PRRB officials. Should these administrative filings and negotiations not bring the desired result, HRS resources include retaining specialized healthcare counsel to initiate legal proceedings in federal court.

The strength of the Medicare Appeal process begins with an understanding of the notice and comment opportunities presented through the rulemaking process to a comprehensive understanding of regulatory Final Rules. With this breadth of knowledge, authoritative appeals perfect our clients claim to reimbursements conforming to complicated statutory formulas.

HRS currently offers dispute resolution services on the following Cost Report Categories:

DSH Uncompensated Care Pool Allocation

    DSH Factor 3
    DSH Factors 1 & 2

DSH Supplemental Security Income (SSI) Ratio

    SSI Errors (Baystate)
    Medicare Part C (Medicare and Medicaid Fractions)
    Dual Eligible (Medicare and Medicaid Fractions)

Crossover Bad Debts

    Unbilled Crossover Bad Debts

Two Midnight Rule

HRS also files reopening requests when necessary, and provides guidance and audit support when interacting with the MAC.