OAA Decisions

Under Section 1878 of the Social Security Act and the regulations at 42 CFR 405.1875, the Administrator of the Centers for Medicare & Medicaid Services has the authority to review decisions rendered by the Provider Reimbursement Review Board and to issue final Agency decisions for the Secretary of the Department of Health and Human Services. If you need a copy of a decision that is not listed on this site, please contact the Office of the Attorney Advisor. Please note that, because of 508 compliance needs, these decisions are not copies of the actual signed Administrator decisions. Copies of the actual signed decisions may be obtained from the Office of the Attorney Advisor.

Decision Number	Case Name	Issue
Decision Number 2003-D01	Case Name Skaggs Community Health Center vs. Mutual of Omaha Insurance Company	Issue Whether 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 were proper.
Decision Number 2003-D02	Case Name Central Texas Medical Center vs. Blue Cross/Blue Shield Association/Trailblazer Health Enterprises, LLC	Issue Whether the Intermediary's determination that the Provider had less than 100 “beds” for DSH eligibility purposes was proper.
Decision Number 2003-D03	Case Name Kaleida Health 97 Ownership of Assets Group vs. Blue Cross and Blue Shield Association/Empire Medicare Services	Issue Whether the Intermediary's adjustments to the Providers' cost reports for FYE 12/31/97 to eliminate the Providers' claimed losses on disposition of assets were proper.
Decision Number 2003-D04	Case Name Maple Crest Care Center vs. Mutual of Omaha Insurance Company	Issue Whether the PRRB has jurisdiction over costs unclaimed on the cost report and a request to reclassify costs for which no audit adjustment was made by the Intermediary.
Decision Number 2003-D05	Case Name Always Better Care Home Health Providers vs. v. Blue Cross and Blue Shield Association/United Government Services, LLC-CA	Issue Whether the Intermediary's adjustment of start-up costs was proper.
Decision Number 2003-D06	Case Name Cardinal Cushing Hospital/Goddard Memorial Hospital vs. Blue Cross/Blue Shield Association/Associated Hospital Services of Maine	Issue Whether there was recognizable loss upon the transfer of assets to Good Samaritan Medical Center from Goddard Memorial Hospital and Cardinal Cushing Hospital that occurred in connection with the consolidation of the two hospitals and the resulting creatio...
Decision Number 2003-D07	Case Name Westview Manor vs. Mutual of Omaha Insurance Company	Issue Whether the Intermediary's adjustment disallowing the allocation of general service costs to the ancillary cost centers was proper.
Decision Number 2003-D08	Case Name Blue Ridge Rehabilitation Center vs. Mutual of Omaha Insurance Company	Issue Whether the Intermediary's adjustment disallowing the allocation of general service costs to the ancillary cost centers was proper.
Decision Number 2003-D09	Case Name Smoky Hill Rehabilitation Center vs. Mutual of Omaha Insurance Company	Issue Whether the Intermediary's adjustment disallowing the allocation of general service costs to the ancillary cost centers was proper.
Decision Number 2003-D10	Case Name Christ the King Manor vs. Blue Cross and Blue Shield Association/Veritus Medicare Svcs.	Issue Whether the Intermediary's reclassification of the Staff Development Coordinator salaries was proper.
Decision Number 2003-D11	Case Name SNI Home Care, Inc. vs. Blue Cross and Blue Shield Association/Cahaba Government Benefit Administrators	Issue Whether the Intermediary's application of the Salary Equivalency Guidelines (Guidelines) to the Provider's physical therapy costs was proper.
Decision Number 2003-D12	Case Name Susquehanna Regional Home Health Services vs. Blue Cross and Blue Shield Association/Cahaba Government Benefit Administrators	Issue Whether the Intermediary's adjustment to rent paid by the Provider to a related party was proper.
Decision Number 2003-D14	Case Name Ingham Regional Medical Center vs. United Government Services, LLC-WI	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.
Decision Number 2003-D15	Case Name Long Island State Veterans Home vs. Blue Cross and Blue Shield Association/Empire Medicare Services	Issue Whether it was 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
Decision Number 2003-D16	Case Name BBL 95-99 Observation Bed Days Group vs. Blue Cross Blue Shield Association/Premera Blue Cross/Riverbend Government Benefits Administrator/Trailblazer Health Enterprises	Issue Whether the Intermediaries' determination that the Providers had less than 100 beds for disproportionate share (DSH) eligibility purposes was proper.
Decision Number 2003-D17	Case Name Natividad Medical Center vs. Blue Cross Blue Shield Association/United Government Services	Issue Whether the Intermediary's adjustment to the residents count and Graduate Medical Education payments was proper.
Decision Number 2003-D18	Case Name Spalding Rehabilitation Hospital vs. Mutual of Omaha Insurance Company	Issue Whether the Intermediary incorrectly determined 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.
Decision Number 2003-D19	Case Name Devon Gables Health Care Center vs. Blue Cross and Blue Shield Association/Blue Cross and Blue Shield of Arizona	Issue Whether the Intermediary properly calculated the Provider's bad debts.
Decision Number 2003-D20	Case Name Meriter Hospital vs. Blue Cross and Blue Shield Association/United Government Services, LLC	Issue Whether the Intermediary's determination of the TEFRA exception request was proper.
Decision Number 2003-D21	Case Name AllCare Home Health vs. Cahaba Government Benefit Administrators	Issue Whether the Intermediary's adjustment to owner's compensation was proper.
Decision Number 2003-D23	Case Name Edinburg Hospital vs. Blue Cross /Blue Shield Association Trailblazer Health Enterprises, LLC	Issue Whether the Intermediary’s determination that the Provider had less than 100 “beds” for DSH eligibility purposes was proper.
Decision Number 2003-D24	Case Name Pleasant Care Corporation- California vs. Mutual of Omaha Insurance Company	Issue Whether the Intermediary's adjustment to deny the allocation of social service costs based on departmental gross chargesw as proper.
Decision Number 2003-D25	Case Name Southwestern Nursing Home & Rehabilitation Center vs. Blue Cross Blue Shield Association/Veritus Medicare Services	Issue 1. Whether the Intermediary's reclassification of Staff Development/Quality Assurance Coordinator salaries was proper. 2. Whether the Intermediary's adjustment allocating social service costs was proper.
Decision Number 2003-D26	Case Name LAC & USC Medical Center vs. BlueCross BlueShield Association/United Government Services, LLC-CA	Issue Whether the Provider's budgeted beds are the most appropriate measure of available beds for purposes of computing the indirect medical education (IME) payment.
Decision Number 2003-D27	Case Name Home Town Health Care vs. Blue Cross Blue Shield/Cahaba Government Administrators	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 ...
Decision Number 2003-D29	Case Name Standish Community Hospital vs. Blue Cross Blue Shield Association/ United Government Services, LLC	Issue Whether the Intermediary's adjustment to DRG payments was proper.
Decision Number 2003-D30	Case Name Patient Care Medical Services, Inc. vs. Blue Cross Blue Shield Association/ United Government Services, LLC	Issue Whether the Intermediary's adjustment to the Per Beneficiary Limit (PBL) calculation was proper.
Decision Number 2003-D31	Case Name University Hospital vs. Blue Cross Blue Shield Association/ AdminaStar Federal, Inc.	Issue 1. Whether the Intermediary's reclassification of certain administrative costs from ambulatory service areas to the Administrative and General Cost Center was proper. 2. Whether the Intermediary's reclassification of clinic dieticians' salary costs to t...
Decision Number 2003-D32	Case Name Texacare, Inc. vs. Cross Blue Shield Association/Palmetto Government Benefits Administrator	Issue Whether the Intermediary's Audit Adjustment #2 which disallowed $108,875 of Administrative and General Costs was proper.
Decision Number 2003-D33	Case Name Cardinal Hill Rehabilitation Hospital vs. Blue Cross/Blue Shield Association/AdminaStar Federal	Issue Whether the all inclusive rate allocation methodology was proper.
Decision Number 2003-D34	Case Name AHS 96 Related Organization Costs Group vs. Blue Cross Blue Shield Association/Riverbend Government Benefits Administrator	Issue Whether the Intermediary's adjustments disallowing the Providers' claimed losses on disposal of assets due to a change of ownership were proper.
Decision Number 2003-D35	Case Name Meridian Hospitals Corporation Group Costs Group vs. Blue Cross Blue Shield Association/Riverbend Government Benefits Administrator	Issue Whether the Intermediary's adjustments disallowing the Providers' claimed losses on disposal of assets due to a change of ownership were proper.
Decision Number 2003-D36	Case Name Castle Medical Center vs. Blue Cross /Blue Shield Association/United Government Services, LLC-CA	Issue Whether the Intermediary adjustment to the disproportionate share hospital (DSH) payment was proper.
Decision Number 2003-D37	Case Name New Hanover Regional Medical Center & Psychiatric Unit vs. Blue Cross and Blue Shield Association/ Blue Cross and Blue Shield of North Carolina	Issue Whether the Intermediary and HCFA properly determined that the Provider's request for an adjustment to the TEFRA target limits was untimely.
Decision Number 2003-D38	Case Name Starke Memorial Hospital vs. Blue Cross Blue Shield Association/AdminaStar Federal	Issue Whether the Intermediary's adjustment to limit reimbursement to the lower of cost or charges for the Provider's distinct part psychiatric unit was proper.
Decision Number 2003-D39	Case Name Hemet Valley Convalescent Hospital vs. BlueCross BlueShield Association/United Government Services, LLC-CA	Issue Whether the Intermediary's denial of the Provider's SNF routine service cost limit exception request was proper.
Decision Number 2003-D40	Case Name Citrus Health and Rehabilitation Center vs. Mutual of Omaha Insurance	Issue Whether CMS properly denied the Provider's request for an exemption from the Medicare skilled nursing facility (SNF) routine cost limits (RCL) as a new provider under 42 CFR 413.30(e) based on CMS' determination that the exemption request was not timely f...
Decision Number 2003-D41	Case Name Collins Health Center vs. BlueCross BlueShield Association/Veritus Medicare Services	Issue Whether the Intermediary's adjustment to remove nursing administration statistics from the ancillary cost centers on worksheet B-1 was proper.
Decision Number 2003-D42	Case Name VNA of Rhode Island vs. Blue Cross Blue Shield Association/Associated Hospital Service	Issue Whether the Intermediary's disallowance of the Provider's Spanish and Portuguese interpreter expenses was proper.
Decision Number 2003-D43	Case Name Helen Ellis Memorial Hospital vs. BlueCross BlueShield Association/First Coast Service Options, Inc.	Issue Whether the Intermediary's determination of obligated capital was proper.
Decision Number 2003-D44	Case Name Wilmac Corporation Group vs. Blue Cross Blue Shield Association/Veritus Medicare Services	Issue Whether the Intermediary's disallowance of liabilities not liquidated timely on the Medicare cost report was proper.
Decision Number 2003-D45	Case Name Angeles Home Health Care, Inc. vs. Blue Cross Blue Shield Association/ United Government Services, LLC - CA	Issue Whether the Intermediary's adjustments of Medicare visits to agree with Medicare's Provider Statistical and Reimbursement (PS&R) report were proper.
Decision Number 2003-D46	Case Name Pioneer Home Health vs. Blue Cross and Blue Shield Association	Issue Whether the CMS properly denied the Provider's request for an exception to the Medicare HHA routine cost limits due to extraordinary circumstances.
Decision Number 2003-D47	Case Name Phelps Memorial Hospital Center vs. BlueCross BlueShield Association/ Empire Medicare Services	Issue Whether the Intermediary's treatment of the Provider's increase in bed size of its exempt rehabilitation unit was proper.
Decision Number 2003-D48	Case Name Mercy Home Health vs. Blue Cross /Blue Shield Association/Cahaba Government Benefit Administrators	Issue Whether the Intermediary's adjustment to home office cost statements was proper.
Decision Number 2003-D49	Case Name Iroquois Memorial Hospital vs. BlueCross BlueShield Association/Adminastar Federal, Inc.	Issue Whether the Provider is entitled to status as a Medicare Dependent Hospital (MDH) for the period of October 1, 2001 through January 14, 2002.
Decision Number 2003-D50	Case Name Pleasant Care Corporation Restorative Nursing Aides Group vs. Mutual of Omaha Insurance Company	Issue Whether the Intermediary's adjustment to restorative nurses aides was proper.
Decision Number 2003-D51	Case Name Pleasant Care Corporation?Standby Costs Group vs. Mutual of Omaha Insurance Company	Issue Whether the Intermediary's adjustment to standby costs was proper.
Decision Number 2003-D52	Case Name Pleasant Care - Pomona vs. Mutual of Omaha Insurance Company	Issue Whether the Intermediary's adjustments reclassifying the Medical Director cost were proper.
Decision Number 2003-D53	Case Name Pleasant Care-Good Samaritan vs. Mutual of Omaha Insurance Company	Issue 1. Whether the Intermediary's adjustment to advertising costs was proper. 2. Whether the Intermediary's adjustment to tax penalties was proper.
Decision Number 2003-D54	Case Name Pleasant Care - San Joaquin vs. Mutual of Omaha Insurance Company	Issue Whether the Intermediary's adjustments reclassifying the Medical Director cost were proper.
Decision Number 2003-D55	Case Name Pleasant Care – Parkview vs. Mutual of Omaha Insurance Company	Issue 1. Whether the Intermediary's adjustment to advertising costs was proper. 2. Whether the Intermediary's adjustments reclassifying Medical Director cost were proper.
Decision Number 2003-D56	Case Name Hospital San Francisco, Inc. vs. Cooperativa de Seguros de Vida de Puerto Rico	Issue Whether the Intermediary's adjustments to the Provider's cost report were proper.
Decision Number 2003-D57	Case Name Hospital San Francisco, Inc. vs. Cooperativa de Seguros de Vida de Puerto Rico	Issue Whether the Intermediary’s adjustment to bad debts was proper.
Decision Number 2003-D58	Case Name Hospital Auxilio Mutuo vs. Cooperativa de Seguros de Vida de Puerto Rico	Issue Whether the Centers for Medicare & Medicaid Services' denial of the Provider's exception request was proper.
Decision Number 2003-D59	Case Name Hospital Dr. Pedro J. Zamora vs. Cooperativa de Seguros de Vida de Puerto Rico	Issue Whether the Intermediary's adjustment to the disproportionate share (DSH) computation was proper.
Decision Number 2003-D60	Case Name West Valley Home Health, Inc. vs. BlueCross BlueShield Association/Cahaba Government Benefit Administrators	Issue 1. Whether the Intermediary's adjustment to home office costs was proper. 2. Whether the Intermediary's adjustment disallowing a portion of the auto allowance was proper. 3. Whether the Intermediary's adjustment to travel and lodging costs was proper.
Decision Number 2003-D61	Case Name Iron County Community Hospital vs. Blue Cross and Blue Shield/United Government Services	Issue Whether CMS’ determination, concerning the Provider’s end stage renal disease (ESRD) exception request, was proper.
Decision Number 2003-D62	Case Name Jeanes Hospital vs. Mutual of Omaha Insurance Company	Issue Whether the Intermediary's adjustment disallowing the Provider's claimed loss on disposal of assets due to a change of ownership was proper.
Decision Number 2003-D63	Case Name Forestville Health & Rehabilitation Center, CT Subacute 96 Disallowance of Rental Expenses Group, Subacute Center of Bristol vs. BlueCross BlueShield Association/Empire Medicare Services	Issue 1. Whether the Intermediary's adjustment disallowing rental expense was proper. 2. Whether the Intermediary's adjustment disallowing capital related expenditures was proper. 3. Whether the Intermediary's adjustment disallowing interest expense was prope...
Decision Number 2003-D64	Case Name St. Joseph Medical Center vs. Blue Cross Blue Shield Association/Blue Cross Blue Shield of Kansas	Issue Whether the Intermediary's determination of loss on consolidation was proper.
Decision Number 2003-D65	Case Name Tenet Healthcare Corporation Group Appeals vs. Mutual of Omaha Insurance Company	Issue Whether the Intermediary correctly applied the Medicare lower of cost or charges limit in determining the Medicare payments to the Providers.
Decision Number 2003-D66	Case Name Westminster at Lake Ridge vs. BlueCross BlueShield Association/United Government Services, LLC-WI	Issue Whether the intermediary's adjustment disallowing Medicare Part A and Part B bad debt was proper.
Decision Number 2004-D01	Case Name HomeCare PRN; HomeCare PRN 96 Allowable Home Office Expenses; and HomeCare PRN 96 Interest Expense vs. Blue Cross and Blue Shield Association/ Associated Hospital Services	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.
Decision Number 2004-D02	Case Name Bournewood Hospital vs. Blue Cross BlueShield Association/Associated Hospital Services of Maine	Issue Whether the Intermediary's adjustments to physician stand-by costs in the routine area were correct.
Decision Number 2004-D03	Case Name Tri-County Home Health Services, Inc. vs. Blue Cross Blue Shield Association/Palmetto Government Benefits Administrators	Issue (1) Whether the Intermediary's adjustment to Board of Director's fees was proper. (2) Whether the Intermediary's adjustment to legal and professional fees was proper. (3) Whether the Intermediary's adjustment to key employee compensation was proper. (4) W...
Decision Number 2004-D04	Case Name Proactive Home Care, Inc. vs. BlueCross BlueShield Association/Cahaba Government Benefit Administrators	Issue Whether the Intermediary's adjustment to include private duty nursing costs on the Medicare cost report was correct.
Decision Number 2004-D05	Case Name Chippewa Dialysis Services vs. Blue Cross Blue Shield Association/United Government Services, LLC -WI	Issue Whether the Centers for Medicare and Medicaid Services correctly denied the Provider's request for an exception to the end stage renal disease (ESRD) composite rate
Decision Number 2004-D06	Case Name Alpena Dialysis Services vs. Blue Cross Blue Shield Association/United Government Services, LLC -WI	Issue Whether the Centers for Medicare and Medicaid Services correctly denied the Provider's request for an exception to the end stage renal disease (ESRD) composite rate.
Decision Number 2004-D07	Case Name Northern Michigan Hospital vs. Blue Cross Blue Shield Association/United Government Services, LLC -WI	Issue Whether the Centers for Medicare and Medicaid Services correctly denied the Provider's request for an exception to the end stage renal disease (ESRD) composite rate
Decision Number 2004-D08	Case Name Heritage Health Care d/b/a Heritage Villa Nursing Center vs. Mutual of Omaha Insurance Company	Issue Whether the Board has jurisdiction over the recoupment of overpayments appealed from a letter from the Centers for Medicare & Medicaid Services.
Decision Number 2004-D09	Case Name Heritage Health Care d/b/a Heritage Villa Nursing Center vs. Mutual of Omaha Insurance Company	Issue Whether the Board has jurisdiction over the recoupment of overpayments appealed from a letter from the Centers for Medicare & Medicaid Services, and the reimbursement effectis less than $10,000
Decision Number 2004-D10	Case Name Preferred Home Health Care vs. Blue Cross and Blue Shield Association/Palmetto Government Benefits Administrator	Issue The propriety of reimbursing home health agencies (HHA) under the Medicare program for expenses that the HHA incurs to provide pastoral care to its patients.
Decision Number 2004-D11	Case Name Incare Home Health, Inc. vs. Blue Cross Blue Shield Association/Palmetto Government BenefitsAdministrators	Issue (1) Whether the Intermediary's adjustment to Board of Director's fees was proper. (2) Whether the Intermediary's adjustment to routine and non-routine supply costs was proper.
Decision Number 2004-D12	Case Name Saginaw General Hospital vs. Blue Cross/Blue Shield Association/United Government Services, LLC	Issue Whether, for the purposes of allocation of administrative and general costs, the Part B physician's compensation and related fringe benefits should be included in total expenses of the private physician practices.
Decision Number 2004-D13	Case Name Hunterdon/Somerset 2001 Wage Index Group vs. Riverbend Government Benefits Administrator	Issue 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.
Decision Number 2004-D14	Case Name Moore Regional Hospital vs. Blue Cross Blue Shield Association/Palmetto Government Benefits Administrators	Issue Whether the Intermediary's determination disallowing the loss incurred on change of ownership was proper.
Decision Number 2004-D15	Case Name LAC + USC Medical Center vs. Blue Cross Blue Shield Association/United Government Services, LLC- CA	Issue Whether the Provider's budgeted beds are the most appropriate measure of available bedsfor purposes of computing the indirect medical education (IME) payment.
Decision Number 2004-D16	Case Name Odessa Regional Hospital vs. Mutual of Omaha Insurance Company	Issue Whether the Intermediary's determination that the Provider had less than 100 beds for DSH eligibility purposes was proper.
Decision Number 2004-D17	Case Name Hatch Valley Home Health Agency vs. Blue Cross Blue Shield Association/Palmetto Government Benefits Administrators	Issue Whether the Intermediary's adjustment to the Provider's cost limits was proper.
Decision Number 2004-D18	Case Name Woodland Terrace Extended Care Center vs. Blue Cross Blue Shield Association/First Coast Service Options, Inc.	Issue Whether the Intermediary's adjustment reducing the adjusted hourly salary equivalency amount allowed for the services of Physical Therapy Aides was proper.
Decision Number 2004-D19	Case Name Twinning Village vs. Blue Cross Blue Shield Association/Veritus Medicare Services	Issue Whether it was 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.
Decision Number 2004-D20	Case Name West Virginia Hospital vs. Blue Cross Blue Shield Association/ Trigon Blue Cross and Blue Shield	Issue Whether the Intermediary's adjustment to bond interest expense was proper.
Decision Number 2004-D21	Case Name Bates Medical Center vs. Blue Cross Blue Shield Association/Arkansas Blue Cross Blue Shield	Issue Whether the Intermediary's determination of the loss on disposal of assets was proper.
Decision Number 2004-D22	Case Name Chestnut Hill Hospital vs. Veritus Medicare Services/Blue CrossBlue Shield Association	Issue Whether 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 were proper.
Decision Number 2004-D23	Case Name Glenwood Regional Medical Center vs. Mutual of Omaha Insurance Company	Issue Whether CMS' methodology for determining an exception from the RCLs for HB SNFs, as set forth in P.R.M. § 2534.5, was proper.
Decision Number 2004-D24	Case Name Visiting Nursing Association of North Central Indiana, Inc. vs. Blue Cross Blue Shield Association/Palmetto Government Benefits Administrators	Issue Whether 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 were proper.
Decision Number 2004-D25	Case Name Tip of Illinois Health Services vs. Blue Cross and Blue Shield Association/Wellmark, Inc.	Issue Whether the Intermediary's application of the Salary Equivalency Guidelines to the Provider's physical therapy costs was proper.
Decision Number 2004-D26	Case Name Aroostook Medical Center vs. Blue Cross Blue Shield Association/Associated Hospital Service of Maine	Issue Whether CMS' denial of the Provider's end stage renal disease composite rate exception request was correct based on applicable Medicare law.
Decision Number 2004-D27	Case Name Baptist Memorial Medical Center vs. Blue Cross Blue Shield Association/Blue Cross Blue Shield of Arkansas	Issue Whether the Provider met the criteria set forth at § 4004(b) of OBRA 1990 and whether the costs at issue met the definition of clinical training costs.
Decision Number 2004-D29	Case Name Carney Hospital (Transitional Care Unit) vs. Blue Cross Blue Shield Association/Associated Hospital Services	Issue Whether the Intermediary's denial of the Provider's request for an exemption from Medicare's routine service cost limits was proper.
Decision Number 2004-D30	Case Name Global Home Care, Inc. Blue Cross Blue Shield Association/United Government Services, LLC	Issue Whether the Intermediary's adjustment to the single business tax was proper.
Decision Number 2004-D31	Case Name Pocono Medical Home Care, Inc. vs. Blue Cross and Blue Shield Association/Cahaba Government Benefit Administrators	Issue Whether the Intermediary's adjustment applying Medicare's Physical Therapy Compensation Guidelines to the Provider's employee physical therapists was proper.
Decision Number 2004-D32	Case Name St. Josephs Hospital vs. Blue Cross /Blue Shield Association/Noridian Administrative Services"	Issue Whether the Intermediary's adjustment to the Provider's disproportionate share hospital (DSH) payment was proper.
Decision Number 2004-D33	Case Name Genesis 96, 97 Proper Cost Category Group and Genesis 98 Payroll Tax/Workers Compensation Cost Group vs. Blue Cross Blue Shield Association/Veritus Medicare Services	Issue Whether the Provider's Federal Insurance Contributions Act (FICA) payroll costs should be classified to the administrative and general cost center.
Decision Number 2004-D34	Case Name Berks Visiting Nurse Association vs. Blue Cross and Blue Shield/Cahaba Government Benefit Administrators	Issue Whether the Intermediary's adjustment applying Medicare's Physical Therapy Compensation Guidelines to the Provider's employee physical therapists was proper.
Decision Number 2004-D35	Case Name Harborside Hospital--Indianapolis vs. Blue Cross Blue Shield Association/ AdminaStar Federal, Inc.	Issue Whether the Provider was entitled to an exemption from the routine cost limit as a new provider.
Decision Number 2004-D36	Case Name Germantown Hospital and Medical Center vs. Mutual of Omaha Insurance Company	Issue Whether the Intermediary's denial of the Provider's loss on disposal of assets was proper.
Decision Number 2004-D37	Case Name Clark Regional Medical Center vs. Blue Cross and Blue Shield Assn./AdminaStar Federal - Kentucky	Issue Whether the Provider's non-acute care swing-bed days should be included in the total of Medicaid patient days used in the calculation of the disproportionate share (DSH) hospital payment.
Decision Number 2004-D38	Case Name Saint Clares Hospital - Dover vs. Blue Cross Blue Shield Association/ Riverbed Government Benefits	Issue Whether the Intermediary's determination of loss on consolidation was proper.
Decision Number 2004-D39	Case Name Angeles Home Health Care, Inc. vs. BlueCross BlueShield Association/United Government Services, LLC-CA	Issue Whether denied Medicare visits should be included in the total visits count for purposes of apportioning costs to the Medicare program.
Decision Number 2004-D40	Case Name Battle Creek Health System and Mercy General Health Partners vs. Blue Cross Blue Shield Association/ United Government Services, LLC	Issue Whether the Intermediary properly concluded that the Provider failed to make reasonable collection efforts and document such efforts with respect to certain claimed bad debts.
Decision Number 2004-D41	Case Name Empire 91-94 Medicaid Eligible Days Group vs. Mutual of Omaha Insurance Company	Issue Whether the Intermediary's determination of the disproportionate share hospital (DSH) computation relating to state-only General Assistance Days was proper.
Decision Number 2004-D42	Case Name Mesa Vista Hospital vs. Blue Cross Blue Shield Association/United Government Services, LLC--CA	Issue Whether the Intermediary properly eliminated the Providers Medicare bad debts due to the Provider allowing discounts to only non-Medicare patients.
Decision Number 2004-D43	Case Name Ochsner Clinic—New Orleans Renal Dialysis Facility and Houma/Bayou Facility vs. Blue Cross Blue Shield Association/ Trispan Health Services	Issue Whether the Intermediary correctly disallowed Medicare bad debts related to amounts not included in the End-Stage Renal Disease (ESRD) composite rate.
Decision Number 2004-D44	Case Name Wayne County Hospital vs. Blue Cross Blue Shield Association/ United Government Services, LLC-WI	Issue Whether the Intermediary properly recognized all termination costs as relating to the period ending 8/13/84 rather than allocating costs to prior years and recognizing the additional Medicare reimbursement as a below the line adjustment on the final 8/13/...
Decision Number 2004-D45	Case Name Florida Convalescent Centers 97 Therapy Management Fee Group vs. First Coast Service Options, Inc./Blue Cross Blue Shield Association	Issue 1. Whether the Intermediary's disallowance of the Provider's therapy management fees was proper. 2. If the Provider's are found to be entitled to a reversal of the Intermediary's disallowance, does the Board have subject matter jurisdiction to determine w...
Decision Number 2004-D46	Case Name Spectrum Home Care, Inc. vs. Blue Cross Blue Shield Association/United Government Services	Issue Whether the Intermediary's adjustment to start-up costs was proper.
Decision Number 2005-D01	Case Name Fajardo Home Care; Guaynabo Home Care Program; Font Martelo Home Care Program and El Gigante Home Care vs. Blue Cross Blue Shield Association/United Government Services	Issue Whether the Providers' receivable financing was a loan or a sale of assets.
Decision Number 2005-D02	Case Name Dialysis Clinic 94 Bad Debt Expense Group vs. Blue Cross Blue Shield Association/Blue Cross and Blue Shield of Georgia	Issue Whether the Intermediary correctly disallowed Medicare bad debts claimed by the Providers on uncollectible deductible and coinsurance amounts pertaining to items and services not included in the End-Stage Renal Disease (ESRD) composite rate.
Decision Number 2005-D03	Case Name Twin Rivers Regional Medical Center vs. Blue Cross Blue Shield Association/ Premera Blue Cross	Issue Whether the Provider was 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.
Decision Number 2005-D04	Case Name Eastern Maine Medical Center vs. Blue Cross Blue Shield Association/ Associated Hospital Service	Issue Whether CMS' denial of the Provider's end stage renal disease (ESRD) composite rate exception request was correct.
Decision Number 2005-D05	Case Name Mercy Healthcare Bakersfield vs. Blue Cross and Blue Shield Association/United Government Services, LLC-CA	Issue Whether CMS partial denial of the Provider's request for an exception to the ESRD composite rates request based on atypical service intensity and patient mix was correct.
Decision Number 2005-D06	Case Name Saint Mary's Medical Center vs. BlueCross BlueShield Association/United Government Services, LLC	Issue Whether for the purposes of allocation of administrative and general costs, the Part B physicians' compensation and related fringe benefits should be included in total expenses of the private physician practices.
Decision Number 2005-D07	Case Name Capeside Cove Good Samaritan Center vs. BlueCross BlueShield Association/Cahaba Government Benefit Administrators	Issue Whether the Intermediary was correct in determining that Provider's request for an exception to the Skilled Nursing Facility (SNF) Routine Cost Limit was untimely filed.
Decision Number 2005-D08	Case Name Bon Secours Venice Hospital vs. Blue Cross Blue Shield Association/First Coast Service Options, Inc.	Issue Whether the Intermediary's adjustments to interest expense relating to the acquisition of medical records and an assembled work force were proper.
Decision Number 2005-D09	Case Name Robert F. Kennedy Medical Center vs. Blue Cross Blue Shield Association/United Government Services, LLC-CA	Issue Whether the Intermediary's adjustment disallowing the Provider's claimed loss on the disposal of assets due to a change of ownership was proper.
Decision Number 2005-D10	Case Name Haven Home Health, Inc. vs. BlueCross BlueShield Association/Palmetto Government Benefits Administrators	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...
Decision Number 2005-D11	Case Name Flagstaff Medical Center and Northern Arizona Homecare-Flagstaff vs. BlueCross BlueShield Association/United Government Services, LLC-CA/BlueCross BlueShield of Arizona	Issue Whether the Intermediary's denial of a request for exception to the Home Health Agency (HHA) per visit cost limits was proper.
Decision Number 2005-D12	Case Name NYCHHC 94 TEFRA Target Amount Per Case E/E Group vs. Blue Cross Blue Shield Association/ Empire Medical Services	Issue Whether the Intermediary properly processed the Providers' TEFRA exception request.
Decision Number 2005-D13	Case Name Terrebonne Home Care, Inc. vs. Blue Cross Blue Shield Association/Palmetto Government Benefits Administrators	Issue Whether the Intermediary denial of the Provider's request for exception to its per-visit cost limits was proper.
Decision Number 2005-D14	Case Name Countryside Manor Health Care Center vs. BlueCross BlueShield Association/AdminaStar Federal - Indiana	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
Decision Number 2005-D15	Case Name Topanga Terrace vs. BlueCross BlueShield Association/United Government Services, LLC - CA	Issue Whether the Intermediary's denial of the Provider's Routine Cost Limit (RCL) exception request was proper
Decision Number 2005-D16	Case Name Hospital Corporation of America (HCA) Providers with Late Notices of Program Reimbursement vs. BlueCross BlueShield Association/Various Intermediaries	Issue What relief is available through appeal to the Provider Reimbursement Review Board for failure of the Intermediary to timely settle the Provider's cost reports, especially where prejudice will result from the failure to settle such cost report.
Decision Number 2005-D17	Case Name Hamburg Health Clinic vs. BlueCross BlueShield Association/TrailBlazer Health Enterprises, LLC	Issue Whether the Intermediary's adjustment to physician/owners compensation was proper.
Decision Number 2005-D18	Case Name Liberty Village vs. BlueCross BlueShield Association/AdminaStar Federal	Issue 1. Whether the Intermediary's adjustment to National Premier Financial Services, Inc., and NPF VI, Inc. Costs/Program Fees was proper. 2. Whether the Intermediary's failure to allow $18,215 of related party depreciation was proper. 3. Whether the Intermed...
Decision Number 2005-D19	Case Name Family Home Care, Inc. vs. BlueCross BlueShield Association/Palmetto Government Benefits Administrators	Issue Whether the Intermediary's adjustment to disallow accrued salaries was proper.
Decision Number 2005-D20	Case Name Parkview Memorial Hospital vs. Blue Cross Blue Shield Association/ AdminaStar Federal	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 "priv...
Decision Number 2005-D21	Case Name Treyton Oak Towers vs. Blue Cross Blue Shield Association/AdminaStar Federal, Inc.	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
Decision Number 2005-D22	Case Name Heritage House of Richmond vs. Blue Cross Blue Shield Association/AdminaStar Federal, Inc.	Issue Whether the Intermediary's adjustment to disallow a portion of the owner's compensation was proper.
Decision Number 2005-D25	Case Name Brady Home Health Care Services, Inc. vs. BlueCross BlueShield Association/ Palmetto Government Benefits Administrators	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 ...
Decision Number 2005-D26	Case Name Rogue Valley Medical Center vs. BlueCross BlueShield Association/Medicare Northwest	Issue Whether the Board properly accepted jurisdiction over a new provider exemption; whether the jurisdiction extended to multiple years and whether CMS' denial of the new provider exemption was proper.
Decision Number 2005-D27	Case Name Memorial Hospital at Gulfport vs. Blue Cross Blue Shield Association/TriSpan Health Services	Issue Whether the Intermediary's disallowance of Medicare bad debts was proper.
Decision Number 2005-D28	Case Name St. Edward Mercy Medical Center vs. BlueCross BlueShield Association/Arkansas Blue Cross & Blue Shield	Issue Whether the Centers for Medicare and Medicaid Service's denial of the Provider's request for new provider exemption was proper.
Decision Number 2005-D29	Case Name San Francisco Medical Center vs. Mutual of Omaha Insurance Company	Issue Whether CMS' partial denial of the Provider's request for an exception to the ESRD composite rate based on atypical patient mix was correct.
Decision Number 2005-D30	Case Name Community Care Hospital vs. BlueCross BlueShield Association/TriSpan Health Services	Issue Whether the Intermediary properly adjusted the method of reimbursing the Provider, a hospital-based skilled nursing facility (SNF), from cost-based reimbursement to the SNF prospective payment system (PPS).
Decision Number 2005-D31	Case Name Roy L. Schneider Hospital vs. Cooperativa de Seguros de Vida de Puerto Rico	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.
Decision Number 2005-D32	Case Name CentraState Medical Center vs. BlueCross BlueShield Association/Riverbend Government Benefits Administrator	Issue Whether the Intermediary failed to properly classify certain projects as old capital.
Decision Number 2005-D33	Case Name California Nurses Home Health Services vs. BlueCross BlueShield Association/United Government Services, LLC-CA	Issue Whether the Intermediary's adjustment to start-up costs was proper.
Decision Number 2005-D34	Case Name Brackenridge Hospital vs. BlueCross BlueShield Association/TrailBlazer Health Enterprises, LLC	Issue Whether the Intermediary properly applied the "Pickle Amendment" in calculating the Provider's Disproportionate Share Hospital (DSH) adjustment.
Decision Number 2005-D35	Case Name Mid-City Home Health vs. BlueCross BlueShield Association/United Government Services, LLC-CA	Issue Whether the liabilities claimed by the Provider are reimbursable under the Medicare principles.
Decision Number 2005-D36	Case Name University Medical Center vs. BlueCross BlueShield Association/Blue Cross & Blue Shield of Arizona	Issue 1. Whether the Intermediary's adjustment, reducing the Provider's IME full-time equivalent (FTE) resident count for time spent by residents in research activities, was proper. 2. Whether the Intermediary's adjustment reducing the Provider's Direct GME an...
Decision Number 2005-D37	Case Name VNA Health Care, Inc. vs. BlueCross BlueShield Association/Cahaba Government Benefit Administrators	Issue Whether the Intermediary's adjustments applying Medicare's salary equivalency guidelines to services performed by the Provider's employee physical and occupational therapists were proper.
Decision Number 2005-D38	Case Name Select Specialty Hospital-Houston Heights vs. Mutual of Omaha Insurance Company	Issue Whether the Board properly found jurisidction over the issue of whether the Intermediary erred in denying the Provider a CIB for fiscal year ending August 31, 1999.
Decision Number 2005-D39	Case Name Arthur G. James Cancer Hospital vs. BlueCross BlueShield Association/AminaStar Federal - Ohio	Issue Whether the Intermediary's adjustment to disallow the interest paid to Ohio State University Hospitals (OSUH) was proper.
Decision Number 2005-D40	Case Name St. Joseph's Health Services of Rhode Island vs. Blue Cross BlueShield Association/BlueCross Blue Shield of Rhode Island	Issue Whether CMS' denial of the Provider's request for an exemption from the SNF RCLs was proper.
Decision Number 2005-D41	Case Name St. Rita's Medical Center vs. Blue Cross Blue Shield Association/AdminaStar Federal Ohio	Issue Whether the Board properly accepted jurisdiction of the Provider's request for a hearing on the issue of whether it was entitled to additional disproportionate share (DSH) reimbursement for inpatient hospital days for which patients were eligible for Medi...
Decision Number 2005-D42	Case Name Rome Memorial Hospital vs. Blue Cross Blue Shield Association/Empire Medicare Services	Issue Whether the Board properly accepted jurisdiction of the Provider's request for a hearing on the issue of whether it was entitled to additional disproportionate share (DSH) reimbursement for inpatient hospital days for which patients were eligible for Medi...
Decision Number 2005-D43	Case Name Pleasant Care 97/98 Payroll Tax Cost Group vs. Mutual of Omaha Insurance Company	Issue Whether the Intermediary should 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).
Decision Number 2005-D44	Case Name Covenant Shores Health Center vs. BlueCross BlueShield Association/AdminaStar Federal Illinois	Issue Whether CMS' denial of the Provider's request for an exception to the routine cost limits (RCLs) for skilled nursing facilities (SNFs) as a new provider was proper.
Decision Number 2005-D45	Case Name UMass Memorial Medical Center vs. BlueCross BlueShield Association/Associated Hospital Service	Issue Whether 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 was proper.
Decision Number 2005-D46	Case Name Evergreen Hospital Medical Center and SNF vs. BlueCross BlueShield Association/Premera Blue Cross	Issue Whether the Provider was entitled to a "new provider" exemption from Medicare's routime cost limits for its hospital-based skilled nursing facility (SNF).
Decision Number 2005-D47	Case Name Alhambra Hospital vs. BlueCross BlueShield Association/United Government Services, LLC - CA	Issue Whether the Intermediary's adjustment excluding dual-eligible patient days associated with the Provider's sub-acute unit from the Provider's DSH percentage was proper.
Decision Number 2005-D48	Case Name Long Beach Memorial Hospital vs. BlueCross BlueShield Association/Empire Medicare Services	Issue Whether the Intermediary's application of the reasonable compensation equivalent limits was proper.
Decision Number 2005-D49	Case Name Ashtabula County Medical Center; The Community Hospital; Akron General Medical Center; Lima Memorial Hospital and The Toledo Hospital vs. BlueCross BlueShield Association/AdminiStar Federal, Inc.	Issue Whether the Intermediary's adjustment excluding patient days related to Ohio's Hospital Care Assurance Program (HCAP) from the Providers' disproportionate share (DSH) calculation was proper.
Decision Number 2005-D51	Case Name Sun Terrace Health Care Center vs. BlueCross BlueShield Association/Empire Medicare Services	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.
Decision Number 2005-D52	Case Name Sun City Center 96 Square Foot Allocations vs. BlueCross BlueShield Association/Empire Medicare Services	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.
Decision Number 2005-D53	Case Name Goleta Valley Community Hospital a/k/a/ Goleta Valley Cottage Hospital vs. BlueCross BlueShield Association/ United Government Services, LLC-CA	Issue Whether the Provider furnished sufficient information to enable CMS to make a decision on the Provider's request for a new provider exemption to Medicare's routine cost limits (RCLs) for skilled nursing facilities (SNFs).
Decision Number 2005-D54	Case Name Nix Health Care System vs. BlueCross BlueShield Association/Trailblazer Health Enterprises, LLC	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.
Decision Number 2005-D55	Case Name Muhlenberg Hospital Center vs. BlueCross BlueShield Association/Veritus Medicare Services	Issue Whether the Intermediary's adjustment disallowing the Provider's loss on sale of assets was proper.
Decision Number 2005-D56	Case Name Central Texas Medical Center vs. BlueCross BlueShield Association/TrailBlazer Health Enterprises, LLC	Issue Whether the observation days and swing bed days should reduce the number of available beds for purposes of calculating the Provider's eligibility for DSH payments.
Decision Number 2005-D57	Case Name Central Texas Medical Center vs. BlueCross BlueShield Association/TrailBlazer Health Enterprises, LLC	Issue Whether the observation days and swing bed days should reduce the number of available beds for purposes of calculating the Provider's eligibility for DSH payments.
Decision Number 2005-D58	Case Name Central Texas Medical Center vs. BlueCross BlueShield Association/TrailBlazer Health Enterprises, LLC	Issue Whether the observation days and swing bed days should reduce the number of available beds for purposes of calculating the Provider's eligibility for DSH payments.
Decision Number 2005-D59	Case Name Central Texas Medical Center vs. BlueCross BlueShield Association/TrailBlazer Health Enterprises, LLC	Issue Whether the observation days and swing bed days should reduce the number of available beds for purposes of calculating the Provider's eligibility for DSH payments.
Decision Number 2005-D60	Case Name Mary Immogene Bassett Hospital-OSDF vs. BlueCross BlueShield Association/Empire Medicare Services	Issue Whether the denial of the Provider's request for an exception to the renal dialysis composite rate by CMS was proper.
Decision Number 2005-D61	Case Name Erwine's Home Health Care, Inc. vs. BlueCross BlueShield Association/Cahaba Government Benefit Administrators	Issue Whether the Intermediary's adjustment applying the physical therapy salary guidelines to fee-for-service employee compensation was proper.
Decision Number 2005-D62	Case Name Shady Lawn Nursing Home vs. BlueCross BlueShield Association/TriSpan Health Services	Issue Whether the Intermediary's adjustment removing the Provider's 'grossing up' of costs and charges for drugs charged to patients was proper.
Decision Number 2005-D63	Case Name Colorado Home Care, Inc. vs. BlueCross BlueShield Association/ Cahaba Government Benefit Administrators	Issue Whether the Intermediary's adjustment applying the Adjusted Hourly Salary Equivalency Guidelines or "physical therapy compensation guidelines" to fee-for-service employee compensation was proper.
Decision Number 2005-D64	Case Name Alamitos West Convalescent vs. BlueCross BlueShield Association/United Government Services, LLC--CA	Issue Whether the Intermediary's adjustment to allow only a 15% increase in the therapy rate for physical therapy supervisors was proper.
Decision Number 2005-D65	Case Name Hill Country Health Services, Inc. vs. Blue Cross Blue Shield Association/Palmetto Government Benefits Administrators	Issue Whether the Intermediary properly disallowed interest expense incurred in connection with the Provider's deferred compensation plan.
Decision Number 2005-D67	Case Name Rhode Island Hospital vs. BlueCross BlueShield Association/Arkansas BlueCross & BlueShield	Issue Whether the Intermediary's adjustment, reducing the Provider's full-time equivalent (FTE) resident count for purpose of calculating the Indirect Medical Education (IME) adjustment, was proper.
Decision Number 2005-D68	Case Name The Manor House at Riverview vs. BlueCross BlueShield Association/AdminaStar Federal-Indiana	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 Rout...
Decision Number 2005-D69	Case Name Columbia Montour Home Health Services vs. BlueCross BlueShield Association/Cahaba Government Benefit Administrators	Issue Whether the Intermediary's adjustment of accounting fees was proper.
Decision Number 2005-D70	Case Name Potomac Home Health Care, Inc. vs. BlueCross BlueShield Association/Cahaba Government Benefit Administrators	Issue Whether the Intermediary's adjustment applying the Salary Equivalency Guidelines or "physical therapy compensation guidelines" to fee-for-service employee compensation was proper.
Decision Number 2005-D71	Case Name Potomac Home Health Care, Inc. vs. BlueCross BlueShield Association/Cahaba Government Benefit Administrators	Issue Whether the Intermediary's adjustment applying the Salary Equivalency Guidelines or "physical therapy compensation guidelines" to fee-for-service employee compensation was proper
Decision Number 2005-D72	Case Name Saddleback Memorial Medical Center vs. BlueCross BlueShield Association/United Government Services, LLC-CA	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.
Decision Number 2006-D01	Case Name Saint Marys Hospital vs. BlueCross BlueShield Association/Noridian Administrative Services	Issue Whether the Intermediary's denial of the Provider's request for an adjustment to its TEFRA target amount due to untimely filing of the request was proper.
Decision Number 2006-D03	Case Name Trenton Psychiatric Hospital vs. BlueCross BlueShield Association/Riverbend Government Benefits Administrator	Issue Whether the Intermediary's adjustments to disallow reimbursement for physician's professional services on a reasonable cost basis was proper.
Decision Number 2006-D04	Case Name Omega Hills, Inc. vs. BlueCross Blue Shield Association/AdminaStar Federal-Indiana (formerly Anthem Insurance Company)	Issue Whether the Intermediary's adjustment to owners compensation was proper.
Decision Number 2006-D05	Case Name Rush-Presbyterian-St. Lukes Medical Center vs. BlueCross BlueShield Association/AdminaStar Federal	Issue 1. Whether the Intermediary's adjustment to the Provider's disproportionate share (DSH) payment was proper. 2. Whether the Intermediary's calculation of the number of interns and residents and the amount of allowable costs for fiscal year 1991 for purpose...
Decision Number 2006-D06	Case Name Professional Home Care, Inc., Garvin and Moore Okla. Professional HC 97 Access Infusion Group vs. BlueCross BlueShield Association/Cahaba Government Benefit Administrators	Issue Whether the Intermediary's adjustment of the Provider's physical therapy costs was proper.
Decision Number 2006-D07	Case Name Chicago 98-00 MSA Wage Index Group vs. Mutual of Omaha Insurance Company	Issue 1. Whether Michael Reese Hospital (Reese) failed to exhaust its administrative remedies for a correction to its wage data during the February-March 1998 window for correcting wage data. 2. Whether Reese Hospital nevertheless met the criteria for a correct...
Decision Number 2006-D08	Case Name Preferred Management Corporation Group vs. BlueCross BlueShield Association/Cahaba Government Benefit Administrators	Issue Whether the Intermediary's adjustments reallocating key employee and owners bonuses were proper.
Decision Number 2006-D09	Case Name Washington County Memorial Hospital vs. BlueCross BlueShield Asssociation/TriSpan Health Services	Issue Whether the Intermediary's computation of the Medicare dependent, small rural hospital (MDH) adjustment, due the Provider for its fiscal year (FY) 2000 cost report decrease in discharges, was correct.
Decision Number 2006-D10	Case Name Highland Medical Center vs. Mutual of Omaha Insurance Company	Issue Whether the Intermediary's determination that the Provider had less than 100 beds for purposes of disproportionate share hospital (DSH) eligibility purposes under the inpatient prospective payment system (IPPS) was proper.
Decision Number 2006-D11	Case Name St. Joseph Hospital vs. Mutual of Omaha Insurance Company	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.
Decision Number 2006-D12	Case Name Immanuel - St. Josephs Hospital vs. Blue Cross Blue Shield Association/Noridian Administrative Services	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.
Decision Number 2006-D13	Case Name Community Hospital of the Monterey Peninsula vs. BlueCross BlueShield Association/United Government Services, LLC-CA	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.
Decision Number 2006-D14	Case Name Harborside Healthcare-Reservoir vs. BlueCross BlueShield Association/Empire Medicare Services	Issue Whether the Intermediary properly denied the Provider's new provider exemption request.
Decision Number 2006-D15	Case Name Acadian HomeCare, Inc. vs. Blue Cross Blue Shield Association/Palmetto Government Benefits Administrators	Issue Whether the Intermediary's disallowance of medical director fees was proper.
Decision Number 2006-D16	Case Name Dameron Hospital vs. Blue Cross Blue Shield Association/United Government Services, LLC	Issue Whether the Intermediary's disallowance of the Provider's inpatient and outpatient Medicare bad debts was proper.
Decision Number 2006-D17	Case Name Alden Court Nursing Home vs. Mutual of Omaha Insurance Company	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.
Decision Number 2006-D18	Case Name The Medical Team vs. Blue Cross Blue Shield Association/Cahaba Government Benefit Administrators	Issue Whether the Intermediary's adjustment applying Medicare's Physical Therapy Compensation Guidelines to the Provider's employee physical therapists was proper.
Decision Number 2006-D19	Case Name Western Arizona Regional Medical Center vs. Blue Cross Blue Shield Association/Blue Cross Blue Shield of Arizona	Issue Whether the Intermediary's adjustment of the Provider's DSH calculation was based upon a proper interpretation of the Medicare DSH statutes as amended by the BIPA of 2000.
Decision Number 2006-D20	Case Name Baystate Medical Center vs. Mutual of Omaha Insurance Company	Issue 1. Whether the 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. 2. Whether the Provider is en...
Decision Number 2006-D21	Case Name HCT 94-95 Physical Therapy AHSEA Exception Group vs. Mutual of Omaha Insurance Company	Issue Whether the Intermediary properly denied the Provider's requests for an exception to the Medicare allowable hourly salary equivalency amount for physical therapy.
Decision Number 2006-D22	Case Name Saint Anthonys Health Center vs. BlueCross BlueShield Association/ AdminaStar Federal Illinois	Issue Whether 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, was proper.
Decision Number 2006-D23	Case Name University of Pittsburgh Medical Center (UPMC) - St. Margaret Hospital vs. BlueCross BlueShield Association/ Veritus Medicare Services	Issue Whether the Intermediary's adjustments to the Medicare cost report that disallowed the loss on disposal depreciable assets due to the facility's change of ownership (CHOW) were proper.
Decision Number 2006-D24	Case Name Advanced Rehabilitation Services, Inc.; Prospect Rehabilitation Services, Inc. vs. BlueCross BlueShield Association/Riverbend Government Benefits Administrator	Issue Whether the Intermediary's adjustments disallowing the Provider's claimed Medicare Bad Debts, disallowed in a prior year period, were proper.
Decision Number 2006-D25	Case Name MGH Home Health vs. BlueCross BlueShield Association/Cahaba Government Benefit Administrators	Issue Whether the Intermediary's application of salary equivalency guidelines to the compensation of physical therapists employed by the Provider on a per visit basis was improper.
Decision Number 2006-D26	Case Name Mary Hitchcock Memorial Hospital vs. BlueCross BlueShield Association/Anthem Health Plans of New Hampshire, Inc.	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.
Decision Number 2006-D27	Case Name Phoenix Baptist Hospital vs. BlueCross BlueShield Association/BlueCross & BlueShield of Arizona	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...
Decision Number 2006-D28	Case Name Provena St. Joseph Medical Center and Provena United Samaritans Medical Center vs. BlueCross BlueShield Association/AdminaStar Federal Illinois	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.
Decision Number 2006-D29	Case Name Montefiore Medical Center vs. BlueCross BlueShield Association/Empire Medicare Services	Issue 1. Whether the Intermediary's adjustments offsetting rental income received by the Provider for employee housing against both operating and capital costs was proper. 2. Whether the Centers for Medicare & Medicaid Service's methodology for determining the ...
Decision Number 2006-D30	Case Name Greenbriar Nursing and Convalescent Center/Guest House of Slidell/Riverland Healthcare Center vs. Blue Cross Blue Shield Association/TriSpan Health Services	Issue Whether the Intermediary's adjustments to reduce the Provider's outpatient therapy costs by 10 percent were proper.
Decision Number 2006-D31	Case Name Olive View Medical Center vs. BlueCross BlueShield Association/United Government Services, LLC-CA	Issue Whether the Provider is entitled to the benefit of the previously granted change in the TEFRA base period for the purpose of applying the TEFRA limit for the Provider's FYE June 30, 1990.
Decision Number 2006-D32	Case Name Osteopathic Founders Foundation vs. Blue Cross Blue Shield Association/Blue Cross Blue Shield of Oklahoma	Issue 1. Whether closing costs incurred in the sale of a hospital are allowable as a deduction from the sales 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 b...
Decision Number 2006-D33	Case Name Visiting Nurse Association of Washington, D.C. vs. BlueCross BlueShield Association/Cahaba Government Benefit Administrators	Issue Whether the Intermediary's adjustment of the Provider's physical therapy costs was proper.
Decision Number 2006-D34	Case Name St. David s 89-92 Related Organization Purchased Services Group vs. Blue Cross Blue Shield Association/Trailblazer Health Enterprises, LLC	Issue Whether the Intermediary's denial of the Provider's request for an exception to the related organization principle for calendar years 1989 through 1992 was proper.
Decision Number 2006-D35	Case Name East Lake Community Health Center vs. Blue Cross Blue Shield Association/AdminaStar Federal	Issue Whether certain adjustments made by the Intermediary were proper.
Decision Number 2006-D36	Case Name Extendicare 99 Uncollect Co-In Dual Elig Group vs. BlueCross BlueShield Association/United Government Services, LLC - WI	Issue Whether the Intermediary properly disallowed bad debts related to uncollectible deductibles and coinsurance arising from therapy services, paid under the Medicare Part B fee schedule, where the Medicare eligible patient was not in a covered Part A stay at...
Decision Number 2006-D37	Case Name Lawrence & Memorial Hospital vs. BlueCross BlueShield Association/Empire Medicare Services	Issue Whether the Intermediary's adjustment to disallow the Connecticut Sales Tax was proper.
Decision Number 2006-D38	Case Name St. Vincents Medical Center vs. BlueCross BlueShield Association/Empire Medicare Services	Issue Whether the Intermediary's adjustment to disallow the Connecticut Sales Tax was proper.
Decision Number 2006-D39	Case Name Loma Linda University Medical Center vs. BlueCross BlueShield Association/United Government Services, LLC-CA	Issue Whether the denial of the Provider's request for an exception to the end stage renal disease (ERSD) composite rate by the Centers Medicare and Medicaid Services (CMS) was proper, or whether it should be deemed to have been approved pursuant to Section 188...
Decision Number 2006-D40	Case Name Loma Linda University Kidney Center vs. BlueCross BlueShield Association/United Government Services, LLC-CA	Issue Whether the denial of the Provider's request for an exception to the end stage renal disease (ERSD) composite rate by the Centers Medicare and Medicaid Services (CMS) was proper, or whether it should be deemed to have been approved pursuant to Section 188...
Decision Number 2006-D41	Case Name Comprehensive Home Care, Inc. vs. BlueCross BlueShield Association/Palmetto Government Benefits Administrators	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.
Decision Number 2006-D42	Case Name Logos Healthcare Rehabilitation, Inc. vs. BlueCross BlueShield Association/Palmetto Government Benefits Administrators	Issue Whether the Intermediary's adjustment to accounting expense was proper.
Decision Number 2006-D43	Case Name Greenwood County Hospital vs. BlueCross BlueShield Association/BlueCross BlueShield of Kansas	Issue Whether the Provider was improperly denied a Medicare low-volume adjustment.
Decision Number 2006-D44	Case Name DCH Regional Medical Center vs. BlueCross BlueShield Association/BlueCross BlueShield of Alabama	Issue Whether the Intermediary/Centers for Medicare and Medicaid Service's 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.
Decision Number 2006-D45	Case Name The Milton S. Hershey Medical Center vs. BlueCross BlueShield Association/Veritus Medicare Services	Issue Whether the CMS denial of the Provider's request for an exception to the end stage renal disease (ESRD) composite rates based on atypical service intensity and patient mix was correct.
Decision Number 2006-D46	Case Name Sisters of Charity Hospital vs. BlueCross BlueShield Association/Empire Medicare Services	Issue Whether the Intermediary properly calculated the Provider's indirect medical education (IME) reimbursement.
Decision Number 2006-D47	Case Name Rush University Medical Center vs. BlueCross BlueShield Association/AdminaStar Federal Illinois	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.
Decision Number 2006-D48	Case Name District of Columbia General Hospital vs. Blue Cross Blue Shield Association/Carefirst of Maryland	Issue Whether the Intermediary's determination of available bed days for the purpose of calculating the Provider's IME payment was accurate.
Decision Number 2006-D49	Case Name CT Subacute Corp. 93 Capital Lease Group vs. BlueCross BlueShield Association/Empire Medicare Services	Issue Whether the Intermediary's adjustments to disallow rental expense as a cost incurred with a related organization were proper.
Decision Number 2006-D50	Case Name CT Subacute Corp. 98 Protested Items Group vs. BlueCross BlueShield Association/Empire Medicare Services	Issue Whether the Intermediary's adjustments to disallow rental expense as a cost incurred with a related organization were proper.
Decision Number 2006-D51	Case Name Gundersen Lutheran Hospital vs. BlueCross BlueShield Association/United Government Services, LLC-WI	Issue Whether the denial of the Provider's request for an exception to the end stage renal disease (ERSD) composite rate was in compliance with 42 CFR 413.180(h).
Decision Number 2006-D52	Case Name Mark Reed Hospital vs. BlueCross BlueShield Association/Noridian Administrative Service	Issue 1. Whether the Intermediary's adjustment to direct nursing costs was proper. 2.Whether the Intermediary properly increased the total patient days to include respite care.
Decision Number 2006-D53	Case Name DePaul Health Center vs. Mutual of Omaha Insurance Company	Issue Whether the Intermediary's adjustment disallowing the consolidation of all of the Provider's therapy services into a single cost center was proper.
Decision Number 2006-D54	Case Name North Okaloosa Medical Center vs. BlueCross Blue ShieldAssociation/First Coast Service Options, Inc.	Issue Whether the Intermediary's adjustment of DSH reimbursement based on its determination that the Provider had less than 100 available beds for DSH eligibility purposes was proper.
Decision Number 2006-D55	Case Name Saint Anthonys Health Center vs. BlueCross BlueShield Association/AdminaStar Federal Illinois	Issue Whether the full amount of Provider's exception requests to the skilled nursing facility (SNF) routine service cost limits under 42 CFR 413.40(f) was properly denied because the Provider did not request the exceptions within 180 days of the original Notic...
Decision Number 2006-D56	Case Name Sutter Merced Medical Center vs. BlueCross BlueShield Association/United Government Services, LLC-CA	Issue Whether the Intermediary properly disallowed Medicare bad debts.
Decision Number 2006-D57	Case Name Glenwood Park, Inc. vs. BlueCross BlueShield Association/United Government Services, LLC-WI	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 (Qualified Medicare Beneficiaries or QMB...
Decision Number 2006-D58	Case Name Wilmington Treatment Center vs. BlueCross BlueShield Association/Cahaba Safeguard Administrators, LLC	Issue Whether the Intermediary's disallowance of Medicare bad debts claimed by the Provider was proper.
Decision Number 2007-D01	Case Name Iowa Lutheran Hospital vs. BlueCross/BlueShield Association/Cahaba Government Benefits Administrator	Issue Whether the Intermediary's adjustments to the Medicare cost report that disallowed the loss on disposal depreciable assets resulting from a merger were proper.
Decision Number 2007-D02	Case Name JFK- Raritan Bay- Hunterdone 03 Wage Index Group vs. BlueCross BlueShield Association/Riverbend Government Benefits Administrator	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...
Decision Number 2007-D03	Case Name Allegany County Department of Health vs. BlueCross BlueShield Association/United Government Services, LLC - WI	Issue Whether the Intermediary's adjustment to reconcile the fiscal year ending (FYE) 12/31/00 home health agency aide charges to the Provider Statistical & Reimbursement Report was proper.
Decision Number 2007-D04	Case Name Central Maine Medical Center, Lewiston, Maine vs. Blue Cross Blue Shield Association/Associated Hospital Services	Issue Whether the Intermediary's denial of the Provider's request for an adjustment to its Tax Equity and Fiscal Responsibility Act (TEFRA) target amount for the fiscal years ending (FYEs) 06/30/96 through 06/30/98 was proper.
Decision Number 2007-D05	Case Name Washington State Medicare DSH Group II vs. BlueCross BlueShield Association/Noridian Administrative Services	Issue Whether patient days related to two Washington State funded programs referred to as MI and GAU should be included in the Medicaid proxy in the Medicare DSH calculation.
Decision Number 2007-D06	Case Name Stormont-Vail Health Care vs. BlueCross BlueShield Association/Blue Cross & Blue Shield of Kansas	Issue Whether the Intermediary's revised Notice of Program Reimbursement (NPR) 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 ...
Decision Number 2007-D07	Case Name St. Joseph Regional Health Center vs. BlueCross BlueShield Association/ TrailBlazer Health Enterprises, LLC	Issue Whether the Intermediary's determination that the Provider should be reimbursed at the rural, as opposed to the urban, inpatient prospective payment system (IPPS) rate for discharges at its Grimes St. Joseph facility was proper.
Decision Number 2007-D08	Case Name Marion General Hospital vs. BlueCross BlueShield Association/TriSpan Health Services	Issue Whether the Board may grant jurisdiction for the adjustment included in the Provider's initial Notice of Program Reimbursement (NPR) pursuant to a revised NPR.
Decision Number 2007-D09	Case Name Atlantic 97 Residents in Nonhosp. Setting Group; Atlantic Health System 99 IME Group; Atlantic Health System 00 FTE Calc. Grp. Vs. BlueCross BlueShield Association/Riverbend Government Benefits Administrator	Issue Whether the Intermediary properly calculated the Provider's 1996 Indirect Medical Education (IME) base year Full-Time Equivalency (FTE) cap, specifically in regards to residents rotating to nonhospital settings.
Decision Number 2007-D10	Case Name St. Benedicts Family Medical Center vs. BlueCross BlueShield Association/ Medicare Northwest	Issue Whether the Provider's physician assistant emergency room availability costs were allowable as Medicare Part A reimbursable expenses.
Decision Number 2007-D11	Case Name Foothill Presbyterian Hospital vs. BlueCross BlueShield Association/United Government Services, LLC-CA	Issue Whether the Intermediary's determination of reimbursable Medicaid bad debts for beneficiaries without Medicaid eligibility (non-cross-over beneficiaries) was proper.
Decision Number 2007-D12	Case Name El Camino Hospital vs. BlueCross BlueShield Association/United Government Services, LLC-CA	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 ...
Decision Number 2007-D13	Case Name Rush Presbyterian- St. Lukes Medical Center (n/k/a Rush University Med. Ctr.) vs. BlueCross BlueShield Association/AdminaStar Federal-Illinois	Issue 1. Whether the Provider's transplant surgery residents should be included in the full-time equivalent (FTE) count for the purposes of both direct graduate medical education (GME) and indirect medical education (IME) reimbursement. 2. Whether the Provider ...
Decision Number 2007-D14	Case Name CHI (Catholic Health Initiatives) 1997-2002 Offshore Captive Insurance Groups vs. Mutual of Omaha Insurance Company	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 ...
Decision Number 2007-D15	Case Name P-B Health Home Care Agency, Inc. vs. BlueCross BlueShield Association/Cahaba Government Benefit Administrators	Issue Whether the Intermediary's adjustment to disallow the cost of accrued compensatory time was proper.
Decision Number 2007-D16	Case Name Martin Luther King, Jr./ Drew Medical Center vs. BlueCross BlueShield Association/United Government Services, LLC-CA	Issue Whether the Intermediary properly increased the number of available beds used to determine the Provider's indirect medical education (IME) payment.
Decision Number 2007-D17	Case Name Hi-Desert Medical Center vs. BlueCross BlueShield Association/United Government Services, LLC - CA (n/k/a National Government Services, LLC-CA)	Issue Whether the Intermediary properly limited the Provider's hospital-based 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.
Decision Number 2007-D18	Case Name Mesquite Community Hospital vs. BlueCross BlueShield Association/ Highmark Medicare Services	Issue Whether the Intermediary's adjustment of the Provider's Medicare bad debts was proper.
Decision Number 2007-D19	Case Name Sewickley Valley Hospital and The Medical Center, Beaver, PA vs. Blue Cross Blue Shield Association/Veritus Medicare Services	Issue Whether the Intermediary's denial of a loss on disposition of assets due to a consolidation of SVH and TMC was proper.
Decision Number 2007-D20	Case Name Western Reserve Care System vs. BlueCross BlueShield Association/AdminaStar Federal, Inc.	Issue 1. Whether the Intermediary's refusal to include the Provider's cost for contracted perfusionist services in its wage index calculations was proper. 2. Whether the Intermediary erred in refusing to include the Provider's cost for contracted pharmacy servi...
Decision Number 2007-D21	Case Name El Centro Regional Medical Center vs. Blue Cross Blue Shield Association/United Government Services, LLC-CA (n/k/a National Government Services, LLC-CA)	Issue Whether the Intermediary properly disallowed the Provider's regular Medicare bad debts.
Decision Number 2007-D22	Case Name Alacare Home Health Services vs. BlueCross BlueShield Association/ Palmetto Government Benefits Administrators	Issue Whether the relevant claims were timely filed by the Provider under 42 CFR 424.44.
Decision Number 2007-D23	Case Name Jordan Hospital vs. BlueCross BlueShield Association/Associated Hospital Services	Issue Whether the Intermediary's denial of the Provider's request for a new provider exemption from the routine cost limits (RCLs) was proper.
Decision Number 2007-D24	Case Name QRS 96 DSH MediKan Days Group vs. BlueCross BlueShield Association/ BlueCross & BlueShield of Kansas	Issue Whether the Intermediary's adjustment excluding secondary MediKan eligible days from the Provider's Medicare DSH calculation was proper.
Decision Number 2007-D25	Case Name Central 99-00 Dixie Diamond Ranch HO Ad. #2 (CIRP) Group; Central 98-99 Dixie Diamond Ranch HO Adj. #9 (CIRP Group) vs. BlueCross BlueShield Association/Cahaba Government Benefit Administrators	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.
Decision Number 2007-D26	Case Name St. Francis Hospital vs. BlueCross BlueShield Association/Palmetto Government Benefits Administrators	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.
Decision Number 2007-D27	Case Name North Memorial Health Care vs. BlueCross BlueShield Association/Noridian Administrative Services	Issue Whether the Provider's fiscal year ending (FYE) 2000 ambulance cost per trip limits were improperly low because the Intermediary improperly applied the 5.8 percent outpatient operating cost reduction and the 10 percent outpatient capital cost reduction to...
Decision Number 2007-D28	Case Name Decatur County General Hospital vs. BlueCross BlueShield Association/Riverbend Government Benefits Administrators	Issue Whether the Provider's fiscal years ending (FYEs) 6/30/00 and 6/30/01 ambulance cost per trip limits were improperly low because the Intermediary improperly applied the 5.8 percent outpatient operating cost reduction and the 10 percent outpatient capital ...
Decision Number 2007-D29	Case Name Arizona 96-99 DSH Group vs. BlueCross BlueShield Association/ Blue Cross and Blue Shield of Arizona (n/k/a Noridian Administrative Services)	Issue Whether Arizona's State-funded general assistance days qualify as Medicaid days for purposes of determining the Provider's Medicare disproportionate share hospital (DSH) adjustments for the fiscal years ending (FYEs) 1994 through 2000.
Decision Number 2007-D30	Case Name Via Christi Regional Medical Center vs. BlueCross BlueShield Association/BlueCross BlueShield of Kansas (n/k/a Wheatlands Administrative Services)	Issue Whether the Intermediarys computation of IME and DGME counts was correct.
Decision Number 2007-D31	Case Name Atlantic 97 FTE Cap for IME Calculation Group vs. BlueCross BlueShield Association/Riverbend Government Benefits Administrator	Issue Whether the cost report instructions improperly apply the indirect medical education (IME) FTE cap to discharges prior to October 1, 1997.
Decision Number 2007-D32	Case Name John L. Doyne Hospital vs. BlueCross BlueShield Association/United Government Services, LLC (n/k/a National Government Services, LLC)	Issue Whether the Intermediary's determination disallowing post-retirement health benefits costs for a terminated provider was proper.
Decision Number 2007-D33	Case Name Bayside Community Hospital vs. Blue Cross Blue Shield Association/Trailblazer Health Enterprises, LLC	Issue Whether the Provider is eligible to receive payment on a reasonable cost basis pursuant to 42 CFR 412.113(c) for certified registered nurse anesthesia services provided in a critical access hospital (CAH).
Decision Number 2007-D34	Case Name Sharp Chula Vista Medical Center vs. BlueCross BlueShield Association/United Government Services, LLC-CA (n/k/a National Government Services, LLC-CA)	Issue Whether the Intermediary properly excluded, from the disproporationate share hospital (DSH) Medicaid fraction, the days attribuatable to the labor and delivery portion of the stays of maternity patients who occupied licensed inpatient beds in Labor, Deliv...
Decision Number 2007-D35	Case Name Good Samaritan Regional Medical Center/Banner Health 94, 96, 97, 98, 99 DSH Calculation Groups/Samaritan 95 DSH Calculation Group vs. BlueCross BlueShield Association/BlueCross & BlueShield of Arizona	Issue Whether Arizona's State-funded general assistance days qualify as Medicaid days for purposes of determining the Provider's Medicare disproportionate share hospital (DSH) adjustments for the fiscal year in dispute.
Decision Number 2007-D36	Case Name VNA of Albany, Inc. vs. BlueCross BlueShield Association/United Government Services, LLC	Issue Whether the Intermediary's adjustment to related party transaction cost was proper.
Decision Number 2007-D37	Case Name High Country Home Health Care, Inc. vs. BlueCross BlueShield Association/Cahaba Government Benefit Administrators	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.
Decision Number 2007-D38	Case Name St. Gertrude's Health Center vs. BlueCross BlueShield Association/Noridian Administrative Services	Issue Whether the Intermediary's denial of the Provider's request for a new provider exemption from the skilled nursing facility (SNF) routine cost limits (RCLs) was proper.
Decision Number 2007-D39	Case Name E.W. Sparrow Hospital vs. BlueCross BlueShield Association/United Government Services, LLC	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 direct graduate medical education (DGME) payment.
Decision Number 2007-D40	Case Name Sierra Nevada Memorial Hospital vs. BlueCross BlueShield Association/United Government Services, LLC	Issue Whether the Provider's regular Medicare outpatient bad debts are not allowed until all collection efforts, including those of a collection agency, have ceased.
Decision Number 2007-D41	Case Name Newport Bay Hospital vs. Mutual of Omaha Insurance Company	Issue Whether the Intermediary's denial of the Provider's request for an adjustment to its Tax Equity and Fiscal Responsibility Act (TEFRA) target amount was proper.
Decision Number 2007-D42	Case Name Carolina Medicorp 1997 Claimed Loss Disallowance Group vs. BlueCross BlueShield Association/Cahaba Safeguard Administrators, LLC	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.
Decision Number 2007-D43	Case Name Baptist Memorial Hospital vs. BlueCross BlueShield Association/Riverbend Government Benefits Administrators	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 hospita...
Decision Number 2007-D44	Case Name Tarrant County Hospital District vs. BlueCross BlueShield Association/Trailblazer Health Enterprises, LLC	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).
Decision Number 2007-D45	Case Name Palmetto General Hospital- SNF vs. Mutual of Omaha Insurance Company	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.
Decision Number 2007-D46	Case Name Franklin Square Hospital Transitional Care Unit, Good Samaritan Hospital Comprehensive Care Unit vs. BlueCross BlueShield Association/CareFirst of Maryland, Inc. (n/k/a Highmark Medicare Services)	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.
Decision Number 2007-D47	Case Name Texas Senior Care vs. BlueCross BlueShield Association/Cahaba Government Benefit Administrators	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 th...
Decision Number 2007-D48	Case Name Spectrum Health-Kent Community Campus vs. BlueCross BlueShield Association/United Government Services, LLC (n/k/a National Government Services, LLC)	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).
Decision Number 2007-D49	Case Name Sacred heart Medical Center-Psychiatric vs. BlueCross BlueShield Association/Noridian Administrative Services (f/k/a Medicare Northwest)	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 ...
Decision Number 2007-D50	Case Name Methodist Hospitals of Memphis vs. BlueCross BlueShield Association/TriSpan Health Services	Issue Whether the Intermediary's adjustment to the Provider's per resident amount (PRA) was proper.
Decision Number 2007-D51	Case Name Aroostook Medical Center vs. BlueCross BlueShield Association/Associated Hospital Services of Maine(n/k/a National Government Services-Maine)	Issue Was CMS denial of the end stage renal disease (ESRD) composite rate exception correct based on applicable Medicare law?
Decision Number 2007-D52	Case Name Allentown-Bethlehem MSA Wage Index Group vs. BlueCross BlueShield Association/Highmark Medicare Services (f/k/a Veritus Medicare Services)	Issue Whether St. Lukes Hospital's letter of March 8, 2001 requesting corrections to its hospital wage data for its fiscal year ended 6/30/1999 satisfied the requirements established by CMS (then HCFA) set forth in 66 Fed. Reg. 39828 -39871 (Aug 1, 2001) for a ...
Decision Number 2007-D53	Case Name St. Francis Hospital vs. BlueCross BlueShield Association/Highmark Medicare Services (f/k/a Veritus Medicare Services)	Issue Whether the Intermediary's application of the reasonable compensation equivalent (RCE) limits was proper.
Decision Number 2007-D54	Case Name UPMC-Braddock Hospital vs. BlueCross BlueShield Association/Veritus Medicare Services (n/k/a Highmark Medicare Services)	Issue Whether the Intermediary's adjustments to the Medicare cost report that disallowed the loss on disposal of depreciable assets resulting from a merger were proper.
Decision Number 2007-D55	Case Name Covenant Health Care vs. BlueCross BlueShield Association/United Government Services, LLC (n/k/a National Government Services)	Issue Whether the Intermediary's determination of the Full-time Equivalent (FTE) intern and resident count for purposes of computing the Provider's Indirect Medical Education (IME) and direct Graduate Medical Education (GME) adjustments for FYEs June 30, 1999 ...
Decision Number 2007-D56	Case Name Innovis Health vs. BlueCross BlueShield Association/Noridian Administrative Services	Issue Whether the Provider is entitled to Transitional Outpatient Payments (TOPs).
Decision Number 2007-D57	Case Name University of Chicago Hospitals & Clinics vs. BlueCross BlueShield Association/National Government Services - Illinois	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 full-time equivalent (FTE) calculation.
Decision Number 2007-D58	Case Name MetroWest Medical Center vs. BlueCross BlueShield Association/Associated Hospital Services (n/k/a National Government Services-Maine)	Issue Whether the Provider's Notice of Program Reimbursement (NPR) dated September 24, 2002 was an original or a revised NPR.
Decision Number 2007-D59	Case Name Mountains Community Hospital vs. BlueCross BlueShield Association/ National Government Services, LLC - CA	Issue Whether the Intermediary properly required the use of a full years Medicaid days in the Disproportionate Share Hospital (DSH) calculation based on its interpretation of the Benefit Improvements and Protection Act (BIPA) of 2000.
Decision Number 2007-D60	Case Name Guam Memorial Hospital Authority vs. BlueCross BlueShield Association/United Government Services, LLC-CA (n/k/a National Government Services-CA)	Issue Whether the Intermediary's adjustment disallowing the Provider's claimed withholding tax expense was proper.
Decision Number 2007-D61	Case Name Montefiore Medical Center vs. BlueCross BlueShield Association/National Government Services - NY	Issue Whether the Intermediary improperly limited the Provider's hospital-based Skilled Nursing Facility (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.
Decision Number 2007-D62	Case Name Hi-Desert Medical Center vs. BlueCross BlueShield Association/National Government Services, LLC - CA	Issue Whether the Intermediary's determination of non-allowable physician office and vacant space costs was proper.
Decision Number 2007-D63	Case Name Saint Mary's Mercy Medical Center vs. BlueCross BlueShield Association/United Government Services, LLC (n/k/a National Government Services)	Issue Whether CMS correctly calculated the Medicare fraction of the disproportionate patient percentage (DPP) for purposes of the DSH payment.
Decision Number 2007-D64	Case Name Harbor Healthcare & Rehabilitation Center vs. BlueCross BlueShield Association/Empire Medicare Services (n/k/a National Government Services-NY)	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 Prov...
Decision Number 2007-D65	Case Name Baptist Memorial Hospital vs. BlueCross BlueShield Association/Riverbend Government Benefits Administrators	Issue 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).
Decision Number 2007-D66	Case Name Memorial Healthcare Center vs. BlueCross BlueShield Association/ National Government Services, LLC -WI	Issue Whether the Intermediary improperly limited the Provider's hospital-based Skilled Nursing Facility (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.
Decision Number 2007-D67	Case Name Rochester 02-03 MSA Wage Index Group vs. BlueCross BlueShield Association/Empire Medicare Services(n/k/a National Government Services-NY)	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).
Decision Number 2007-D68	Case Name St. Joseph's Hospital/St. John's Northeast Hospital vs. BlueCross BlueShield Association/Noridian Government Services	Issue 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 Memorand...
Decision Number 2007-D69	Case Name Logos Healthcare Rehabilitation Inc. vs. BlueCross BlueShield Association/ Palmetto Government Benefits Administrators	Issue Whether the Intermediary's adjustment to accounting expense was proper.
Decision Number 2007-D70	Case Name Logos Healthcare Rehabilitation Inc. vs. BlueCross BlueShield Association/ Palmetto Government Benefits Administrators	Issue 1. Did the Intermediary improperly reopen the cost report? 2. Was the Intermediary's adjustment to bad debts proper? 3. Was the Intermediary's adjustment to salaries proper?
Decision Number 2007-D71	Case Name Logos Healthcare Rehabilitation Inc. vs. BlueCross BlueShield Association/Palmetto Government Benefits Administrators	Issue 1. Was the Intermediary's adjustment to Medicare bad debts proper? 2. Were the Intermediary's adjustments to salaries - administrative proper? 3. Was the Intermediary's adjustment to salaries - physical therapy proper? 4. Was the Intermediary's adjustment...
Decision Number 2007-D72	Case Name Logos Healthcare Rehabilitation Inc. vs. BlueCross BlueShield Association/ Palmetto Government Benefits Administrators	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?
Decision Number 2007-D73	Case Name Logos Healthcare Rehabilitation of South Carolina vs. BlueCross BlueShield Association/Palmetto Government Benefits Administrators	Issue 1. Did the Intermediary improperly reopen the cost report? 2. Was the Intermediary's adjustment to Medicare bad debts proper?
Decision Number 2007-D74	Case Name Logos Healthcare Rehabilitation of South Carolina vs. BlueCross BlueShield Association/Palmetto Government Benefits Administrators	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?
Decision Number 2007-D75	Case Name Logos Healthcare Rehabilitation of South Carolina vs. BlueCross BlueShield Association/Palmetto Government Benefits Administrators	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?
Decision Number 2007-D76	Case Name Logos Healthcare Rehabilitation of South Carolina vs. BlueCross BlueShield Association/Palmetto Government Benefits Administrators	Issue 1. Was the Intermediary's adjustment to salaries proper? 2. Was the Intermediary's adjustment to contract labor proper?
Decision Number 2007-D77	Case Name Logos Healthcare Rehabilitation of Tennessee vs. BlueCross BlueShield Association/Palmetto Government Benefits Administrators	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?
Decision Number 2007-D78	Case Name Santa Barbara Cottage Hospital vs. BlueCross BlueShield Association/ National Government Services, LLC - CA	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 ...
Decision Number 2008-D01	Case Name Marion General Hospital vs. BlueCross BlueShield Association/National Government Services - Indiana	Issue Whether the rescission of the Provider's approved request for Sole Community Hospital (SCH) status was proper.
Decision Number 2008-D02	Case Name LAC 98 DSH/Non-Federal Low-Income Days Group vs. BlueCross BlueShield Association/National Government Services - CA	Issue 1. Whether the Providers are 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 i...
Decision Number 2008-D03	Case Name Bayfront Medical Center vs. BlueCross BlueShield Association/First Coast Service Options, Inc.	Issue Whether the Intermediary's disallowance of the discharges not reflected in the PS&R was proper.
Decision Number 2008-D04	Case Name Hallmark Health System, Inc. vs. BlueCross BlueShield Association/National Government Services-Maine (f/k/a Associated Hospital Service)	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.
Decision Number 2008-D05	Case Name Summer Hill Nursing Home vs. Mutual of Omaha Insurance Company	Issue Whether the Intermediary properly adjusted the Provider's Medicare bad debts.
Decision Number 2008-D06	Case Name Queen of the Valley Hospital vs. BlueCross BlueShield Association/National Government Services, LLC - CA	Issue Whether the Intermediary improperly allowed 0.54 intern and resident FTE for IME purposes on the Provider's fiscal year ending (FYE) December 31, 1996 Medicare cost report.
Decision Number 2008-D07	Case Name St. Marys Hospital - Milwaukee vs. BlueCross BlueShield Association/National Government Services, LLC-WI	Issue 1. Whether CMS properly calculated the Provider's Medicare disproportionate share hospital (DSH) adjustment by not including 52 patient days from the Supplemental Security Income (SSI) fraction. 2. Whether the Intermediary improperly calculated the Provid...
Decision Number 2008-D08	Case Name Visiting Nurse Association of Texas vs. BlueCross BlueShield Association/Palmetto Government Benefits Administrators	Issue Whether the Intermediary's disallowance of $35,390 to remove the portion of Home Health First (HHF) management fees attributable to the cost of a deferred compensation plan for executives was proper.
Decision Number 2008-D09	Case Name Medical Park Hospital vs. BlueCross BlueShield Association/Arkansas BlueCross & BlueShield	Issue Whether the Provider's Disproportionate Share Hospital (DSH) adjustment was correctly calculated.
Decision Number 2008-D10	Case Name Hackensack University Medical Center vs. BlueCross BlueShield Association/Riverbend Government Benefits Administrator	Issue Whether the Intermediary's adjustments to the Provider's direct graduate medical education and indirect medical education full-time equivalent counts were proper.
Decision Number 2008-D11	Case Name Hackensack University Medical Center vs. BlueCross BlueShield Association/Riverbend Government Benefits Administrator	Issue Whether the Intermediary erred by not including patient days attributable to certain patients, who were not eligible for Medicaid but who were given assistance under the New Jersey Charity Care Program (CCP), in the calculation of the Medicaid proxy to de...
Decision Number 2008-D12	Case Name Baptist Regional Medical Center vs. BlueCross BlueShield Association/National Government Services - Kentucky	Issue Whether the Intermediary properly adjusted Medicare bad debts accounts considered indigent by the Provider.
Decision Number 2008-D13	Case Name Covenant Health System 91, 93-97 DSH/Medicaid Proxy Group vs. Mutual of Omaha Insurance Company	Issue Whether the Intermediary's calculation of the disproportionate share hospital (DSH) payment was proper.
Decision Number 2008-D14	Case Name Riverside Center for Jewish Seniors vs. BlueCross BlueShield Association/Highmark Medicare Services	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.
Decision Number 2008-D15	Case Name Allentown Osteopathic Medical Center vs. BlueCross BlueShield Association/Veritus Medicare Services (n/k/aHighmark Medicare Services)	Issue Whether the Intermediary's adjustment, disallowing the loss claimed by the Provider, was proper.
Decision Number 2008-D16	Case Name Hillcrest Baptist Medical Center vs. BlueCross BlueShield Association/TrailBlazer Health Enterprises, LLC	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 d...
Decision Number 2008-D17	Case Name Sparrow Health 98-99 IME Managed Care Group vs. BlueCross BlueShield Association/United Government Services	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.
Decision Number 2008-D18	Case Name Mercy Center for Health Care Services vs. BlueCross BlueShield Association/AdminaStar Federal, Inc.	Issue Whether the Intermediary's adjustment disallowing the loss on disposal of depreciable assets through consolidation was proper.
Decision Number 2008-D19	Case Name North Dakota 99-01 Adjustment of FTE GME/IME Group vs. BlueCross BlueShield Association/Noridian Administrative Services	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.
Decision Number 2008-D20	Case Name HealthEast Woodwinds Hospital vs. BlueCross BlueShield Association/Noridian Administrative Services	Issue Whether the Intermediary's refusal to reimburse the Provider for capital-related costs under the hold harmless methodology was proper.
Decision Number 2008-D21	Case Name Vitality Rehab, Inc. vs. Mutual of Omaha Insurance Company	Issue Whether the Intermediary properly disallowed bad debts claimed for uncollectible deductibles and coinsurance amounts related to outpatient therapy services furnished to Medicare beneficiaries dually eligible for Medicare and Medicaid, and paid under the P...
Decision Number 2008-D22	Case Name Cooper University Hospital vs. BlueCross BlueShield Association/Riverbend Government Benefits Administrator	Issue Whether the Intermediary erred by not including patient days attributable to certain patients, who were not eligible for Medicaid but who were given assistance under the New Jersey Charity Care Program (CCP), in the calculation of the Medicaid proxy to de...
Decision Number 2008-D23	Case Name University of Texas M.D. Anderson Cancer Center vs. BlueCross BlueShield Association/TrailBlazer Health Enterprises	Issue 1. Whether the Intermediary properly disallowed the Provider's request for an adjustment to the TEFRA rate-of-increase ceiling to account for the cost of new drugs that were not approved in the 1983 base year. 2. Whether the Intermediary properly calculat...
Decision Number 2008-D24	Case Name Summit Medical Center vs. BlueCross BlueShield Association/National Government Services, LLC - CA	Issue Whether the TEFRA base year used by the Intermediary to compute a target amount for the Provider's excluded psychiatric unit for the February 28, 1998 and February 28, 1999 cost years was proper.
Decision Number 2008-D25	Case Name University of California, Davis Medical Center vs. BlueCross BlueShield Association/National Government Services, LLC - CA	Issue Whether the Intermediary properly corrected the Provider's reported payments, more than three years after the date of the original Notice of Program Reimbursement (NPR).
Decision Number 2008-D26	Case Name Loma Linda University Medical Center vs. BlueCross BlueShield Association/United Government Services, LLC - CA (n/k/a National Government Services, LLC-CA)	Issue Whether the payments for indirect medical education (IME) and direct graduate medical education (DGME) was understated as a significant number of managed care days and discharges for inpatient services for Medicare beneficiaries were not included in the c...
Decision Number 2008-D27	Case Name Oswego Medical Center vs. BlueCross BlueShield Association/Wheatlands Administrative Services	Issue Whether the Intermediary's adjustment to the Provider's claimed owners compensation was proper.
Decision Number 2008-D28	Case Name Quality Lifestyles of Mesa vs. BlueCross BlueShield Association/Cahaba Government Benefit Administrators	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.
Decision Number 2008-D29	Case Name UPHS 99/ 2000 Medicare Choice Beneficiaries Group vs. Mutual of Omaha Insurance Company	Issue Whether the Provider's reimbursement for indirect medical education (IME) and direct graduate medical education (DGME) for Medicare managed care patients was properly disallowed by the Intermediary for fiscal year 1999 and fiscal year 2000 for failure to ...
Decision Number 2008-D30	Case Name Forest Hospital vs. BlueCross BlueShield Association/National Government Services - Illinois	Issue 1. Whether the Intermediary properly adjusted Medicare bad debts. 2. Whether the Intermediary properly adjusted the Provider's treatment of asset refiling. 3. Whether the Intermediary properly adjusted public relations and marketing expenses. 4. Whether t...
Decision Number 2008-D31	Case Name Medical Center of North Hollywood vs. BlueCross BlueShield Association/National Government Services-CA	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.
Decision Number 2008-D32	Case Name Port Huron Hospital vs. BlueCross BlueShield Association/National Government Services, LLC - WI	Issue 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 ...
Decision Number 2008-D33	Case Name Oak Knoll Health Care Center vs. BlueCross BlueShield Association National Government Services	Issue 1. Whether the Provider is entitled to a new provider exemption from the skilled nursing facility (SNF) routine cost limitation (RCL) under 42 C.F.R. Section 413.30(e) for the fiscal year ending (FYE) December 31, 1995. 2. Whether the Intermediary's denia...
Decision Number 2008-D34	Case Name Henry Ford Hospital vs. BlueCross BlueShield Association/ National Government Services, LLC -WI	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 requir...
Decision Number 2008-D35	Case Name St. Vincent Mercy Medical Center vs. BlueCross BlueShield Association/National Government Services - Ohio	Issue 1. Whether outpatient observation bed days should be included in the bed count for the purpose of calculating the Provider's indirect medical education or IME reimbursement. 2. Whether to include Medicaid outpatient observation days when determining the P...
Decision Number 2008-D36	Case Name Cedars-Sinai Medical Center vs. BlueCross BlueShield Association/National Government Services	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.
Decision Number 2008-D37	Case Name Beverly Hospital vs. BlueCross BlueShield Association/Associated Hospital Services	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...
Decision Number 2008-D38	Case Name Polyclinic Medical Center vs. Blue Cross Blue Shield Association/ Veritus Medicare Services (n/k/a Highmark Medicare Services)	Issue Whether the Intermediary's adjustments to the Provider's cost report that disallowed the loss on disposal of depreciable assets through consolidation were proper.
Decision Number 2008-D39	Case Name Harrisburg Hospital/ Seidle Memorial Hospital vs. Blue Cross Blue Shield Association/Veritus Medicare Services (n/k/a Highmark Medicare Services)	Issue Whether the Intermediary's adjustments to the Provider's cost report that disallowed the loss on disposal of depreciable assets through consolidation were proper.
Decision Number 2008-D40	Case Name Marias Medical Center vs. BlueCross BlueShield Association/Blue Cross and Blue Shield of Montana	Issue Whether the Intermediary properly denied reimbursement of the Certified Registered Nurse Anesthetist (CRNA) standby costs.
Decision Number 2008-D41	Case Name Munson Medical Center vs. BlueCross BlueShield Association/National Government Services, LLC - WI	Issue Whether the Intermediary correctly limited the Provider's ambulance reimbursement to its charges.
Decision Number 2008-D42	Case Name Oakwood Healthcare System 1992-2001 Capital Prosp. Rate Sys. Hosp. Spec. Rate Determination Grp vs. BlueCross BlueShieldAssociation/National Government Services, LLC - WI	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...
Decision Number 2008-D43	Case Name Tulsa Regional Medical Center vs. BlueCross BlueShield Association/Chisholm Administrative Services (f/k/a Blue Cross of Oklahoma)	Issue Whether the Intermediary properly adjusted the Provider's indirect medical education full-time equivalent (FTE) cap.
Decision Number 2008-D44	Case Name Cancer Treatment Center of Tulsa vs. BlueCross BlueShield Association/BlueCross BlueShield of Oklahoma	Issue Whether the Intermediary properly treated the Provider as an acute care prospective payment system (PPS) facility instead of an excluded cancer hospital.
Decision Number 2008-D45	Case Name Swedish American Hospital vs. Mutual of Omaha Insurance Company (n/k/a Wisconsin Physicians Service)	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.
Decision Number 2009-D01	Case Name Roanoke 93 DSH Medicaid Percentage Group vs. BlueCross BlueShield Association/National Government Services	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.
Decision Number 2009-D02	Case Name Rochester 2004 MSA Wage Index Group vs. Blue Cross Blue Shield Association/National Government Services -NY	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 avera...
Decision Number 2009-D03	Case Name QRS 1994 DSH Medicare Managed Care and Medicaid Eligible Days Group vs. BlueCross BlueShield Asociation/Noridian Administrative Services	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)(...
Decision Number 2009-D04	Case Name Flagstaff Medical Center vs. BlueCross BlueShield Association/Noridian Administrative Services	Issue Whether the Intermediary properly calculated and applied the Provider's ambulance cost per trip limit.
Decision Number 2009-D05	Case Name Mayo Clinic Hospital vs. BlueCross BlueShield Association/Noridian Administrative Services	Issue Whether the Intermediary used proper cost-to-charge ratios in calculating the Provider's outlier payments.
Decision Number 2009-D06	Case Name Banner Health System 2000 DSH Calculation Group vs. BlueCross BlueShield Association/Noridian Administrative Services (f/k/a BlueCross BlueShield of Arizona)	Issue Whether the Provider's State-funded categories of assistance qualify as Medicaid days for purposes of determining the Provider's Medicare disproportionate share hospital adjustments (DSH) for the fiscal year 2000.
Decision Number 2009-D07	Case Name Pleasant Care Corp. Utilization Review Cost Group vs. Wisconsin Physicians Service (formerly Mutual of Omaha Insurance Company)	Issue Whether the Intermediarys adjustment to utilization review costs was proper.
Decision Number 2009-D08	Case Name Quality 89-92 Hospital Based SNF Group vs. BlueCross BlueShield Association/National Government Services, LLC - CA	Issue Whether the Centers for Medicare and Medicaid Services (CMS) methodology for determining the Provider's exception to the hospital-based skilled nursing facility cost limits was proper.
Decision Number 2009-D09	Case Name St. Luke Community Healthcare vs. BlueCross BlueShield Association/Noridian Administrative Services	Issue Whether the Intermediary's disallowance of the Provider's certified registered nurse anesthetist (CRNA) on-call costs was proper.
Decision Number 2009-D10	Case Name Kindred Healthcare 05 Bad Debts vs. Wisconsin Physicians Service (formerly Mutual of Omaha)	Issue Whether the Intermediary's adjustments to disallow Medicare bad debts written off by the Provider 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 ...
Decision Number 2009-D11	Case Name Quality Reimbursement Services (QRS)Catholic Healthcare West (CHW) DSH Labor Room Days Groups vs. Blue Cross Blue Shield Association/United Government Services, LLC -CA	Issue Whether the Intermediary improperly disallowed from the calculation of the Provider's 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 tha...
Decision Number 2009-D12	Case Name SRI 1987-1994 DSH SSI% Group vs. Blue Cross Blue Shield Association/National Government Services (IL)	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 Provider's Notices of Program...
Decision Number 2009-D13	Case Name Langley Porter Psychiatric Institute vs. BlueCross BlueShield Association/National Government Services - CA	Issue Whether the Intermediary's determination of the Provider's direct graduate medical education (DGME) payment was proper.
Decision Number 2009-D14	Case Name Harrison House of Georgetown vs. Blue Cross Blue Shield Association/Empire Medicare Services (n/k/a National Government Services)	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 pr...
Decision Number 2009-D15	Case Name St. Josephs Hospital and Health Center vs. BlueCross BlueShield Association/BlueCross BlueShield of Texas	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.
Decision Number 2009-D16	Case Name Yale-New Haven Health Services Group Appeals vs. BlueCross BlueShield Association/National Government Services	Issue Whether the Intermediary properly disallowed payments for indirect medical education (IME) and direct graduate medical education (DGME) with respect to discharges of Medicare beneficiaries who were enrolled in the Medicare Choice or other Medicare risk ...
Decision Number 2009-D17	Case Name Hospice 2009 BNAF Group/Bluegrass 2009 BNAF Group vs. Blue Cross Blue Shield Association/Palmetto Government Benefit Administrators	Issue Should the PRRB grant expedited judicial review over the question of whether the Secretary's elimination of the budget neutrality adjustment factor (BNAF) used in the calculation of hospice payment rates was proper?
Decision Number 2009-D18	Case Name Valley Presbyterian Hospital vs. BlueCross BlueShield Association/First Coast Service Options-CA	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 ...
Decision Number 2009-D19	Case Name St. Cloud Hospital vs. BlueCross BlueShield Association/Noridian Administrative Services	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 Providers fiscal years ended June 30, 1997, 1998, 1999, and 2000.
Decision Number 2009-D20	Case Name Henry Ford Health System Managed Care GME/IME Payments Group vs. BlueCross BlueShield Association/National Government Services, LLC	Issue Whether the Intermediary properly disallowed payments for indirect medical education (IME) and direct graduate medical education (DGME) with respect to discharges of Medicare beneficiaries who were enrolled in the Medicare + Choice or other Medicare risk ...
Decision Number 2009-D21	Case Name Triad 2007 Liability for Periodic Interim Payments to Former Owner Group vs. BlueCross BlueShield Association/Blue Cross Blue Shield of Georgia	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.
Decision Number 2009-D22	Case Name Mercy Hospital of Pittsburgh (n/k/a University of Pittsburgh Medical Center (UPMC)) vs. BlueCross BlueShield Association/Highmark Medicare Services (formerly Blue Cross of Western Pennsylvania)	Issue Whether interest is due on the continuing underpayments that exist as a result of the fiscal Intermediary's 10 year delay in implementing PRRB Case No. 91-2673.
Decision Number 2009-D23	Case Name Jeanes Hospital vs. Wisconsin Physicians Service (Formerly Mutual of Omaha Insurance Company)	Issue Whether the Jeanes Hospital merger was a bona fide sale.
Decision Number 2009-D24	Case Name New England Deaconess Hospital vs. Blue Cross/ Blue Shield Association/ National Government Services	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.
Decision Number 2009-D25	Case Name Connecticut 94 thru 98 DSH Group vs BlueCross BlueShield Association National Government Services	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 app...
Decision Number 2009-D26	Case Name National DSH Dual Eligible Group Appeal vs. Blue Cross Blue Shield Association/ National Government Services	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.
Decision Number 2009-D27	Case Name St. Marys Hospital-Milwaukee vs. Blue Cross Blue Shield Association/National Government Services, LLC-WI	Issue Whether the Intermediary improperly calculated the Provider's Medicare DSH adjustment by excluding 365 Long Term Respiratory Unit (LTRU) patient days from the Medicaid proxy of the DSH calculation.
Decision Number 2009-D28	Case Name Lunch Hour Dispute Wage Index Group Appeals vs. BlueCross BlueShield Association/ National Government Services, Inc. -IL (formerly AdminaStar Federal, Inc.)	Issue Whether paid lunch period time should be added to hours used to calculate the Provider's hourly wage rates.
Decision Number 2009-D29	Case Name St. Francis Regional Medical Center vs. Blue Cross Blue Shield Association/ Blue Cross Blue Shield of Kansas	Issue Whether the Intermediary's adjustments disallowing a loss claimed by the Provider upon its consolidation with St. Joseph Medical Center to form Via Christi Regional Medical Center was proper.
Decision Number 2009-D30	Case Name SRI 1998 DSH Medicare Part C Days Group vs. Blue Cross Blue Shield Association/Noridian Administrative Services	Issue Whether the exclusion of patient days attributable to Medicare+Choice (M+C) enrollees from the Medicaid fraction in calculating the Provider's disproportionate patient percentage contravenes the statute and regulations.
Decision Number 2009-D31	Case Name College Station Medical Center Part C Days Group vs. Wisconsin Physicians Service	Issue Whether the Intermediary properly excluded observation bed days for purposes of determining whether the Provider had less than 100 available beds for disproportionate share hospital (DSH) eligibility purposes.
Decision Number 2009-D32	Case Name Sharp Coronado Hospital and HealthCare Center vs. Blue Cross /Blue Shield Association United Government Services, LLC - CA	Issue 1. Whether the Intermediary's calculation of the Provider's disproportionate share hospital (DSH) payments, as it pertains to sub-acute unit days, was proper. 2. Whether the Intermediary's calculation of the Provider's DSH payments, as it pertains to Medi...
Decision Number 2009-D33	Case Name Cleveland Regional Medical Center vs. Wisconsin Physicians Service	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.
Decision Number 2009-D34	Case Name Whidden Memorial Hospital vs. Blue Cross Blue Shield Association	Issue 1. Whether the Intermediary's audit adjustments disallowing the entire loss on the disposition of assets claimed by the Provider, when the Provider corporation merged with another provider corporation, were proper. 2. Whether the Intermediary properly den...
Decision Number 2009-D35	Case Name Allina 1995-2003 DSH Dual Eligible Days Group vs. Blue Cross /Blue Shield Association/Noridian Administrative Services	Issue Whether it was proper for the Intermediary to exclude from the Medicaid fraction, patient days associated with patients who were dually eligible for both Medicare and Medicaid, but for which Medicare did not cover the days, nor make a payment.
Decision Number 2009-D36	Case Name Select Medical 2002-2003 Freestanding New Hospital Capital-Related Costs Groups vs. Wisconsin Physicians Service	Issue Whether the Intermediary's adjustments to the Provider's reimbursable capital cost after denying new hospital status was proper.
Decision Number 2009-D37	Case Name Canonsburg General Hospital vs. BlueCross BlueShield Association	Issue Whether CMS' methodology for determining the Provider's exception to the hospital-based skilled nursing facility (HB-SNF) routine cost limits was proper.
Decision Number 2009-D38	Case Name Southwest Consulting 1999-2002 State of MA Uncompensated Care Days Group vs. Blue Cross Blue Shield Association/Associated Hospital Services	Issue Whether the Intermediary properly computed the numerator of the Medicaid fraction that was used to calculate the Provider's disproportionate share hospital (DSH) payments for fiscal years (FYs) 1999, 2000, 2001 and 2002 by excluding inpatient days attribu...
Decision Number 2009-D39	Case Name Southwest Consulting 95-01 Disproportionate Share Hospital Georgie Indigent Care Trust Fund vs. Blue Cross Blue Shield Association/Blue Cross Blue Shield of Georgia	Issue Whether the hospital days attributable to individuals who applied to the Provider's 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 fr...
Decision Number 2009-D40	Case Name National Parkinson Foundation CORF; NPF Rehab of Florida/Pompano NPF Florida North Miami Beach vs. BlueCross BlueShield Association/First Coast Service Options, Inc.	Issue Whether the Intermediary's adjustments reflected in the revised Notices of Program Reimbursement (NPR), that reduced allowable home office costs, were proper.
Decision Number 2009-D41	Case Name Kingston Hospital vs. BlueCross BlueShield Association/National Government Services, New York (formerly Empire Medicare Services)	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.
Decision Number 2009-D42	Case Name Kindred Hospital-Kansas City; Kindred Hospital-St. Louis vs. Wisconsin Physician Services	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.
Decision Number 2010-D01	Case Name University Hospital vs. BlueCross BlueShield Association/TrailBlazer Health Enterprises, LLC	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.
Decision Number 2010-D02	Case Name Select Medical 2003-2006 New Hospital Capital-Related Costs Groups vs. Wisconsin Physicians Service (formerly Mutual Of Omaha Insurance)	Issue Whether the Intermediary's adjustments to the Provider's reimbursable capital costs after denying new hospital status was proper.
Decision Number 2010-D03	Case Name Crozer-Keystone Hospital Specific 2007 Wage Index Rural Floor Group vs. Blue Cross and Blue Shield Association	Issue Whether the Board properly denied jurisdiction over the issue of whether CMS erred in calculating a budget neutrality adjustment to the Inpatient Prospective Payment System (IPPS) standardized amount to account for the effect of the rural floor on the wag...
Decision Number 2010-D04	Case Name Royal Oaks Hospital vs. BlueCross BlueShield Association/TriSpan Health Services	Issue Whether the Intermediary properly declined to establish a per-resident amount (PRA) and full-time equivalent (FTE) cap applicable to Providers graduate medical education (GME) costs.
Decision Number 2010-D05	Case Name New Jersey 2000/2001/2002 Charity Care DSH Groups vs. Blue Cross Blue Shield Association/Riverbend Government Benefits Administrator	Issue Whether the Intermediary properly excluded New Jersey Charity Care Program (NJCCP) days from the Medicare disproportionate share (DSH) calculation for fiscal year ending (FYEs) 2000 through 2002 for the hospitals in this group appeal.
Decision Number 2010-D06	Case Name Greenville Hospital Center vs. Blue Cross Blue Shield Association/Palmetto Government Benefits Administration	Issue Whether the Intermediary's disallowance of resident time spent in didactic activities for purposes of the indirect medical education (IME) adjustment was proper.
Decision Number 2010-D07	Case Name Mercy Medical Center vs. Wisconsin Physician Services	Issue Whether the Intermediary improperly calculated the Provider's Medicare disproportionate share hospital (DSH) payment by excluding patient days attributable to hospital inpatients who were eligible for Medicaid and enrolled in Medicare Part A for all or a ...
Decision Number 2010-D08	Case Name Autumn Bridge, LLC vs. Blue Cross Blue Shield Association/Palmetto Government Benefits Administrators	Issue 1. Whether the Provider has demonstrated that it is entitled to a hearing before the Board because there is $10,000 in controversy. 2. To what extent, if at all, Medicare's $720,991 demand for repayment from the Provider for fiscal year 2006 would be decr...
Decision Number 2010-D09	Case Name City of Hope National Medical Center vs. BlueCross BlueShield Association/First Coast Services Option, Inc.	Issue Whether the Provider timely filed its Tax Equity and Fiscal Responsibility Act (TEFRA) exception request.
Decision Number 2010-D10	Case Name Genesis Health 96 Salaries of Therapists Group vs. BlueCross and BlueShield Association/First Coast Service Options, Inc.	Issue Whether the Intermediary's deletion of therapy costs from line 25, column 9 of Worksheet B-1 of the Provider's Medicare cost reports is proper and in accordance with Medicare cost reporting practices and procedures.
Decision Number 2010-D11	Case Name HCA 01 Outpatient Therapy Bad Debts Group vs. Wisconsin Physician Services	Issue Whether the Intermediary properly disallowed reimbursement for the Provider's uncollected coinsurance and deductible amounts relating to outpatient therapy services, paid under the Medicare Part B fee schedule, and claimed as a bad debt for the Provider's...
Decision Number 2010-D12	Case Name Ober Kaler 2005 and 2006 Illinois Provider Tax Groups, Southern Illinois Hospital Services 2005 and 2006 Illinois Provider Tax Groups, Memorial Health System 2005 Illinois Provider Tax Group, Blessing Health System 2005 Illinois Provider Tax Group vs. Blu...	Issue Whether the Intermediary's disallowance of the Illinois property tax assessment was proper.
Decision Number 2010-D13	Case Name Royal Coast Rehabilitation Center vs. Blue Cross Blue Shield Association/First Coast Services Options, Inc.	Issue Whether the Intermediary's adjustment disallowing bad debts arising from coinsurance and deductibles for dual eligible Medicare and Medicaid beneficiaries was proper.
Decision Number 2010-D14	Case Name Mercy Hospital vs. BlueCross BlueShield Association,First Coast Services Option	Issue Whether the Provider has a right to a hearing on correction of its cost report to reclassify certain nurse expenses.
Decision Number 2010-D15	Case Name Affinity Medical Center vs. BlueCross BlueShield Association/National Government Services	Issue Whether the Board has jurisdiction over the resident-to-bed ratio where an alleged error in the filed cost report was discovered by the Provider after the final determination was issued.
Decision Number 2010-D16	Case Name Chestnut Hill Benevolent Association vs. Blue Cross/Blue Shield Association/ Riverbend Government Benefits Administration	Issue Whether the Intermediary improperly reclassified the Provider's nursing school costs and related statistics to a non-reimbursable cost center.
Decision Number 2010-D17	Case Name Broadview, Inc. vs. Blue Cross/Blue Shield Association/ Riverbend Government Benefits Administration	Issue Whether the Intermediary improperly reclassified the Provider's nursing school costs and related statistics to a non-reimbursable cost center.
Decision Number 2010-D18	Case Name Arden Wood, Inc. vs. Blue Cross/Blue Shield Association/ Riverbend Government Benefits Administration	Issue Whether the Intermediary improperly reclassified the Provider's nursing school costs and related statistics to a non-reimbursable cost center.
Decision Number 2010-D19	Case Name The Leaves, Inc. vs. Blue Cross/Blue Shield Association/ Riverbend Government Benefits Administration	Issue Whether the Intermediary improperly reclassified the Provider's nursing school costs and related statistics to a non-reimbursable cost center.
Decision Number 2010-D20	Case Name SD 94/95/96-97 Inpatient Crossover Bad Debts Groups/Sharp HC 97 Inpatient Unproc Crossover Bad Debts Group vs. Blue Cross Blue Shield Association/National Government Services, Inc.	Issue Whether the Providers have been properly paid for bad debts for Medicare deductible and coinsurance amounts associated with Medicaid eligible inpatients for services between May 1, 1994 and June 30, 1998.
Decision Number 2010-D21	Case Name Reflections Wellness Center, Inc. vs. Blue Cross Blue Shield Association/First Coast Services Options, Inc.	Issue Whether the Intermediary's adjustment disallowing bad debts arising from coinsurance and deductibles for dual eligible Medicare and Medicaid beneficiaries was proper.
Decision Number 2010-D22	Case Name Nazareth Hosptial and St. Agnes Medical Center vs. Blue Cross Blue Shield Association/Noridian Administrative Services	Issue Whether general assistance (GA) days should be added to the numerator of the Medicaid proxy in the disproportionate share (DSH) payment calculation.
Decision Number 2010-D23	Case Name Life Care Center of Scottsdale vs. Blue Cross Blue Shield Association/National Government Services, Inc.	Issue Whether the CMS must-bill policy applies to the Provider's dual eligible bad debts when the Provider does not participate in the Medicaid program.
Decision Number 2010-D24	Case Name The Queens Medical Center vs. BlueCross BlueShield Association/First Coast Services Options, Inc.-CA	Issue Whether the Intermediary improperly excluded patient days associated with patients who were dually eligible for both the Medicare and Medicaid programs but for such days there was no Medicare Part A payment or coverage available (dual eligible days) from ...
Decision Number 2010-D25	Case Name Select Specialty 05 Medicare Dual Eligible Bad Debts Group vs. Blue Cross Blue Shield Association/Wisconsin Physicians Service	Issue Whether the CMS must-bill policy applies to the Provider's dual eligible bad debts when the Providers does not participate in the Medicaid program.
Decision Number 2010-D26	Case Name QRS Medicare Part A Title XIX Eligible Patient Days Group I vs. Blue Cross Blue Shield Association/Noridian Administrative Services	Issue Whether Medicaid eligible days for Medicare Part A patients should be considered for inclusion in either the Medicaid fraction or the Medicare Supplemental Security Income percentage of the disproportionate share hospital (DSH) adjustment payments.
Decision Number 2010-D27	Case Name Saint Barnabas 2000-2004 DSH Adjustment Groups Appeal And St. Peters University Hospital vs. Blue Cross Blue Shield Association/Riverbend Government Benefits Administrator	Issue Whether the Intermediary underpaid the Provider's fiscal years 2000 through 2004 Medicare operating and capital disproportionate share hospital (DSH) adjustments by not including the Provider's New Jersey Charity Care Program (NJCCP) inpatient days from t...
Decision Number 2010-D28	Case Name Benedictine Hospital vs. BlueCross BlueShield Assocation/National Government Services- New York (formerly Empire Medicare Services)	Issue Whether the Intermediary properly adjusted the Provider's family practice residency program direction graduate medical education (DGME) and indirect graduate medical education (IME) full-time equivalent (FTE) count for the fiscal year ending December 31, ...
Decision Number 2010-D29	Case Name Hope Horizon Center, Inc. and Homestead Behavioral Clinic, Inc. vs. Blue Cross Blue Shield Association/First Coast Service Options, Inc.	Issue Whether the Intermediary's adjustment disallowing bad debts arising from coinsurance and deductibles for dual eligible Medicare and Medicaid beneficiaries was proper.
Decision Number 2010-D30	Case Name Medical College of Georgia Hospital vs. Blue Cross Blue Shield Association/Cahaba Government Benefits Administrators-GA	Issue Whether the Board had jurisdiction over the Provider's appeals of the question of whether the disproportionate share (DSH) adjustment was incorrectly determined due to a significant error in the Supplemental Security Income (SSI) percentage where the requ...
Decision Number 2010-D31	Case Name Medical College of Georgia Hospital vs. Blue Cross Blue Shield Association/Cahaba Government Benefits Administrators-GA	Issue Whether the Board had jurisdiction over the Provider's appeals of the question of whether the disproportionate share (DSH) adjustment was incorrectly determined due to a significant error in the Supplemental Security Income (SSI) percentage where the requ...
Decision Number 2010-D32	Case Name Clinton Memorial Hospital vs. Blue Cross Blue Shield Association/National Government Services, Inc.	Issue Whether outpatient observation bed days should be included in the bed count for the purpose of calculating the Provider's indirect medical education (IME) reimbursement.
Decision Number 2010-D33	Case Name UPMC 2001-2007 DSH Medical Assistance Under State Medicaid Plan Groups vs. Blue Cross Blue Shield Association/Highmark Medicare Services-PA Administrator	Issue Whether days for which patients received charity care in Pennsylvania were required by the Medicare statute to be included in the numerator of the Medicaid proxy of the Medicare DSH calculation.
Decision Number 2010-D34	Case Name Canon Healthcare Hospice	Issue Whether the Intermediary followed the proper reopening procedures prior to the issuance of the Intermediary's letter dated June 11, 2007 (Notice of Effect of Inpatient Day Limitation and Hospice Cap Amount) recalculating the hospice cap for years ending O...
Decision Number 2010-D35	Case Name Toyon 85-98 112% Hospital-Based Peer Group Mean; Catholic Healthcare West 96-98 112% Hospital-Based Peer Group Mean; Sutter Health 91-99 112% Hospital-Based Peer Group Mean; St. Joseph Health System 92-98 112% Hospital-Based Peer Group Mean; Toyon 1999...	Issue Whether CMS' methodology for determining the Provider's exception to the hospital-based skilled nursing facility (SNF) cost limits was proper.
Decision Number 2010-D36	Case Name Southwest Consulting 2004 DHS Dual Eligible Days Group; CHI 2004 Dual Eligible Days Group; Caritas Christi Health Care 2004 DSH Dual Eligible Days Group vs. Blue Cross Blue Shield Association/Wisconsin Physician Services/National Government Servs. ME	Issue Whether the Board had jurisdiction to grant the Provider's request for EJR over the validity of the provisions of the CMS Ruling CMS-1498-R.
Decision Number 2010-D37	Case Name Carney Hospital Transitional Care Unit vs. BlueCross BlueShield Association/National Government Services	Issue Whether the Intermediary's denial of the Provider's request for a new provider exemption from the Medicare routine service cost limits (RCLs) for skilled nursing facilities (SNFs) was proper in light of the standards set forth in "St. Elizabeth Medical Ce...
Decision Number 2010-D38	Case Name King & Spalding Inclusion of Medicare Advantage Days in 2007 SSI Ratios Group/Shands HealthCare Inclusion of Medicare Advantage Days in 2007 SSI Ratios Group/North Shore-Long Island Jewish HS Inclusion of Medicare Advantage Days in 2007 SSI Ratios Group v...	Issue Whether the Board properly granted jurisdiction over the Provider's request for expedited judicial review (EJR) over the question of whether Medicare Part C days should be excluded from the numerator and denominator of the Supplemental Security Income (SS...
Decision Number 2010-D38-R	Case Name Allina Health Services, et. al. vs. Sylvia M. Burwell, Secretary, Department of Health and Human Services	Issue Whether enrollees in Medicare Part C are "entitled to benefits" under Part A, as that phrase is used at section 1886(d)(5)(F)(vi)(I) of the Social Security Act, and, therefore, whether these days should be counted in the numerator and denominator of the "...
Decision Number 2010-D39	Case Name Salt Lake Regional Medical Center vs. BlueCross BlueShield Association/Noridian Administrative Services	Issue Whether the Board had jurisdiction to grant the Provider's request for expedited judicial review (EJR) over the validity of the provisions of the CMS Ruling CMS-1498-R.
Decision Number 2010-D40	Case Name Adventist DSH Waiver Days Group vs. BlueCross BlueShield Association/First Coast Service Options, Inc.	Issue Whether the Intermediary properly exluded expansion wavier days from the Provider's Medicare disproportionate share hospital (DSH) calculation for days attributable to patients who received medical assistance through Tennessee's Medicaid demonstration pro...
Decision Number 2010-D41	Case Name Norfolk MSA 2004 Wage Index Group vs. BlueCross BlueShield Association/National Government Services, Inc.-WI	Issue Whether the Intermediary erred in excluding certain contract labor costs, home office costs, and wage-related costs that were claimed by Bon Secours-DePaul Medical Center, Maryview Medical Center, and Mary Immaculate Hospital and used to calculate the fed...
Decision Number 2010-D42	Case Name St. Joseph Mercy Hospital-Oakland vs. BlueCross BlueShield Association/National Government Service-WI	Issue Whether the Medicare Proxy component of the disproportionate share hospital (DSH) adjustment must be remanded to the Intermediary without adjudication by the Board pursuant to CMS Ruling 1498-R.
Decision Number 2010-D43	Case Name Palmetto General Hospital- Skilled Nursing Facility vs. Wisconsin Physicians Service	Issue In light of the August 29, 2007 Remand Order from the Administrator of the Centers for Medicare and Medicaid Services, what is the proper regulation and manual provision to apply to the facts of this case and what is the relevance of the Provider's cost r...
Decision Number 2010-D44	Case Name Southcrest Hospital vs. Wisconsin Physicians Service	Issue Whether the Provider, as a new provider, is entitled to the hold-harmelss payment methodology under the capital prospective payment system beyond the 10-year transition period.
Decision Number 2010-D45	Case Name University Medical Center vs. Blue Cross and Blue Shield Association	Issue 1. Whether the Intermediary properly excluded resident rotations for research and scholarly activities when calculating the resident full time equivalent (FTE) count for indirect medical education (IME) adjustment purposes. 2. Whether the Intermediary'...
Decision Number 2010-D46	Case Name Davies Medical Center vs. BlueCross BlueShield Association/First Coast Service Options, Inc.	Issue Whether the Intermediary properly denied the Provider's Tax Equity and Fiscal Responsibility Act (TEFRA) exception request.
Decision Number 2010-D47	Case Name Illinois Masonic Medical Center vs. BlueCross BlueShield Association/ National Government Services, Inc.	Issue Whether the Board has jurisdiction over Medicaid eligible days that were not specifically considered within the implementation of a revised Notice of Program Reimbursement (NPR).
Decision Number 2010-D48	Case Name Southwest Consulting DSH SSI Group Appeals- Consolidated Pilot Project vs. Blue Cross Blue Shield Association/ Wisconsin Physician Services	Issue Whether the Board has jurisdiction to grant the Provider's request for expedited judicial review (EJR) over the validity of the provisions of the CMS Ruling CMS-1498-R.
Decision Number 2010-D49	Case Name Interim Health Care of Oklahoma City vs. BlueCross BlueShield Association/ Palmetto Government Benefits Administrator	Issue Whether the Provider demonstrated that the amount in controversy under 42 C.F.R. 405.1875 was satisfied.
Decision Number 2010-D50	Case Name Walter O. Boswell Memorial Hospital vs. Blue Cross /Blue Shield Association/AdminaStar Federal Illinois	Issue 1. Whether the Provider's nursing education program qualified as provider-operated. 2. Whether, assuming the Provider's nursing education program did not qualify as provider-operated, the Provider is entitled to receive an additional payment to account...
Decision Number 2010-D51	Case Name University of Louisville Hospital vs. BlueCross BlueShield Association/National Government Services	Issue Whether the Intermediary properly reduced the Provider's number of resident full-time equivalents (FTEs) used for purposes of Medicare direct graduate medical education (GME) and indirect graduate medical education (IME) payment based on its contention th...
Decision Number 2010-D52	Case Name Southwest Consulting DSH Medicare+Choice Days Group Appeals vs. BlueCross BlueShield Association/NHIC Corp. c/o National Government Services/ Wisconsin Physicians Service, And Noridian Administrative Services	Issue Whether Medicare+Choice (M+C) days should be included in the Medicaid fraction used to calculate the disproportionate share hospital (DSH) adjustment.
Decision Number 2010-D53	Case Name Henry Ford Health System vs. Blue Cross BlueShield Association/National Government Services, LLC	Issue 1. Whether the Intermediary properly determined the Provider's full-time equivalent (FTE) counts used for purposes of calculating payment for direct graduate medical education (GME) and indirect medical education (IME) based on its exclusion of residents...
Decision Number 2011-D01	Case Name Kaiser Foundation Hospitals Southern California 1999-2003 FTE Cap Group Appeals vs. Palmetto GBA/First Coast Service Options	Issue Whether the Intermediary has improperly adjusted the Providers' direct graduate medical education (GME) intern and resident full-time (FTE) counts for their respective fiscal years ended (FTEs) 12/31/1999 through 12/31/2003 by disallowing various FTEs ass...
Decision Number 2011-D02	Case Name Penrose/St. Francis Health Services vs. Wisconsin Physicians Service, Inc.	Issue Whether the Intermediary improperly recouped alleged overpayments resulting from an incorrect cost-to-charge ratio (CCR) calculated and applied by the Intermediary to determine outlier payments made to the Provider for inpatient rehabilitation services fu...
Decision Number 2011-D03	Case Name Diversicare 05-06 Medicare Bad Debts Group vs. Blue Cross Blue Shield Association/National Government Services, Inc.	Issue Whether the Intermediary's adjustments to the Provider's Medicare bad debts were proper.
Decision Number 2011-D04	Case Name Sonoma Valley Health Care District vs. BlueCross BlueShield Association/United Government Services, LLC	Issue Whether the Intermediary's reclassification of clinic meals statistics on Worksheet B-1 from the reimbursable "clinic" cost center to a non-reimbursable cost center was proper.
Decision Number 2011-D05	Case Name Unique Care Home Health vs. BlueCross BlueShield Association/Palmetto Government Benefits Administrators, LLC	Issue Whether the Provider Statistical and Reimbursement Reports (PS&Rs) used to settle the Provider's cost reports for the fiscal years ended May 31, 1998 and March 17, 1999 were accurate.
Decision Number 2011-D06	Case Name UPMC 2003-2006 Count of FTE Resident CIRP Groups vs. BlueCross BlueShield Association/Highmark Medicare Services	Issue Whether the Intermediary/Medicare Administrative Contractor properly calculated the Provider's 1996 resident cap for purposes of direct graduate medical education and indirect graduate medical education payments.
Decision Number 2011-D07	Case Name Marian Medical Center vs. Blue Cross Blue Shield Association/National Government Services (n/k/a First Coast Service Options-California)	Issue Whether a loss on disposal of assets is required to be recognized by Medicare as a result of the April 24, 1997 statutory merger of the Provider.
Decision Number 2011-D08	Case Name Autumn Bridge LLC vs. BlueCross BlueShield Association/Palmetto Government Benefits Administrators	Issue 1. Whether the Provider demonstrated that it is entitled to a hearing before the Board because there is at least $10,000 in controversy. 2. To what extent, if at all, Medicare's $397,228 demand for repayment from the Provider for fiscal year 2007, calcula...
Decision Number 2011-D09	Case Name Various Charity Care/Ohio HCAP DSH Group Appeals vs. Blue Cross Blue Shield Association/National Government Services, Inc.	Issue Whether the Intermediary properly excluded the Ohio Hospital Care Assurance Program (HCAP) days from the Medicare disproportionate share hospital (DSH) calculation.
Decision Number 2011-D10	Case Name Indiana DSH-HCI Days Groups I-V vs. BlueCross BlueShield Association/National Government Services, Inc.	Issue Whether the Intermediary's non-inclusion of the Indiana Hospital Care for the Indigent (HCI) program patient days as Medicaid eligible days, whether paid or unpaid, in the calculation of the Medicaid proxy for Medicare Disproportionate Share Hospital (DSH...
Decision Number 2011-D11	Case Name Coosa Valley Medical Center vs. BlueCross BlueShield Association/ Cahaba Government Benefits Administrators, LLC	Issue Whether the Centers for Medicare and Medicaid Services reversal of the Provider's rural referral center (RRC) classification was proper.
Decision Number 2011-D12	Case Name Various Genesis Health Care Corporation Providers vs. Blue Cross Blue Shield Association/Highmark Medicare Services	Issue Whether the Intermediary properly adjusted the Providers' bad debts, based on reasonable collection efforts and the "must bill" policy, for the fiscal year ended December 31, 2004.
Decision Number 2011-D13	Case Name Western Medical Center- Santa Ana vs. BlueCross BlueShield Association/First Coast Service Options-CA	Issue Whether it was proper for CMS to reduce by two percent the Medicare annual payment update for the Provider for federal fiscal year 2008.
Decision Number 2011-D14	Case Name Yale New Haven HS 2001-2004 DSH SAGA Days Groups vs. Blue Cross Blue Shield Association/National Government Services, Inc.	Issue Whether the Intermediary's exclusion of days identified by the group as inpatient days attributable to individuals who received medical assistance under the Connecticut State-Administered General Assistance (SAGA) program from the Medicare disproportionat...
Decision Number 2011-D15	Case Name Pacific Alliance Medical Center vs. Wisconsin Physician Service	Issue Whether the Provider is entitled to the full market basket update for Federal Fiscal Year ending 2009 under the Reporting Hospital Quality Data for Annual Payment Update Program.
Decision Number 2011-D16	Case Name Columbia Memorial Hospital vs. Blue Cross Blue Shield Assn./National Government Services, Inc.	Issue Whether CMS' determination to reduce the Provider's inpatient prospective payment system market basket update for federal fiscal year (FY) 2009 by two (2.0) percentage points was proper.
Decision Number 2011-D17	Case Name Charleston Area Medical Center vs. Blue Cross and Blue Shield Association/United Government Services	Issue Whether the provider has a right to a hearing on certain graduate medical education costs and kidney acquisition costs that were not claimed on the cost report.
Decision Number 2011-D18	Case Name George Washington University Hospital vs. Wisconsin Physicians Service	Issue Whether the Intermediary properly extrapolated the sample error rate to the population in adjusting Medicaid eligible days.
Decision Number 2011-D19	Case Name QRS 1999-2003 DSH Medicare Part C Days Groups vs. BlueCross BlueShield Association/ Noridian Administrative Services, LLC; National Government Services, LLC; TrailBlazer Health Enterprises, LLC; and Wisconsin Physicians Service	Issue Whether Medicare+Choice (M+C) days should be included in the Medicaid fraction used to calculate the disproportionate share hospital (DSH) adjustment.
Decision Number 2011-D20	Case Name QRS 1995-1998 DSH Medicare HMO Days Groups vs. Blue Cross Blue Shield Association; Noridian Administrative Services - National Government Services - Trailblazer Health Enterprises	Issue Whether for fiscal years 1995-1998 the Intermediary should include dual-eligible, Medicare health maintenance organization (HMO) patient days in the Medicaid proxy in determining Medicare reimbursement for disproportionate share hospital (DSH) payments in...
Decision Number 2011-D21	Case Name McCamey Hospital and Convalescent Center vs. BlueCross BlueShield Association/Trailblazer Health Enterprises, LLC	Issue Whether the Provider is entitled to payment of "fair compensation" pursuant to 42 C.F.R.Section 413.13.
Decision Number 2011-D22	Case Name Rankin County Hospital District vs. BlueCross BlueShield Association/Trailblazer Health Enterprises, LLC	Issue Whether the Provider is entitled to payment of "fair compensation" pursuant to 42 C.F.R Section 413.13.
Decision Number 2011-D23	Case Name Memorial Hermann Hospital vs. BlueCross BlueShield Association/Trailblazer Health Enterprises, LLC	Issue Whether the Intermediary properly disallowed the loss claimed by Hermann Hospital representing a complete write-off of the book value of its depreciable assets as a result of the merger with the Memorial Hospital System.
Decision Number 2011-D24	Case Name QRS 1996 DSH MediKan Days Group vs. Wisconsin Physicians Services	Issue Whether in light of the hold harmless provision of PM A-99-62 and A-01-13, the Intermediary should include all MediKan patient days, primary and secondary, in the Medicaid Proxy used to compute the Provider's disproportionate share hospital (DSH) adjustme...
Decision Number 2011-D25	Case Name John L. Doyne Hospital vs. BlueCross BlueShield Association/National Government Services - WI	Issue Whether the Provider's post-retirement health benefit costs are allowable costs in the Provider's terminating cost report under Provider Reimbursement Manual (PRM) Section 2176.
Decision Number 2011-D26	Case Name Canon Healthcare Hospice vs. Blue Cross Blue Shield Association/Palmetto Government Benefits Administration	Issue Whether a full or partial waiver is permissible for the Provider's hospice inpatient day limitation overpayment for the cap year November 1, 2004 through October 31, 2005.
Decision Number 2011-D27	Case Name Kaleida Health vs. BlueCross BlueShield Association/National Government Services	Issue 1. Whether the Intermediary's adjustment of the Provider's direct Graduate Medical Education (GME) per resident amount was proper. 2. Whether the Intermediary properly excluded research time the Provider alleges was related to patient care from the FTE re...
Decision Number 2011-D28	Case Name Valley Presbyterian Hospital vs. BlueCross BlueShield Association/First Coast Service Options - California	Issue Whether CMS properly reduced the Provider's federal fiscal year (FFY) 2008 inpatient prospective payments system market basket adjust by two (2.0) percentage points.
Decision Number 2011-D29	Case Name Memorial Hospital of Salem County vs. BlueCross BlueShield Association/Highmark Medicare Services (formerly Riverbend Government Benefits Administrator)	Issue Whether the Intermediary properly included all appropriate Medicaid eligible days in calculating the Provider's disproportionate patient percentage for purposes of the Medicare disproportionate share hospital (DSH) adjustment under the Prospective Payment...
Decision Number 2011-D30	Case Name Universal Health Services, Inc. (UHS) 2004 and 2005 Medicare Bad Debts Still at Agency Group Appeal vs. BlueCross BlueShield Association/HighMark Medicare Services; Wisconsin Physician Service	Issue Whether the Intermediary properly disallowed the Providers' bad debts solely on the ground that accounts related to such bad debts were still pending at outside collection agencies.
Decision Number 2011-D31	Case Name George Washington University Hospital vs. BlueCross BlueShield Association/Care First of Maryland, Inc.; Highmark Medicare Services; Wisconsin Physicians Service	Issue Whether the Intermediary's adjustment of the Provider's Medicare bad debts because they were written off while they remained at an outside collection agency, were appropriate.
Decision Number 2011-D32	Case Name Exempla Lutheran Medical Center vs. Wisconsin Physician Services	Issue Whether the Intermediary properly disallowed the Provider's entire Medicare disproportionate share hospital (DSH) payment.
Decision Number 2011-D33	Case Name Winn Parish Medical Center vs. Wisconsin Physicians Service	Issue Whether the Provider is eligible to be classified and reimbursed as (MDH) for the fiscal years ending (FYEs) 12/31/01, 12/31/02, 12/31/04, 12/31/05, 03/31/07, and 03/31/08.
Decision Number 2011-D34	Case Name Sutter 98-99 Managed Care (CIRP) Group vs. BlueCross BlueShield Association/First Coast Service Options, Inc.	Issue Whether the Intermediary properly disallowed payments for indirect medical education (IME) and direct graduate medical education (DGME) payments related to managed care days, discharges, and simulated payments for the fiscal years in contention.
Decision Number 2011-D35	Case Name Saints Mary and Elizabeth Medical Centers vs. BlueCross BlueShield Association/National Government Services, Inc.	Issue Whether CMS properly reduced the Provider's Outpatient Prospective Payment System (OPPS) Calendar Year (CY) 2009 market basket update by two (2.0) percentage points.
Decision Number 2011-D36	Case Name Southern Christian Medical Center vs. BlueCross BlueShield Association/First Coast Service Options, Inc. - Fl (formerly Cooperativa de Seguros de Vida de Puerto Rico)	Issue Whether the Intermediary improperly excluded certain days attributable to Puerto Rico Medicaid enrollees who were classified by the Administration De Seguros De Salute De Puerto Rico as category six, for which Puerto Rico receives no Federal matching fund...
Decision Number 2011-D37	Case Name Partners 2002-2004 DSH Medicare+Choice CIRP Groups vs. BlueCross BlueShield Association/NHIC Corp., c/o National Government Services, Inc.	Issue Whether Medicare+Choice (M+C) days should be included in the Medicaid fraction used to calculate the disproportionate share hospital (DSH) adjustment.
Decision Number 2011-D38	Case Name Prosser Memorial Hospital vs. Blue Cross Blue Shield Association/Noridian Administrative Services	Issue Whether the Intermediary's adjustment to the Provider's ambulance service rates was proper.
Decision Number 2011-D39	Case Name Baycare 2002 Medicare+Choice Days Group vs. BlueCross BlueShield Association/First Coast Service Options, Inc.	Issue Whether inpatient days for Medicaid-eligible patients who were enrolled in Medicare+Choice (M+C) plan under Part C of the Medicare statute were properly excluded from the numerator of the Medicaid fraction that is used to calculate the disproportionate sh...
Decision Number 2011-D40	Case Name UMass Health System 2004 DSH Medicare+Choice Group vs. BlueCross BlueShield Association/NHIC Corp., c/o National Government Services, LLC	Issue Whether inpatient days for Medicaid-eligible patients who were enrolled in Medicare+Choice (M+C) plan under Part C of the Medicare statute were properly excluded from the numerator of the Medicaid fraction that is used to calculate the disproportionate sh...
Decision Number 2011-D41	Case Name Strategic Reimbursement/Carondelet/ Resurrection Health Medicare Part C Days-DSH Group Appeals vs. BlueCross Blue Shield Association/National Government Services/Noridian Administrative Services, LLC	Issue Whether Medicare+Choice (M+C) days should be included in the Medicaid fraction used to calculate the disproportionate share hospital (DSH) adjustment.
Decision Number 2011-D42	Case Name Memorial Hermann - Memorial City Hospital vs. BlueCross BlueShield Association/TrailBlazer Health Enterprises, LLC	Issue Whether the Board has jurisdiction over the issue of whether the provider is entitled to be reimbursed for the interest implicit in the capital lease of the hospital facilities and equipment.
Decision Number 2011-D43	Case Name Kingsbrook Jewish Medical Center vs. BlueCross BlueShield Association/National Government Services Inc.	Issue Whether the Provider's cost reimbursement should be computed taking into account the charges included in the Provider's log of late charges which have not been billed to Medicare.
Decision Number 2011-D44	Case Name Kingsbrook Jewish Medical Center vs. BlueCross BlueShield Association/National Government Services Inc.	Issue Whether the Provider's cost reimbursement should be computed taking into account the charges included in the Provider's log of late charges which have not been billed to Medicare.
Decision Number 2011-D45	Case Name Good Shepherd Rehabilitation Hospital- Bethlehem vs. Blue Cross Blue Shield Association/Highmark Medicare Services -PA	Issue Whether the Intermediary properly reimbusred the Provider based on the blended rate for inpatient rehabilitation facilities (IRF) versus the 100 percent federal prospective payment system (PPS) rate for IRFs.
Decision Number 2011-D46	Case Name Borgess Medical Center and Bronson Methodist Hospital vs. Blue Cross Blue Shield Association/National Government Services, Inc.	Issue Whether the Intermediary's adjustment to the direct graduate medical education (GME) and indirect medical education (IME) counts for residents training at the Kalamazoo Center for Medical Studies/Michigan State University (KCMS) nonhospital site clinics w...
Decision Number 2011-D47	Case Name DMC Hospitals FFY 2010 Wage Index Pension Group vs. BlueCross BlueShield Association/National Government Services, Inc.	Issue Whether the Intermediary properly disallowed the Providers' pension costs for the fiscal year ended December 31, 2006 in determining the Medicare geographical wage index for federal fiscal year (FFY) 2010.
Decision Number 2012-D01	Case Name Hall Render Wage Index Group Appeals vs. BlueCross Blue Shield Association/National Government Services and Wisconsin Physician Services	Issue 1. Whether the Fiscal Intermediary and CMS properly determined the Wage Indexes for St. Elizabeth Medical Center; St. Luke Hospital East; St. Luke Hospital West; Mercy Hospital Anderson; University Hospital, Inc.; Jewish Hospital; Mercy Hospital Fa...
Decision Number 2012-D02	Case Name L.O. Crosby Memorial Hospital vs. BlueCross BlueShield Association/Pinnacle Business Solutions, Inc.	Issue 1. Whether CMS is precluded from recovering the alleged overpayments from the Provider's fiscal year end 12/31/97 and 10/31/98 cost reports due to the Intermediary's issuance of the Notice of Program Reimbursement over ten years after the cost report year...
Decision Number 2012-D03	Case Name Lakeland Regional Medical Center vs. BlueCross BlueShield Assocation/National Government Services	Issue Whether the Intermediary's adjustment of the Provider's Medicare bad debts because they were written off while they remained at an outside agency, was proper.
Decision Number 2012-D04	Case Name Oakwood Annapolis Hospital vs. BlueCross BlueShield Assocation/National Government Services	Issue Whether the Oakwood Annapolis Family Practice Residency Program, which received provisional accreditation from the Accreditation Council for Graduate Medical Education (ACGME), met the definition of a new program in 2004.
Decision Number 2012-D05	Case Name Youngstown-Warren 02 Wage Index vs. BlueCross BlueShield Assocation/National Government Services, Inc.	Issue 1. Whether the Fiscal Intermediary erred in refusing to exclude the Provider's bonus or call back hours paid from its Federal Fiscal Year (FFY) 2002 wage index calculations. 4. Whether the Fiscal Intermediary erred in refusing to include the Provider's c...
Decision Number 2012-D06	Case Name Lifespan SWC 2003 DSH Medicare+Choice Days Group vs. National Government Services/BlueCross Blue Shield Association	Issue Whether inpatient days for Medicare-eligible patients who were enrolled in a Medicare+Choice (M+C) plan under Part C of the Medicare statute were properly excluded from the numerator of the Medicaid fraction that is used to calculate the disproportionate ...
Decision Number 2012-D07	Case Name Alegent Health-Immanuel Medical Center vs. Wisconsin Physicians Service	Issue Whether the Intermediary's adjustments to disallow the Provider's indirect medical education (IME) and direct graduate medical education (DGME) reimbursement for its graduate medical education activities were correct.
Decision Number 2012-D08	Case Name Rush University Medical Center vs. BlueCross/Blue Shield Association/National Government Services, Inc. (formerly AdminaStar Federal, Inc.)	Issue 1. Whether the Intermediary properly calculated the number of interns and residents for fiscal year (FY) 1993 for purposes of the Provider's direct graduate medical education (DGME). 2-A. Whether the Intermediary's adjustments to the Provider's bed count,...
Decision Number 2012-D09	Case Name Rush University Medical Center vs. BlueCross/Blue Shield Association/National Government Services, Inc. (formerly AdminaStar Federal, Inc.)	Issue 1. Whether the Intermediary's adjustments to the Provider's bed count, as used for purposes of the indirect medical education (IME) calculation, was proper. 2. Whether, in calculating the Provider's bed count as used for purposes of IME calculation, ther...
Decision Number 2012-D10	Case Name Alameda Hospital- SNF vs. BlueCross BlueShield Association/First Coast Service Options, Inc.	Issue Whether the United States District Court's memorandum decision, finding the Secretary's methodology was improper under the precedent established in "Alaska Professional Hunters Association, Inc. v. FAA", also applies to the Secretary's low occupancy adjus...
Decision Number 2012-D11	Case Name Doctors Medical Center of Modesto vs. Wisconsin Physicians Service	Issue Whether the Intermediary improperly eliminated all direct medical education and indirect medical education reimbursement for the Provider's family practice residency program for fiscal years ended May 31, 2001 through May 31, 2007.
Decision Number 2012-D12	Case Name Research Medical Center vs. Wisconsin Physicians Service	Issue Whether the Intermediary's determination of additional amounts paid to the Provider for nursing and allied health (N&AH) education associated with Medicare+Choice (M+C) enrollees was proper.
Decision Number 2012-D13	Case Name Fort Wayne (Indiana) FFY 2002 MSA Wage Index Group vs. BlueCross/Blue Shield Association/National Government Services, Inc. (formerly AdminaStar Federal, Inc.)	Issue Whether the Fiscal Intermediary and the Centers for Medicare and Medicaid Services (CMS) appropriately included certain paid hours not actually worked by Parkview Health System (Parkview) employees for purposes of calculating the federal fiscal year 2002 ...
Decision Number 2012-D14	Case Name Norwalk Hospital vs. BlueCross BlueShield Association/National Government Services, Inc.	Issue Whether the Provider Reimbursement Review Board has jurisdiction over the Medicaid eligible days for which there was no adjustment made by the Intermediary within the Notice of Program Reimbursement (NPR).
Decision Number 2012-D15	Case Name Canon Health Care Hospice vs. BlueCross BlueShield Association/Palmetto Government Benefits Administration.	Issue Whether a full or partial waiver is permissible for the Provider's hospice inpatient day limitation overpayment for the cap year November 1, 2005 through October 31, 2006.
Decision Number 2012-D16	Case Name Alegent Health-Immanuel Medical Center vs. Wisconsin Physicians Service	Issue Whether the Intermediary's adjustments to disallow the Provider's indirect medical education (IME) and direct graduate medical education (DGME) reimbursement for its graduate medical education activities were correct.
Decision Number 2012-D17	Case Name Ober Kaler DSH Charity Care Groups vs. BlueCross BlueShield Association/Highmark Medicare Services and Cahaba Government Benefits Administrator	Issue Whether days associated with patients covered under the New Jersey Charity Care Program should be included in the numerator of the Medicaid proxy of the Medicare disproportionate share hospital (DSH) calculation pursuant to § 1886(d)(5)(F)(vi)(II) of the...
Decision Number 2012-D18	Case Name Doctors Hospital vs. BlueCross BlueShield Association/CGS Administrators, LLC	Issue Whether the Intermediary properly disallowed Medicare bad debt expense.
Decision Number 2012-D19	Case Name HCR Manor Care 1999 Laundry and Central Supply Statistics Group vs. BlueCross BlueShield Association/Highmark Medicare Services	Issue Whether the Intermediary's adjustments to the Laundry and Linen and the Central Service and Supply statistics were proper.
Decision Number 2012-D20	Case Name John H. Stroger, Jr. Hospital of Cook County vs. BlueCross BlueShield Association/National Government Services, Inc.	Issue Whether the Intermediary's exclusion of the physician malpractice expense from Worksheets A-8-2 and D-9 of the cost report was proper.
Decision Number 2012-D21	Case Name San Joaquin Community Hospital-SNF vs. BlueCross Blue Shield Association/First Coast Service Options, Inc.	Issue Whether the Secretary's failure to reclassify costs in the peer group construction was arbitrary, capricious or plainly erroneous.
Decision Number 2012-D22	Case Name Lemuel Shattuck Hospital vs. BlueCross BlueShield Association/National Government Services, Inc.	Issue Whether the allocation of the physician costs between Part A and Part B was proper.
Decision Number 2012-D23	Case Name QRS 1991-2006 Colorado DSH/General Assistance Days Group vs. BlueCross BlueShield Association/Trailblazer Health	Issue Whether days associated with patients covered under the Colorado Indigent Care Program (CICP) should be included in the numerator of the "Medicaid proxy" of the Medicare disproportionate share hospital (DSH) calculation pursuant to § 1886(d)(5)(F)(vi)(II...
Decision Number 2012-D24	Case Name Swedish American Hospital vs. Wisconsin Physicians Service (formerly Mutual of Omaha Insurance Company)	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, 2004 through May 31, 2007 FTE counts were correct.
Decision Number 2012-D25	Case Name Bergen Regional Medical Center vs. BlueCross BlueShield Association/Novitas Solutions, Inc.	Issue Whether the Provider Reimbursement Review Board has jurisdiction over the calculation of the Provider's 1996 Indirect Medical Education Cap Reduction for the redistribution of unused residency slots.
Decision Number 2013-D01	Case Name QRS 1995, 1996, 1998-2007 DSH/Pennsylvania General Assistance Days Group vs. Blue Cross Blue Shield Association/Novitas Solutions, Inc.	Issue Whether Pennsylvania Charity Care Program (e.g., general assistance) days should be included in the numerator of the Medicaid proxy of the Medicare disproportionate share hospital (DSH) calculation pursuant to § 1886(d)(5)(F)(vi)(II) of the Social Secur...
Decision Number 2013-D02	Case Name QRS 93-07 DSH/Iowa Indigent Patient/Charity Care (GA) Group vs. Blue Cross Blue Shield Association/Wisconsin Physicians Service	Issue Whether Iowa Charity Care Program days (e.g., general assistance) should be included in the numerator of the Medicaid proxy of the Medicare disproportionate share hospital (DSH) calculation pursuant to § 1886(d)(5)(F)(vi)(II) of the Social Security Act, ...
Decision Number 2013-D03	Case Name Maine Medical Center vs. Blue Cross Blue Shield Association/National Government Services	Issue Whether the Intermediary’s exclusion of the crossover bad debts for cost reporting periods ending September 30, 2002 and September 30, 2003 due to a lack of documentation was proper.
Decision Number 2013-D04	Case Name The Phoenix Clinic vs. Wisconsin Physician Services	Issue Whether the Intermediary properly removed total costs and total payments.
Decision Number 2013-D05	Case Name Maine Coast Memorial Hospital vs. Blue Cross Blue Shield Association/NHIC, Corp. c/o National Government Services, Inc.	Issue Whether Maine Coast Memorial Hospital's request to be designated as a Sole Community Hospital was properly denied.
Decision Number 2013-D06	Case Name Mountain State Health Alliance 05 Bad Debt- Passive Collection CIRP Group vs. BlueCross BlueShield Association/Cahaba Government Benefits Administrators, LLC	Issue Whether the Intermediary's adjustments to remove Medicare bad debts from the Providers' cost reports were proper.
Decision Number 2013-D07	Case Name HLB Wage Index Pension and Post Retirement Cost Groups- FFY 2007 and 2008 vs. BlueCross BlueShield Association/Palmetto GBA; Palmetto GBA c/o First Coast Service Options, Inc.; Wisconsin Physicians Service and Novitas Solutions, Inc.	Issue Whether the Intermediary improperly eliminated or reduced the pension and postretirement benefit (PRB) costs of the Providers, and the pension costs of the Catholic Healthcare West medical centers (CHW Providers) for the purposes of computing their prospe...
Decision Number 2013-D08	Case Name Lima Memorial Hospital vs. BlueCross BlueShield Association/CGS Administrators, LLC	Issue Whether the Intermediary improperly calculated reimbursement for the Provider's skilled nursing facility unit during the skilled nursing facility PPS (prospective payment system) transition period.
Decision Number 2013-D09	Case Name Maine Type 6 Medicaid Dual Eligible Days DSH Group	Issue Whether the Intermediary's reopening adjustment to exclude Type 6 Medicaid dual eligible days from the Providers' Medicaid fraction used in the calculation of the disproportionate share hospital adjustment was proper.
Decision Number 2013-D10	Case Name QRS 1995, 2001-2002, 2004-2005 Missouri DSH/General Assistance Days Group vs. Blue Cross Blue Shield Association/Wisconsin Physicians Service	Issue Whether days associated with patients “covered” under the Missouri State Plan should be included in the numerator of the Medicaid proxy of the Medicare disproportionate share hospital (DSH) calculation pursuant to §1886(d)(5)(F)(vi)(II) of the Social...
Decision Number 2013-D11	Case Name Marion General Hospital vs. BlueCross BlueShield Association/National Government Services, Inc.	Issue Whether the Medicare Administrative Contractor's (MAC) denial of Marion General Hospital's Sole Community Hospital Low Volume Adjustment was proper based on procedural and timing requirements.
Decision Number 2013-D12	Case Name Battle Creek MI MSA Fy 2006 Wage Index Group vs. Wisconsin Physicians Service	Issue Whether the Intermediary appropriately included wage data from Trillium Hospital for purposes of calculating the Federal Fiscal year (FFY) 2006 hospital wage index for the Battle Creek, Michigan Metropolitan Statistical Area (MSA).
Decision Number 2013-D13	Case Name UMDNJ- University Hospital vs. Blue Cross Blue Shield Association/Cahaba Safeguard Administrators, LLC	Issue Whether the Medicare administrative contractor properly determined that the Provider was not entitled to reimbursement for medical education pass-through costs related to the university’s nursing education and allied health program because the Provider...
Decision Number 2013-D14	Case Name St. Francis Hospital, Inc. vs. Blue Cross and Blue Shield Association/Palmetto Government Benefits Administrators	Issue Whether the Intermediary's determination not to increase certain Medicare cost outlier payments was proper, where the outliers were underpaid because of an erroneous overpayment of DSH, which was a factor in the outlier amount calculation and which the MA...
Decision Number 2013-D15	Case Name St. Francis Medical Center vs. Wisconsin Physician Services	Issue Whether the Intermediary used the correct number of days when computing the disproportionate share percentage when the cost-reporting periods overlapped April1, 2004.
Decision Number 2013-D16	Case Name BB&L 95-03 IME Research FTE Group vs. BlueCross BlueShield Association/Noridian Administrative Services	Issue Whether time spent in research when the residents were assigned to the inpatient prospective payment system portion and/or the outpatient department of the Providers should be included in the full-time equivalent counts (FTE) for indirect medical educatio...
Decision Number 2013-D17	Case Name Alpena Dialysis Services vs. vs. Wisconsin Physicians Service	Issue Whether CMS' denial of the Provider's request for an exception to the ESRD composite rate was proper.
Decision Number 2013-D18	Case Name Blumberg Ribner 91-99 SNF 112% Peer Mean Group vs. BlueCross BlueShield Association/Palmetto GBA c/o First Coast Service Options	Issue Whether CMS’ methodology for determining the Providers’ exception to the hospital-based SNF routine cost limit was proper.
Decision Number 2013-D19	Case Name River Region Medical Center vs. BlueCross BlueShield Association/Novitas Solutions, Inc.	Issue Whether the Intermediary correctly determined the Provider's disproportionate share hospital ("DSH")payment for the fiscal period November 1, 1998 to June 30, 1999
Decision Number 2013-D20	Case Name Mountain View Regional Medical Center vs. Wisconsin Physician Services	Issue Whether the Intermediary's determination that the Provider should be reimbursed under the federal rate of the inpatient prospective payment system for capital costs for the fiscal year end 2003 was proper.
Decision Number 2013-D21	Case Name QRS UMHC 1991-1996 DSH/Michigan General Assistance Days Group vs. BlueCross BlueShield Association/Wisconsin Physicians Service	Issue Whether days associated with patients “covered” under the Michigan Indigent/Charity Care Program should be included in the numerator of the Medicaid proxy of the Medicare disproportionate share hospital (DSH) calculation pursuant to §1886(d)(5)(F)(vi...
Decision Number 2013-D22	Case Name Holy Redeemer Hospital and Medical Center vs. BlueCross BlueShield Association/Highmark Medicare Services	Issue Whether the Intermediary's adjustment disallowing therapy services claims pursuant to a comprehensive medical review was proper.
Decision Number 2013-D23	Case Name QRS DSH Florida General Assistance Days Group vs. BlueCross BlueShield Association/First Coast Service Options, Inc.-FL	Issue Whether the Intermediary properly excluded Florida's Charity Care and Low Income days (e.g., general assistance) from the disproportionate share hospital (DSH) calculation.
Decision Number 2013-D25	Case Name Medical Professionals for Home Care, Inc. vs. BlueCross BlueShield Association/Palmetto Government Benefits Administrators	Issue Whether the imposition of a 2 percent reduction in the Medicare payments to the home health agency for calendar year (CY) 2012 was proper.
Decision Number 2013-D26	Case Name CMK Home Health Agency, Inc. vs. BlueCross BlueShield Association/Palmetto GBA	Issue Whether the imposition of a 2 percent reduction in the Medicare payments to the home health agency for calendar year (CY) 2012 was proper.
Decision Number 2013-D27	Case Name Inteli Home Healthcare, Inc. vs. BlueCross BlueShield Association/Palmetto GBA	Issue Whether the imposition of a 2 percent reduction in the Medicare payments to the home health agency for calendar year (CY) 2012 was proper.
Decision Number 2013-D28	Case Name Sun City Home Care, Inc. vs. BlueCross BlueShield Association/Palmetto Government Benefits Administrators	Issue Whether the imposition of a 2 percent reduction in the Medicare payments to the home health agency for calendar year (CY) 2012 was proper.
Decision Number 2013-D29	Case Name Spectrum Home Care, Inc.vs. BlueCross BlueShield Association/National Government Services	Issue Whether the imposition of a 2 percent reduction in the Medicare payments to the home health agency for calendar year (CY) 2012 was proper.
Decision Number 2013-D30	Case Name LivinRite Home Health Services vs. BlueCross BlueShield Association/CGS Administrators, LLC	Issue Whether the imposition of a 2 percent reduction in the Medicare payments to the home health agency for calendar year (CY) 2012 was proper.
Decision Number 2013-D31	Case Name All Care Home Health 2012 2% Reduction CIRP Group vs. BlueCross BlueShield Association/CGS Administrators, LLC	Issue Whether the imposition of a 2 percent reduction in the Medicare payments to the home health agency for calendar year (CY) 2012 was proper.
Decision Number 2013-D32	Case Name Carinosa Healthcare, Inc. vs. BlueCross BlueShield Association/Palmetto GBA	Issue Whether the imposition of a 2 percent reduction in the Medicare payments to the home health agency for calendar year (CY) 2012 was proper.
Decision Number 2013-D33	Case Name MS Healthcare Center, Inc. vs. BlueCross BlueShield Association/Palmetto GBA	Issue Whether the imposition of a 2 percent reduction in the Medicare payments to the home health agency for calendar year (CY) 2012 was proper.
Decision Number 2013-D34	Case Name Porter Hospital vs. Blue Cross and Blue Shield Association/National Government Services	Issue Porter Hospital vs. Blue Cross and Blue Shield Association/National Government Services
Decision Number 2013-D35	Case Name Cleveland Clinic Hospital vs. BlueCross BlueShield Association/CGS Administrators, LLC	Issue Whether the contractor's decision to exclude certain physician Medicare Part A administrative costs under time study codes L and O from the Provider's fiscal year (FY) 2002 wage index data in calculating the FY 2006 wage index should be reversed.
Decision Number 2013-D36	Case Name St. Luke 2001-2007 DSH Inclusion of Title XIX Eligible Days CIRP Group vs. Blue Cross Blue Shield Association/CGS Administrators, LLC	Issue Whether days associated with patients covered under the Kentucky Hospital Care Program (KHCP) should be included in the numerator of the Medicaid proxy of the Medicare disproportionate share hospital (DSH) calculation pursuant to § 1886(d)(5)(F)(vi)(II) ...
Decision Number 2013-D37	Case Name Hall Render Pension/Post Retirement Wage Index Appeals FFY 2007 through 2011 vs. BlueCross BlueShield Association/Various	Issue Whether the Fiscal Intermediaries' adjustments to pension costs for the affected providers resulted in erroneous wage indices for the areas where adjustments were made.
Decision Number 2013-D38	Case Name Washington General Assistance Days Groups vs. Blue Cross Blue Shield Association/Noridian Administrative Services -WA/AK/Wisconsin Physician Services	Issue Whether patient days associated with the Medically Indigent (MI) and General Assistance/Unemployable (GAU) Programs in Washington State should be included in the numerator of the Medicaid fraction of the Medicare Disproportionate Share Hospital (DSH) paym...
Decision Number 2013-D39	Case Name St. Vincent Hospital & Health Center vs. BlueCross BlueShield Association/Wisconsin Physicians Service	Issue Whether the Provider Reimbursement Review Board has jurisdiction over Ambulatory Surgery Costs and Organ Acquisition Costs where the Intermediary made no audit adjustment to the cost report.
Decision Number 2013-D40	Case Name Toyon DSH General Assistance Days Groups 1989-2000 vs. BlueCross BlueShield Association	Issue Whether State only eligible (but unpaid) patient days (commonly referred to as General Assistance or GA days), were erroneously excluded from the Medicaid proxy in the Disproportionate Share Hospital (DSH) calculations.
Decision Number 2013-D41	Case Name CampbellWilson Nursing Home Days Groups vs. BlueCross BlueShield Association/Novitas Solutions, Inc./CGS Administrators, LLC/Noridian Administrative Services c/o First Coast Service Options, Inc./Wisconsin Physicians Service	Issue Whether CMS properly omitted from the Providers' DSH calculation the patient days of individuals who were Supplemental Security Income ("SSI") recipients but who had the amount of their cash payments reduced to zero while they remained in a nursing home. ...
Decision Number 2013-D42	Case Name Health Alliance Hospital vs. BlueCross/BlueShield Association/NHIC Corp., c/o National Government Services, Inc.	Issue Whether the observation bed days for the Provider’s fiscal year ending September 30, 2003 (“FY 2003”) were properly netted from the calculation of the bed count for purposes of qualifying for a disproportionate share hospital (“DSH”) payment, th...
Decision Number 2014-D01	Case Name Owensboro Medical Health System vs. Blue Cross Blue Shield Association/CGS Administrators, LLC	Issue Whether medical assistance/general assistance days associated with patients covered under the Kentucky State Plan should be included in the numerator of the Medicaid proxy of the Medicare disproportionate share hospital (DSH) calculation pursuant to § 18...
Decision Number 2014-D02	Case Name Hospice Complete, Inc. Hospice Complete, Inc./Southern Care 2008 Hospice Cap CIRP Group vs. BlueCross BlueShield Association/Palmetto GBA	Issue Whether the Providers' cap liability for 2006-2008 should be recalculated in light of Southern Care Hospice's monetary settlement of the qui tam lawsuits filed against it in the United States District Court for the Northern District of Alabama.
Decision Number 2014-D03	Case Name Danbury Hospital vs. BlueCross BlueShield Association/National Government Services, Inc	Issue Whether the PRRB has jurisdiction over a claim for Medicaid Eligible Days for which there was no adjustment made by the Intermediary within the Notice of Program Reimbursement.
Decision Number 2014-D04	Case Name Canon Health Care Hospice, LLC vs. BlueCross BlueShield Association/Palmetto GBA	Issue Whether the Intermediary erred in calculating the Inpatient Day Limitation over a period greater than 12 months for the Provider's cap year ended October 31, 2008.
Decision Number 2014-D05	Case Name Ashton Hall Nursing & Rehabiliation Center vs. BlueCross BlueShield Association/Novitas Solutions, Inc.	Issue Whether the Intermediary's adjustment to disallow Medicare Bad Debts on the Medicare Cost Report was proper.
Decision Number 2014-D06	Case Name Accord Health 2005 Crossover Bad Debts Group vs. BlueCross BlueShield Association/Novitas Solutions, Inc.	Issue Whether the Intermediary's exclusion of unbilled crossover bad debts was proper.
Decision Number 2014-D07	Case Name Deborah Heart and Lung Center vs. Blue Cross Blue Shield Association	Issue Whether CMS improperly denied the Provider’s request to be reclassified as a rural hospital under section 1886(d)(8)(E) of the Social Security Act and 42 CFR 412.103.
Decision Number 2014-D08	Case Name Dana Farber Cancer Institute vs. BlueCross BlueShield Association/NHIC Corp. c/o National Government Services, Inc.and Cahaba Safeguard Administrators, LLC	Issue Whether the Medicare Administrative Contractor (MAC) erred in disallowing certain of the costs associated with Dana Farber Cancer Institute state provider tax expense in the Provider's Fiscal Year 2004 through Fiscal Year 2008 cost reporting periods.
Decision Number 2014-D09	Case Name Welch Community Hospital vs. Blue Cross Blue Shield Association/Palmetto GBA	Issue Whether the Intermediary’s adjustment to reclassify Rural Health Clinic (RHC) visits associated with contracted physicians, and the associated full-time equivalents (FTEs), from the cost report Worksheet M-2, line 9 to Worksheet M-2, line 1 was proper.
Decision Number 2014-D10	Case Name Eastern Maine Medical Center vs. BlueCross BlueShield Association/NHIC, Corp., c/o National Government Services, Inc.	Issue Whether the Intermediary’s exclusion of certain outside rotations from the Provider’s direct Graduate Medical Education (GME) and Indirect Medical Education (IME) full time equivalent count was proper.
Decision Number 2014-D11	Case Name Cooper Hospital/University Medical Center vs. Blue Cross Blue Shield Association/Novitas Solutions, Inc.	Issue Whether a provider's collection effort on inpatient and outpatient bad debts must include personal telephone calls to patients to comprise a reasonable collection effort. 2. Whether the Intermediary incorrectly determined that the regulations affirmativel...
Decision Number 2014-D12	Case Name City of Hope National Medical Center vs. BlueCross BlueShield Association/Palmetto Government Benefit Administrators/Cahaba Safeguard Administrators	Issue Whether the Intermediary properly offset investment income against operating and capital-related interest expense for the fiscal years ending September 30, 2004, September 30, 2005, and September 30 2006.
Decision Number 2014-D13	Case Name CHS 2004-2006 Medicare Bad Debt Passive Collection CIRP Groups vs. Various	Issue Whether the Intermediary's adjustments to remove the Medicare bad debts claimed by the Provider while the debts were still at the collection agency were proper.
Decision Number 2014-D14	Case Name Swedish American Hospital vs. Blue Cross Blue Shield Association/Wisconsin Physicians Service	Issue Whether the Temporary Cap Increase Exception applies to the Provider's 1996 base year IME/GME FTE count for osteopathic and allopathic medicine interns and residents and the caps application to the May 31, 1999 through May 31, 2003 FTE counts.
Decision Number 2014-D15	Case Name Unity Healthcare vs. Blue Cross Blue Shield Association/Wisconsin Physicians Service	Issue Whether the Medicare Administrative Contractor (MAC) properly calculated the Medicare dependent hospital volume decrease adjustment (VDA) for the Provider, for fiscal year 2006, by excluding certain variable and semi-fixed costs.
Decision Number 2014-D16	Case Name Lakes Regional Healthcare vs. Blue Cross Blue Shield Association/Wisconsin Physicians Service	Issue Whether the Medicare Administrative Contractor (MAC), properly calculated the Medicare dependent hospital volume decrease adjustment (VDA) for the Provider, for fiscal year 2006, by excluding certain variable and semi-fixed costs.
Decision Number 2014-D17	Case Name Wyatt, Tarrant & Combs FFY 07 Occupational Mix Adjustment Group vs. Blue Cross and Blue Shield Association/CGS Administrators, LLC	Issue 1. Whether the inclusion of surgical technicians, mental health technicians, and heart center recovery technicians in the all-others category instead of the nursing aides, orderlies and attendants category in the Provider's occupational-mix survey was cor...
Decision Number 2014-D18	Case Name Methodist Hospital- Southlake; Methodist Hospital-Northlake; Methodist Hospitals, Inc. vs. Wisconsin Physicians Service/Blue Cross Blue Shield Association	Issue Whether the Medicare Administrative Contractor's disallowance of Methodist Hospital's bad debt claims should be reversed.
Decision Number 2014-D19	Case Name St. John Health 2004-2005 Bad Debt Moratorium CIRP Group/Hall Render 2005-2006 Bad Debt Moratorium Group vs. BlueCross BlueShield Association/Highmark Medicare Services/Wisconsin Physicians Service	Issue Whether the Intermediary properly disallowed the Providers’ bad debts solely on the ground that accounts related to such bad debts were still pending at outside collection agencies.
Decision Number 2014-D20	Case Name Chestnut Hill Benevolent Association/The Leaves, Inc./Arden Wood, Inc./Broadview, Inc. vs. Cahaba Government Benefits Administration/Blue Cross Blue Shield Association	Issue Whether the training offered by the Providers is necessary to enter the specialty of Christian Science nursing in a RNHCI and, therefore, eligible for pass-through reimbursement, or whether the Providers' nurse training program is continuing education tha...
Decision Number 2014-D21	Case Name Legacy Hospcie and Palliative Care, LLC vs. CGS Administrators, LLC/Blue Cross and Blue Shield Association	Issue Whether the imposition of a two percent reduction in Legacy Hospice and Palliative Care LLC's Medicare payments for calendar year 2014 was proper.
Decision Number 2014-D22	Case Name Cleveland Clinic Florida Hospital vs. Wisconsin Physicians Service	Issue Whether the Intermediary's removal of residents who participated in Colorectal Surgery (fiscal years (FYs) 2002-2006), Internal Medicine (FYs 2004-2006), and Neurology (FYs 2004-2006) programs (collectively, "Programs") from the Provider's Graduate Medica...
Decision Number 2014-D23	Case Name Mary Greeley Medical Center vs. Blue Cross Blue Shield Association/Wisconsin Physicians Service	Issue 1. Whether the MAC and CMS Regional Office for Region VII evaluated market share for the Provider for the correct geographic area when they denied the Provider’s request for classification as a sole community hospital (SCH) on the grounds that the Provi...
Decision Number 2014-D24	Case Name Southwest Ambulatory Behavioral Services, Inc. vs. Novitas Solutions, Inc./Blue Cross and Blue Shield Association	Issue Whether the Intermediary’s adjustment to the allocation of the Provider’s cost was proper.
Decision Number 2014-D25	Case Name The Memorial Hospital at North Conway vs. National Government Services, Inc./Blue Cross and Blue Shield Association	Issue Whether the offset of "investment income" up to the amount of interest expense claimed by the Provider for the fiscal year ending June 30, 2007, was proper.
Decision Number 2014-D26	Case Name University of Pittsburgh Medical Center (formerly Mercy Hospital of Pittsburgh) vs. Highmark Medicare Services (formerly Blue Cross of Western Pennsylvania/Blue Cross and Blue Shield Association	Issue Whether interest is due the Provider under 42 C.F.R. § 405.378.
Decision Number 2014-D27	Case Name Cooper Hospital/University Medical Center vs. Novitas Solutions, Inc./Blue Cross and Blue Shield Association	Issue Whether days associated with patients covered under the New Jersey Charity Care Program should be included in the numerator of the Medicaid proxy of the Medicare disproportionate share hospital ("DSH") calculation pursuant to 42 U.S.C. Section 1395ww(d)(5...
Decision Number 2014-D28	Case Name New York City Health and Hospitals Corporation Improper Application of Weighted Discharge Cap CIRP Groups vs. National Government Services/BlueCross BlueShield Association	Issue Whether the Intermediary properly applied the weighted discharge cap to the Providers’ ancillary costs.
Decision Number 2014-D29	Case Name Community Hospital of Anaconda vs. Noridian Administrative Services/Blue Cross and Blue Shield Association	Issue Whether the Medicare Administrative Contractor’s disallowance of the Provider’s certified registered nurse anesthetist (CRNA) on-call costs was proper.
Decision Number 2014-D30	Case Name HMA 2004-2006 Bad Debt Group Appeals vs. Wisconsin Physicians Service/Blue Cross and Blue Shield Association	Issue Whether the Intermediary properly disallowed the Providers' non-indigent debts for fiscal year ends 2004, 2005, and 2006, for not meeting all applicable regulatory requirements.
Decision Number 2015-D01	Case Name OhioHealth 2004 Clark Bed Days Group vs. CGS Administrators/BlueCross BlueShield Association	Issue Whether the Intermediary's application of the Sixth Circuit Court of Appeals' holding in "Clark Regional Medical Center v. U.S. Dept. of Health and Human Servs.", to the determination of the number of available bed days for purposes of calculating the app...
Decision Number 2015-D02	Case Name St. Vincent-Randolph Hospital vs. Wisconsin Physician Services/Blue Cross and Blue Shield Association	Issue Whether the Medicare Contractor's disallowance of the interest expense for the Provider’s 2004, 2005, 2006, 2007, and 2008 fiscal years was proper.
Decision Number 2015-D03	Case Name Rural Family DGME Group Appeals vs. BlueCross BlueShield Association	Issue 1. Was the use of CMS' sequential geography methodology (SGM) for setting the Providers' base year per resident amounts for Medicare reimbursement of certain graduate medical education costs valid and consistent with 42 U.S.C. Section 1395ww(h)(2)(F) and ...
Decision Number 2015-D04	Case Name Breckinridge Health, Inc., New Horizons Health Systems, Inc., CAH 2009 Provider Tax Group, CHC 2009 CAH Provider Tax CIRP Group, and ARH CAH Provider Tax CIRP Group vs. National Government Services, Inc./CGS Administrators, LLC/Blue Cross and Blue Shield ...	Issue Whether the Medicare contractor properly offset the Kentucky provider tax assessment for each of the seven hospitals for the fiscal years at issue by the corresponding amount of the Kentucky Medicaid Disproportionate Share Hospital payment that each hospi...
Decision Number 2015-D05	Case Name Barberton Citizens Hospital vs. CGS Administrators, LLC/Blue Cross and Blue Shield Association	Issue Whether the PRRB has jurisdiction over the Medicaid eligible days issue in the appeals.
Decision Number 2015-D06	Case Name Santa Cruz, CA 03-05 MSA Hospital Wage Index Group vs. Noridian Healthcare Solutions, LLC/Blue Cross and Blue Shield Association	Issue Whether the Medicare Contractor and the CMS properly determined the Provider's Metropolitan Statistical Area Wage Index for Federal Fiscal Year 2004.
Decision Number 2015-D07	Case Name Mercy Hospital vs. First Coast Service Options, Inc./Blue Cross and Blue Shield Association	Issue 1. Whether the Board has jurisdiction to review the MAC’s determination that the days of patients who were eligible for medical assistance under an approved Medicaid State plan and enrolled in a Medicaid plus Choice plan under Part C of Medicare should ...
Decision Number 2015-D08	Case Name QRS CT 2002-2006General Assistance/Charity Care Group; QRS CT 2000 General Assistance/CharityCare Days Group vs. National Government Services/Blue Cross and Blue Shield Association	Issue Whether the exclusion by the Medicare Contractor of days identified as inpatient days attributable to individuals who received medical assistance/general assistance under the Connecticut State Administered General Assistance Program from the Medicaid fra...
Decision Number 2015-D09	Case Name Alta Vista Regional Hospital vs. Wisconsin Physician Services/Blue Cross and Blue Shield Association	Issue Whether the Medicare Contractor’s denial of the Provider's request for a sole community hospital volume decrease adjustment payment was proper.
Decision Number 2015-D10	Case Name Liberty Healthcare Group, LLC vs. Palmetto GBA/Blue Cross and Blue Shield Association	Issue Whether it was proper to impose a 2 percent reduction in the Medicare payments to the Provider's home health agency located for calendar year 2014.
Decision Number 2015-D11	Case Name Fairbanks Memorial Hospital vs. Wisconsin Physician Services/BlueCross BlueShield Association	Issue Whether the Medicare Contractor's calculation of the Provider's volume decrease adjustment amount was determined correctly.
Decision Number 2015-D12	Case Name Tehachapi Valley Hospital vs. Noridian Healthcare Solution/Blue Cross and Blue Shield Association	Issue Whether the Medicare Contractor's denial of the Provider's request for a low volume adjustment payment under 42 C.F.R. Section 412.92(e) was proper.
Decision Number 2015-D13	Case Name Lutheran Hospital of Indiana vs. Wisconsin Physicians Service/Blue Cross and Blue Shield Association	Issue Whether the Medicare Contractor’s adjustment to remove time for off-site rotations was proper.
Decision Number 2015-D14	Case Name Hampton Behavioral Health Center vs. Novitas Solutions, Inc./BlueCross BlueShield Association	Issue Whether the Medicare Contractor improperly disallowed from the calculation of the Provider’s bad debt expense, for the subject fiscal year, bad debts associated with patients whose accounts were not billed to Medicaid prior to the accounts being written...
Decision Number 2015-D16	Case Name Sutter Auburn Faith Hospital vs. Cahaba Safeguard Administrators, LLC	Issue Whether the Board has jurisdiction to review the Medicare Contractor’s determination of the low-income patient (LIP) adjustment for the 2006 fiscal year.
Decision Number 2015-D17	Case Name Riverside Hospital of Louisiana vs. Cahaba GBA c/o National GovernmentServices	Issue Whether the payment penalty that CMS imposed under the Long-Term Care Hospital Quality Reporting Program to reduce the Provider’s payment update for Fiscal Year 2015 by two percent was proper.
Decision Number 2015-D18	Case Name Loma Linda University Medical Center vs. Noridian Healthcare Solutions, LLC	Issue Whether the denial of the Provider’s request for an exception to the end stage renal disease composite rate by CMS was proper.
Decision Number 2015-D19	Case Name Loma Linda University Kidney Center vs. Noridian Healthcare Solutions, LLC	Issue Whether the denial of the Provider’s request for an exception to the end stage renal disease composite rate by CMS was proper.
Decision Number 2015-D20	Case Name Sutter Auburn Faith Hospital vs. Cahaba Safeguard Administrators, LLC	Issue Whether the Board had jurisdiction to review the Medicare Contractor’s determination of the low-income patient (LIP) adjustment for the 2003 fiscal year.
Decision Number 2015-D21	Case Name Wilmington Treatment Center vs. Palmetto GBA	Issue 1. Whether the Medicare Contractor’s adjustment to the provider-based physician professional component was proper. 2. Whether the Medicare Contractor’s recoupment of payments related to the denial of inpatient admissions was proper. 3. Whether the Med...
Decision Number 2015-D22	Case Name Ochsner Medical Center-Northshore vs. Wisconsin Physicians Service	Issue Whether the reduction of the Provider’s market basket update for federal fiscal year 2015 under the Hospital Inpatient Quality Reporting program was proper.
Decision Number 2015-D23	Case Name Medicare Inpatient/Outpatient Unbilled Bad Debts Group Appeals vs. Noridian Healthcare Solutions, LLC	Issue Whether the Providers were required to bill the State Medicaid program and submit a State remittance advice (RA) to the Medicare Contractor (MAC) as a precondition for the Medicare program to pay bad debts for unpaid coinsurance and deductibles for indivi...
Decision Number 2015-D24	Case Name Northwest Texas Healthcare System vs. Novitas Solutions, Inc.	Issue Whether the current year bed count and the available bed days were properly recorded for fiscal year 2005, and whether the current year bed count and available bed days and the available bed days used to calculate the prior year intern to resident ratio w...
Decision Number 2015-D25	Case Name Faxton-St. Luke's Healthcare vs. National Government Services, Inc.	Issue Whether the MAC’s adjustment to the Provider’s bad debts for indigent patients was proper.
Decision Number 2015-D26	Case Name The Phoenix Clinic vs. Wisconsin Physicians Service	Issue 1. Whether a community mental health center is a “provider of services” entitled to a hearing before the PRRB under 42U.S.C. § 1395oo. 2. If a CMHC is a “provider of services,” does this finding necessarily implicate other documentation obligati...
Decision Number 2015-D27	Case Name Sutter Auburn Faith Hospital vs. Cahaba Safeguard Administrators, LLC	Issue Whether the Board had jurisdiction to review the Medicare Contractor’s determination of the low-income patient (LIP) adjustment for the 2005 fiscal year.
Decision Number 2015-D28	Case Name Sutter Auburn Faith Hospital vs. Cahaba Safeguard Administrators, LLC	Issue Whether the Board had jurisdiction to review the Medicare Contractor’s determination of the low-income patient (LIP) adjustment for the 2004 fiscal year for the inpatient rehabilitation facility.
Decision Number 2015-D29	Case Name HealthSouth 2006 SSI Percentage Group/HealthSouth 2007 SSI Percentage CIRP Group vs. Cahaba Government Benefits Administrators, LLC	Issue Whether the Board had jurisdiction to review the Medicare Contractor’s determination of the low-income patient (LIP) adjustments for the cost reporting periods at issue for the inpatient rehabilitative facilities.
Decision Number 2015-D30	Case Name BMHCC 2004-2006 LIP SSI% CIRP Group vs. National Government Services, Inc.	Issue Whether the Board had jurisdiction to review the Medicare Contractor’s determination of the low-income patient (LIP) adjustment for the Provider for fiscal years 2004, 2005, and 2006.
Decision Number 2016-D01	Case Name HCA 00, 02 DSH Medicare + Choice Plan Days, HCA 03 DSH Medicare + Choice Plan Days, HCA 04 DSH Medicare + Choice Plan Days vs. Noridian Healthcare Solutions/ Wisconsin Physicians Service	Issue Whether inpatient days for Medicaid-eligible patients who were enrolled in a Medicare+Choice (M+C) plan under Medicare part C were properly excluded from the numerator of the Medicaid fraction that is used to calculate the disproportionate share hospital ...
Decision Number 2016-D02	Case Name Queen of the Valley Medical Center vs. Noridian Healthcare Solutions, LLC	Issue Whether the Board has jurisdiction to review the Medicare Contractor’s determination of the number of Medicaid eligible days included in the numerator of the low-income patient (LIP) adjustment for the 2006 fiscal year.
Decision Number 2016-D03	Case Name Grinnell Regional Medical Center vs. Wisconsin Physicians Service	Issue Whether the Medicare Contractor properly denied the Provider's request for a volume decrease payment adjustment.
Decision Number 2016-D04	Case Name St. Joseph Hospital of Eureka vs. Noridian Healthcare Solutions	Issue Whether the Board has jurisdiction to review the Medicare Contractor's determination of the low-income patient (LIP) adjustment for the 2007 fiscal year.
Decision Number 2016-D05	Case Name BayCare Alliant Hospital vs. First Coast Service Options, Inc.	Issue Whether the payment penalty that CMS imposed under the Long-Term Care Hospital Quality Reporting Program to reduce the Provider’s payment update for FY2015 by two percent was proper.
Decision Number 2016-D06	Case Name QRS 1997-1999 Kansas DSH MediKan Days Groups vs. Wisconsin Physicians Service	Issue Whether secondary MediKan days should have been included in the Provider's Medicaid fraction for the Disproportionate Share Hospital (DSH) calculation in the disputed cost reports.
Decision Number 2016-D07	Case Name Provena Health 2006 LIP SSI Percentage Calc. Group vs. National Government Services, Inc.	Issue Whether the Board has jurisdiction to review the Medicare Contractor’s determination of the low-income patient (LIP) adjustment for the Providers for the 2006 fiscal years (FYs).
Decision Number 2016-D08	Case Name Landmark Hospital of Columbia vs. Wisconsin Physicians Service	Issue Whether the payment penalty that CMS imposed under the Long-Term Care Hospital Quality Reporting Program toreduce the Provider’s payment update for FY2015 by two percent was proper.
Decision Number 2016-D10	Case Name New Bedford Rehabilitation Hospital vs. CGS Administrators	Issue Whether the payment penalty that CMS imposed under the Long-Term Care Hospital Quality Reporting Program to reduce the Provider’s payment update for FY2015 by two percent was proper.
Decision Number 2016-D11	Case Name University of Louisville Hospital vs. CGS Administrators, LLC	Issue
Decision Number 2016-D12	Case Name William Beaumont-Royal Oak vs. Wisconsin Physicians Service	Issue Whether the Provider submitted sufficient documentation for its non-Provider-operated nurse clinical training program costs to support pass-through reimbursement for fiscal years (FY s) 2005 and 2006.
Decision Number 2016-D13	Case Name Mercy General Hospital vs. Cahaba Safeguard Administrators, LLC	Issue Whether the Medicare Contractor properly calculated the amount of the Provider's exception to the routine cost limitations (RCLs) for hospital-based skilled nursing facilities (or HB-SNFs) by excluding from the calculation those costs that were above the ...
Decision Number 2016-D14	Case Name Integris/Deaconess 2005 Non-Provider Setting IME/GME CIRP Group vs. Novitas Solutions, Inc.	Issue Whether the Medicare Contractor’s exclusion of all of the family practice interns and residents for each of the Providers from their respective full-time equivalent (FTE) counts, and the Medicare Contractor’s denial of the associated indirect medical ...
Decision Number 2016-D15	Case Name Mid-Delta '03 Hospice Cap Group vs. Palmetto GBA	Issue Whether the Medicare Contractor used the proper date to start the running of the 3-year reopening period for the 2003 hospice cap calculation by CMS for the cap tear ending October 31, 2003.
Decision Number 2016-D16	Case Name St. Anthony Regional Hospital vs. Wisconsin Physicians Service	Issue Whether the Medicare Administrative Contractor (MAC), correctly determined the amount of the Sole Community Hospital (SCH) volume decrease adjustment (VDA) in accordance with the regulations and Program instructions per 42 C.F.R. § 412.92(e)(3), and the ...
Decision Number 2016-D17	Case Name HCA DSH-Colorado State Database Group Appeals vs. Novitas Solutions, Inc.	Issue Whether patient days which the Providers have identified as "inactive" in the Colorado State Medicaid program should be included in the Medicaid proxy that is used in the calculation of the Medicare payment for the disproportionate share hospitals (DSH).
Decision Number 2016-D18	Case Name CCT&B 2005-2006 Hurricane Katrina § 1115 Waiver UCP Days Group vs. Novitas Solutions, Inc.	Issue Whether the MAC improperly excluded the inpatient days related to Uncompensated Care Pool (UCCP)services which CMS approved on March 24, 2006, under Hurricane Katrina Multi-State § 1115 demonstration from the Provider's disproportionate share Hospital (D...
Decision Number 2016-D19	Case Name Singing River Health System vs. Novitas Solutions, Inc.	Issue Whether the MAC improperly excluded the inpatient days related to Uncompensated Care Pool (UCCP) seivices which CMS approved on March 24, 2006, under Hurricane Katrina Multi-State § 1115 demonstration from the Providers' disproportionate share Hospital (...
Decision Number 2016-D20	Case Name UTMD Anderson Cancer Center vs. Cahaba Safeguard Administrators, LLC and Novitas Solutions, Inc.	Issue 1. Whether the Provider’s request for adjustments to the TEFRA target amount should be granted. 2. Whether the Medicare Contractor’s adjustment to certain Company P expenses was proper.
Decision Number 2016-D21	Case Name Baptist Memorial Hospital-Memphis vs. Cahaba Government Benefits Administrators, LLC c/o National Government Services, Inc.	Issue Whether the Medicare Contractor’s disallowance of the costs for the Providers’s Allied Health Care Management Program (“AHCMP”) was correct.
Decision Number 2016-D22	Case Name Select Specialty Medicare Dual Eligible Bad Debts CIRP Groups vs. Novitas Soultions, Inc.	Issue Whether the CMS must-bill policy applies to the Providers’ dual eligible bad debts when the Providers did not participate in the Medicaid Program.
Decision Number 2016-D23	Case Name Valeo Home Healthcare Services, LLC vs. CGS Administrators	Issue Whether the Medicare Contractor properly imposed a 2 percent payment reduction upon the Provider for calendar year 2015 for failure to submit quality data as required by the Deficit Reduction Act of 2005.
Decision Number 2016-D24	Case Name Texas Specialty Hospital of Lubbock vs. Novitas Solutions, Inc.	Issue Whether the payment penalty that CMS imposed under the Long-Term Care Hospital Quality Reporting Program to reduce the Provider’s update for Fiscal Year 2015 by 2 percent was proper.
Decision Number 2016-D25	Case Name LifeCare Hospitals vs. Novitas Solutions, Inc. and Wisconsin Physicians Service	Issue Whether the CMS must-bill policy applies to the Providers’ dual-eligible bad debts when the Providers did not participate in Medicaid.
Decision Number 2016-D26	Case Name Toyon 1997-2001 Intern and Resident Research FTE Group vs. Noridian Healthcare Solutions	Issue Whether the Medicare Contractor properly reduced the Provider’s Indirect Medical Education (IME) Full Time Equivalent (FTE) resident counts, for time spent by resident in research activities.
Decision Number 2016-D27	Case Name H. Lee Moffitt Cancer Center vs. First Coast Service Options, Inc.	Issue Whether the Medicare Contractor properly calculated the Provider’s payment-to-cost ratio (PCR) for both fiscal years under appeal.
Decision Number 2017-D01	Case Name Trinity Regional Medical Center vs. Wisconsin Physician Services	Issue Whether the Medicare Administrative Contractor correctly determined the amount of the Sole Community Hospital volume decrease adjustment in accordance with the regulations and Program instructions per the reugliaton and the Provider Reimbursement Manual.
Decision Number 2017-D02	Case Name The Park Associates, Inc. vs. National Government Services, Inc.	Issue Whether the Medicare Contractor’s methodology allocating Park Associates pooled home office costs improperly denied reimbursement to the Providers.
Decision Number 2017-D03	Case Name Cornerstone Hospital West Monroe vs. Novitas Solutions, Inc.	Issue Whether the payment penalty imposed by CMS to reduce the Provider's FY 2015 Medicare payment by 2 percent was proper.
Decision Number 2017-D04	Case Name Southwest Consulting U Mass Memorial Health Care and Steward Health 2009 DSH CCHIP Section 1115 Waiver Days Groups vs. Novitas Solutions, Inc.	Issue Whether days attributable to patients who were eligible for, and received, assistance through the Massachusetts Commonwealther Care Health Insurance Program, under a CMS approved § 1115 waiver, should be included in the numerator of the Medicaid fraction...
Decision Number 2017-D05	Case Name East Texas Medical Center-Athens vs. Novitas Solutions, Inc.	Issue Whether the Provider was assigned to the correct Core Based Statistical Area (CBSA) for the Federal Fiscal Year 2015.
Decision Number 2017-D06	Case Name Memorial Hermann Continuing Care Hospital vs. Cahaba Safeguard Administrators, LLC	Issue Whether the Medicare Contractor's adjustment to apply the "must bill" policy to bad debts related to dual eligible Medicare and Medicaid beneficiaries was proper.
Decision Number 2017-D07	Case Name Saint Alphonsus Regional Medical Center vs. Noridian Healthcare Solutions, Inc.	Issue Whether the Medicare Contractor’s adjustments disallowing the Provider’s claimed reimbursement for GME and IME costs in the non-hospital setting, by reducing its FTE countbecause these costs were shared with another hospital, was proper.
Decision Number 2017-D08	Case Name Greenbrier Behavioral Health vs. Wisconsin Physicians Services	Issue Whether the Provider is eligible for the third year inpatient psychiatric facility prospective payment system transition rate for the cost reporting period beginning on January 1, 2008 and ending on December 31, 2008.
Decision Number 2017-D09	Case Name North Sunflower County Hospital vs. Novitas Solutions, Inc.	Issue Whether the CMS "must-bill" policy applies to the Provider's dual eligible unpaid deductible and coinsurance amounts related to the Provider's geropsychiatric program.
Decision Number 2017-D10	Case Name Hospice & Palliative Care of Westchester vs. National Government Services, Inc.	Issue Whether the Centers for Medicare & Medicaid Services’ determination that the Provider is subject to a reduced Federal Fiscal Year 2015 Annual Payment Update under the Hospice Quality Reporting Program was proper.
Decision Number 2017-D11	Case Name Hall Render Optional and CIRP DSH Dual/SSI Eligible Group Appeals- Medicare Fraction & Hall Render, Individual, Optional and CIRP DSH Dual/SSI Eligible Group Appeals- Medicare Fraction vs. Medicare Administrative Contractors	Issue Whether Medicare Disproportionate Share Hospital reimbursement calculations for the Providers were understated due to the failure of the Centers for Medicare & Medicaid Services and the relevant Medicare administrative contractors to include all supplem...
Decision Number 2017-D12	Case Name Hall Render Optional and CIRP DSH Dual/SSI Eligible Group Appeals- Medicare Fraction & Hall Render, Individual, Optional and CIRP DSH Dual/SSI Eligible Group Appeals- Medicare Fraction vs. Medicare Administrative Contractors	Issue Whether Medicare Disproportionate Share Hospital reimbursement calculations for the Providers were understated due to the failure of the Centers for Medicare & Medicaid Services and the relevant Medicare administrative contractors to include all suppleme...
Decision Number 2017-D13	Case Name La Cheim School, Inc. vs. Noridian Health Care Solutions	Issue Whether the Providers can claim Medicare and Medicaid crossover bad debts for reimbursement without billing the appropriate state agency.
Decision Number 2017-D14	Case Name Portia Bell Hume Behavioral Health & Training Center vs. Noridian Health Care Solution	Issue Whether the Provider can be paid by the Medicare program for certain dual eligible Medicare and Medicaid crossover bad debts without billing and obtaining a remittance advice from the appropriate state Medicaid agency.
Decision Number 2017-D15	Case Name Community Health Network Rehabilitation Hospital vs. Wisconsin Physicians Services	Issue Whether the Provider satisfied Inpatient Rehabilitation Facility Quality Reporting Program requirements applicable to it during its first year of Medicare participation such that it would be entitled to the full market basket rate during fiscal year 2015.
Decision Number 2017-D16	Case Name West Carroll Memorial Hospital vs. Novitas Solutions, Inc.	Issue Whether the reduction of the Provider's annual payment update for calendar year 2015 under the hospital outpatient quality reporting program was proper.
Decision Number 2017-D17	Case Name BBL Direct GME PRA Adj. Group vs. Noridian Healthcare Solutions, LLC	Issue Whether the use of Centers for Medicare and Medicaid Services’ sequential geography methodology for setting the Providers’ base year per resident amounts for Medicare reimbursement of certain graduate medical education costs, which flow through and a...
Decision Number 2017-D18	Case Name Vibra Hospital of Fort Wayne vs. Wisconsin Physicians Service	Issue Whether the payment penalty that the Centers for Medicare and Medicaid Services imposed under the Long-Term Care Hospital Quality Reporting Program to reduce the Provider's payment update for Fiscal Year 2015 by 2 percent was proper.
Decision Number 2017-D19	Case Name Clarke County Hospital vs. Wisconsin Physicians Service	Issue Whether the Medicare Administrative Contractor improperly disallowed certain home office costs claimed by the Provider, on the grounds that it was not related to the entity that had furnished the services.
Decision Number 2017-D20	Case Name Stormont-Vail Healthcare, Inc. vs. Wisconsin Physicians Service	Issue Whether the Provider was the legal operator of Baker University Nursing School pursuant to 42 C.F.R. § 413.85(f)(1) (2008), thus qualifying under the Medicare program for pass-through reimbursement for the reasonable costs of its operation.
Decision Number 2017-D21	Case Name Vibra Hospital of Amarillo/Vibra Hospital of Richmond vs. Wisconsin Physicians Service	Issue Whether the payment penalty that the Centers for Medicare and Medicaid Services imposed under the Long-Term Care Hospital Quality Reporting Program to reduce the Provider's payment update for Fiscal Year 2015 by 2 percent was proper.
Decision Number 2017-D22	Case Name Mercy Des Moines/Mercy Health Network 2008-2010 Home Office Cost Report Related Party Groups vs. Wisconsin Physicians Service	Issue Whether the Medicare Contractor’s revised determination that the Providers are not related to Mercy Medical Center-Des Moines, and all cost report adjustments stemming from that determination, were appropriate.
Decision Number 2017-D23	Case Name Millennium Home Care, LLC vs. Palmetto GBA c/o National Government Services	Issue Whether the Provider should be subject to a 2 percent reduction in home health prospective payment system payments for calendar year 2015 in accordance with 42 C.F.R. § 484.225(i) (2013).
Decision Number 2017-D24	Case Name Twin Lakes Regional Medical Center vs. CGS Administrators	Issue Whether CMS' decision to impose a 2 percent reduction to the Market Basket Update for fiscal year 2013, which also resulted in the Provider's ineligibility to participate in the Hospital Value Based Purchasing Program, was proper.
Decision Number 2017-D25	Case Name Florida Hospital vs. First Coast Service Options, Inc.	Issue Whether the Medicare Administrative Contractor properly disallowed a portion of the Hospital’s indigent bad debts claimed for the cost reporting periods for fiscal years ending December 31, 2006, December 31, 2007 and December 31, 2008, on the basis tha...
Decision Number 2017-D26	Case Name Santa Rosa Memorial Hospital vs. Cahaba Safeguard Administrators, LLC	Issue Whether the Board has jurisdiction to review the Medicare Contractor’s determination of the low-income patient (LIP) adjustment for the Provider for the 2008 fiscal years (FY).
Decision Number 2017-D27	Case Name Rochester General Hospital vs. National Government Services, Inc.	Issue Whether the Provider is entitled to a temporary increase in its resident full time equivalent (FTE) count due to the closing of one of the other three hospitals in a medical education training program.
Decision Number 2017-D28	Case Name Valley Hospital Medical Center vs. Novitas Solutions, Inc.	Issue Whether the Medicare Contractor’s exclusion of Medicare Advantage/HMO charges and days from the calculation of the direct graduate medical education (DGME) payment for the Provider for its fiscal year ending December 31, 2006 (FY 2006) was proper.
Decision Number 2017-D29	Case Name Doctor's Memorial Hospital vs. First Coast Service Options, Inc.	Issue Whether the payment penalty that CMS imposed under the Hospital Inpatient Quality Reporting (IQR) program to reduce the Provider’s payment update for fiscal year 2016 by twenty-five percent of the 2.7 percent Market Basket update was proper
Decision Number 2017-D30	Case Name Mercy Medical Center vs. Wisconsin Physicians Service	Issue Whether CMS June 27, 2012 determination that the Provider did not meet the quality reporting program requirements for Fiscal Year 2013 and that its failure to meet these requirements would result in a two percent (2.0%) reduction in the FY 2013 market bas...
Decision Number 2017-D31	Case Name Pocohontas Community Hospital vs. Wisconsin Physicians Service	Issue Whether the Medicare Contractor improperly disallowed certain home office costs claimed by the Provider on the grounds that it was not related to the entity that had furnished the services.
Decision Number 2018-D01	Case Name Greene County Medical Center vs. Wisconsin Physicians Service	Issue Whether the Medicare Contractor improperly disallowed certain home office costs claimed by the Provider on the grounds that it was not related to the entity that had furnished the services.
Decision Number 2018-D02	Case Name Desert Star Home Health vs. Palmetto GBA c/o National Government Services	Issue Whether the Provider should be subject to a two percent reduction to its calendar year 2017 home health market basket percentage increase for failure to meet Home Health Quality Reporting Program requirements in accordance with 42 C.F.R. § 484.225(i).
Decision Number 2018-D03	Case Name Hillcrest Specialty Hospital vs. Wisconsin Physicians Service	Issue Whether the CMS “must-bill” policy applies to the Provider’s claimed dual eligible beneficiaries unpaid coinsurance and deductibles when the Provider does not participate in the respective State’s Medicaid program.
Decision Number 2018-D04	Case Name Pomerene Hospital (F.K.A. Joel Pomerene Memorial Hospital) vs. CGS Administrators	Issue Whether the Medicare Contractor’s adjustments to the Provider’s Electronic Health Record (EHR) incentive payment based on the exclusion of inpatient days for which the Provider provided covered services to Medicare Advantage (MA) patients is correct.
Decision Number 2018-D05	Case Name Kindred 2006-2014 LTCH/SNF Bad Debts CIRP Groups vs. Wisconsin Physicians Service	Issue Whether the CMS “must-bill” policy applies to the Providers’ claimed dual eligible beneficiaries unpaid coinsurance and deductibles when the Providers do not participate in the respective State’s Medicaid program.
Decision Number 2018-D06	Case Name HealthEast 2007 Paramed Ed-CPE CIRP Group/ HealthEast 2008 Paramed Ed-CPE CIRP Group vs. National Government Services	Issue "0Whether the Medicare Contractor’s adjustment to the Clinical Pastoral Education (CPE) costs from being reported as an allied health educational activity to an administrative and general expense is correct.
Decision Number 2018-D07	Case Name Montgomery General Hospital vs. Palmetto GBA c/o National Government Services	Issue Whether the Medicare Contractor improperly calculated and adjusted the Provider's defined benefit pension plan contribution cost that the Provider claimed on its fiscal year 2007 cost report.
Decision Number 2018-D08	Case Name Toyon 2002-2006 LIP SSI Realignment Group vs. Noridian Healthcare Solutions	Issue Whether the Supplemental Security Income (SSI) ratio used to calculate the Medicare Low Income Patient (LIP) adjustment for inpatient rehabilitation facilities (IRFs) accurately reflected the number of patient days corresponding to the IRF cost reporting ...
Decision Number 2018-D09	Case Name TLC Health Network- Lake Shore Hospital vs. National Government Services, Inc.	Issue Whether the reduction of the Provider’s Market Basket Update for federal fiscal year 2016 under the Hospital Inpatient Quality Reporting (IQR) Program was proper.
Decision Number 2018-D10	Case Name Progressive Health Center, Inc. vs. Novitas Solutions, Inc.	Issue Whether the CMS “must-bill” policy applies to the Provider’s claimed dual eligible beneficiaries unpaid coinsurance and deductibles when the Provider does not participate in the respective State’s Medicaid program.
Decision Number 2018-D11	Case Name Progressive Health Center, Inc. vs. Novitas Solutions, Inc.	Issue Whether the CMS “must-bill” policy applies to the Provider’s claimed dual eligible beneficiaries unpaid coinsurance and deductibles when the Provider does not participate in the respective State’s Medicaid program.
Decision Number 2018-D12	Case Name St. Anthony Hospital vs. Novitas Solutions, Inc.	Issue Whether the Medicaid days attributable to child and adolescent patients who received services in three of the Provider’s inpatient behavioral health units (namely the ACCENTS Unit, the Human Restoration Unit, and the Positive Outcomes Unit) can be inclu...
Decision Number 2018-D13	Case Name Mercy Hospital, Inc. d/b/a/ Carolinas Healthcare System- Pineville vs. Palmetto GBA c/o National Government Services	Issue Whether the full reduction of the Provider’s annual increase factor by 2 percent for fiscal year 2017 for failing to timely submit one of the six required data under the Inpatient Rehabilitation Facility (IRF) Quality Reporting Program (QRP) was proper.
Decision Number 2018-D14	Case Name High Ridge House vs. Cahaba GBA c/o National Government Services, Inc.	Issue Whether the Medicare Administrative Contractor improperly reclassified Provider costs related to providing housing free of charge for temporary, on-call and other staff, and for housing leasing at market value to the Director of Christian Science Nursing...
Decision Number 2018-D15	Case Name Nassau Suffolk 2007, 2008, 2009 Wage Index Calculation Groups vs. National Government Services, Inc.	Issue Whether the Medicare Contractor should have excluded the aberrant wage index data from Brunswick Hospital Center when calculating the Nassau-Suffolk Core-Based Statistical Area (CBSA) wage index calculations for fiscal years 2007, 2008 and 2009.
Decision Number 2018-D16	Case Name St. Joseph's Hospital vs. National Government Services, Inc.	Issue Whether the Provider should be subjected to a reduction of one quarter of the market basket update to the fiscal year 2017 Inpatient Prospective Payment System (IPPS) rates for the failure to meet the Hospital Inpatient Quality Reporting (IQR) Program req...
Decision Number 2018-D17	Case Name St. Anthony North Hospital vs. Novitas Solutions, Inc.	Issue Whether the Medicare Contractor improperly reduced the Provider’s adjusted indirect medical education (IME) full time equivalent (FTE) count from 6.48 to zero.
Decision Number 2018-D18	Case Name Mountain States Health Alliance 05 Bad Debt- Passive Collection CIRP Group vs. Cahaba Government Benefits Administrators, LLC	Issue Whether the Providers engaged in “reasonable collection efforts” notwithstanding their differential treatment of Medicare and non-Medicare bad debt, in light of the Reed City and St. Francis Board decisions.
Decision Number 2018-D19	Case Name Sutter Health 2001-2003 Regular Bad Debts- Collection Agency CIRP Group vs. Noridian Healthcare Solutions	Issue Whether the Providers are entitled to reimbursement of their Medicare bad debts for the fiscal years ending December 31, 2001, 2002 and 2003.
Decision Number 2018-D20	Case Name Wyatt FFY 08 Wage Index (Occupational Mix Adjustment) Group vs. CGS Administrators, LLC	Issue 1. Whether the inclusion of surgical technicians, mental health technicians, and heart center recovery technicians in the “All other occupations” category instead of the “Nursing aides, orderlies and attendants” category in the Provider’s occupa...
Decision Number 2018-D21	Case Name Florida Section 1115 DSH Waiver Days Groups vs. First Coast Service Options	Issue Whether the Low-Income Pool Section 1115 waiver days should be included in the Medicaid fraction of the disproportionate share hospital (DSH) calculations.
Decision Number 2018-D22	Case Name Florida Section 1115 LIP Rehab DSH Waiver Days Group vs. First Coast Service Options	Issue Whether the Low-Income Pool Section 1115 waiver days should be included in the Medicaid fraction of the Low Income Patient (LIP) calculations for the inpatient rehabilitative facilities (IRFs).
Decision Number 2018-D23	Case Name Momence Meadows Nursing and Rehabilitation Center, LLC vs. National Government Services	Issue Whether the Medicare Administrative Contractor’s adjustment that eliminated $183,879 of claimed Medicare reimbursable bad debts was proper and in accordance with Medicare regulations and the Provider Reimbursement Manual (PRM).
Decision Number 2018-D24	Case Name Westchester General Hospital vs. First Coast Service Options	Issue Whether the payment reduction to the market basket update imposed under the Hospital Inpatient Quality Reporting (IQR) program for fiscal year 2015 was proper.
Decision Number 2018-D25	Case Name The Mary Imogene Basset Hospital vs. National Government Services, Inc. vs. National Government Services, Inc.	Issue Whether the Provider, as a Sole Community Hospital (SCH), was properly reimbursed for Indirect Medical Education (IME) costs for services provided to Medicare Advantage (MA) patients for the cost reporting years at issue.
Decision Number 2018-D26	Case Name Greenwood Leflore Hospital vs. Novitas Solutions, Inc.	Issue Whether the CMS decision to reduce the Provider’s Market Basket Update (MBU) for Fiscal Year (FY) 2017 by twenty-five percent, pursuant to the Hospital Inpatient Quality Reporting program (IQR), was proper.
Decision Number 2018-D27	Case Name Central Iowa Healthcare vs. Wisconsin Physicians Service	Issue Whether the Provider is entitled to the full Market Basket Update for the fiscal year 2017.
Decision Number 2018-D28	Case Name Providence Sacred Heart Medical Center vs. Noridian Healthcare Solutions,LLC	Issue Whether the MAC properly disallowed reimbursement for direct graduate medical education (GME) and indirect medical education (IME) costs in the non hospital setting by reducing the Provider’s full-time equivalent (FTE) resident counts to exclude residen...
Decision Number 2018-D29	Case Name Doctors Hospital of Stark County vs. CGS Administrators	Issue Whether the Medicare Contractor’s adjustments to the Provider’s available beds and bed days and prior-year resident-to-bed ratio for cost reporting periods ending 6/30/2001, 6/30/2002 and 6/30/2003 were proper.
Decision Number 2018-D30	Case Name Horizon Home Care & Hospice vs. National Government Services	Issue Whether the imposition of a two percent reduction in the Provider's fiscal year 2016 Medicare payments was proper.
Decision Number 2018-D31	Case Name Mary Free Bed Hospital & Rehab Center vs. Wisconsin Physicians Service	Issue Whether the Provider is entitled to the full market basket update for Fiscal Year 2017.
Decision Number 2018-D32	Case Name Lightbridge Hospice vs. National Government Services	Issue Whether the imposition of a two percent reduction in the Provider's fiscal year 2016 Medicare payments was proper.
Decision Number 2018-D33	Case Name Beaumont Hospital, Wayne (f/k/a Oakwood Annapolis Hospital) vs. Wisconsin Physicians Services	Issue Whether the Provider is entitled to higher direct graduate medical education (DGME) and indirect medical education (IME) full-time equivalent (FTE) resident caps for a new family medicine residents training program.
Decision Number 2018-D34	Case Name Northern Utah Healchare d/b/a St. Mark's Hospital vs. Wisconsin Physicians Services	Issue Whether the Provider is entitled to the full Outpatient Prospective Payment System (OPPS) market basket rate for Calendar Year 2015 based on its reported Hospital Outpatient Quality Reporting (HOQR) validation data.
Decision Number 2018-D35	Case Name Riverside Methodist Hospital vs. CGS Administrators, LLC	Issue Whether the determination that the Provider failed to meet the validation requirements for the Calendar Year 2015 Hospital Outpatient Quality Reporting (HOQR) Program was proper.
Decision Number 2018-D36	Case Name Covenant Medical Center, Inc. vs. Wisconsin Physicians Service	Issue Whether, for purposes of the graduate medical education (GME) payment and indirect medical education (IME) adjustments for FYE’s 06/30/2007, 06/30/2008 and 06/30/2009, the Provider is entitled to count full time equivalent (FTE) residents training in th...
Decision Number 2018-D37	Case Name Hospice Care in Westchester and Putnam, Inc. vs. National Government Services	Issue Whether the Centers for Medicare & Medicaid Services’ reduction to the Provider’s Annual Payment Update (APU) for Fiscal Year (FY) 2016 was proper.
Decision Number 2018-D38	Case Name North Carolina Baptist Hospital vs. Palmetto GBA c/o National Government	Issue Whether a two percentage point reduction in the Provider’s fiscal year 2017 annual increase factor, due to failure to meet Inpatient Rehabilitation Facility Quality Reporting Program (IRF-QRP) requirements, was proper.
Decision Number 2018-D39	Case Name Grace Community Home Health, Inc. vs. National Government Services	Issue Whether the Provider should be subject to a two percentage point reduction to its calendar year 2017 home health market basket percentage increase for failure to meet the Home Health Quality Reporting Program requirements in accordance with 42 C.F.R. § ...
Decision Number 2018-D40	Case Name Guardian Homecare LLC vs. CGS Administrators	Issue Whether the imposition of a two percent reduction in the Provider’s Medicare payments for calendar year 2017 was proper.
Decision Number 2018-D41	Case Name University Medical Center vs. Wisconsin Physicians Service	Issue Whether the Medicare Administrative Contractor determined Medicare reimbursement for Disproportionate Share Hospital (DSH) payments in accordance with the Medicare statute, 42 U.S.C. § 1395ww(d)(5)(F)(vi). Specifically, whether the numerator of the “Me...
Decision Number 2018-D42	Case Name Conway Regional Rehabilitation Hospital vs. Novitas Solutions, Inc.	Issue Whether the reduction of the Provider's Annual Payment Update (APU) for the federal fiscal year 2017 by the Centers for Medicare & Medicaid Services under the Inpatient Rehabilitation Facility (IRF) Quality Reporting Program (QRP) was proper.
Decision Number 2018-D43	Case Name QRS 2004-2005 Medicare Part A Title XIX Eligible Patient Days Group III; QRS Empire 2000, 2003-2004, 2006-2007 Medicare Part A Title XIX Eligible Days – No Pay Part A CIRP Group; and QRS 10/1/2004 – 2008 DSH No Pay Part A Group vs. Noridian Healthca...	Issue Whether patient days associated with Medicare Part A, Title XIX eligible patients that were not included in the Supplemental Security Income (SSI) percentage factor of the Medicare Disproportionate Share Hospital (DSH) formula should be included in the Me...
Decision Number 2018-D44	Case Name Garden City Hospital vs. Wisconsin Physicians Service	Issue Whether the Provider timely submitted required quality data during the required timeframes, and is entitled to the full Market Basket Update for Fiscal Year 2017.
Decision Number 2018-D45	Case Name Faxton-St. Luke's Healthcare vs. National Government Services, Inc.	Issue Whether the Medicare Contractor's disallowance of all bad debt claims for patients deemed indigent is in accordance with the Medicare regulations and manual provisions as described in Centers for Medicare & Medicaid Services’ Provider Reimbursement Manu...
Decision Number 2018-D46	Case Name Our Lady of the Lake Regional Medical Center vs. Novitas Solutions, Inc.	Issue Whether the Medicare Contractor's recalculation of the Provider’s per-resident amount was consistent with the law requiring the use of 1998 census region hospital data to determine the cap on the Provider’s recalculated per-resident amount.
Decision Number 2018-D47	Case Name Post Acute Medical Specialty Hospital of Texarkana North vs. Novitas Solutions, Inc.	Issue Whether the payment penalty that CMS imposed under the Long-Term Care Hospital Quality Reporting Program to reduce the Provider’s payment update for the federal fiscal year of 2017 by two percent was proper
Decision Number 2018-D48	Case Name Providence Health & Services 10/1/2004-12/31/2007 Dual Eligible Days CIRP Group vs. Noridian Healthcare Solutions	Issue Whether patient days associated with Medicare Part A and Title XIX eligible patients that were not included in the SSI percentage factor of the Medicare Disproportionate Share formula should be included in the Medicaid fraction of the Medicare DSH formula...
Decision Number 2018-D49	Case Name Akin Gump 2006-2008 Florida Low Income Pool Waiver Days Groups vs. First Coast Service Options, Inc.	Issue Whether days attributable to patients who received assistance under Florida’s Low-Income Pool Medicaid waiver days should be included in the numerator of the Medicaid fraction used to calculate the Providers’ disproportionate share hospital payments....
Decision Number 2018-D50	Case Name Pomona Valley Hospital Medical Center vs. Noridian Healthcare Solutions	Issue Whether the Medicare Administrative Contractor properly calculated the Provider’s disproportionate share hospital reimbursement with respect to the Provider’s Supplemental Security Income percentage.
Decision Number 2018-D51	Case Name Rice Memorial Hospital vs. National Government Services	Issue Whether the Medicare Administrative Contractor was correct when it calculated the Provider’s volume decrease adjustment (VDA) by prorating the amount of the VDA according to the portion of the year during which the Provider maintained sole community hos...
Decision Number 2018-D52	Case Name St. Mary's Regional Hospital vs. National Government Services	Issue Whether the Medicare Administrative Contractor was correct when it calculated the Provider’s volume decrease adjustment (VDA) by prorating the amount of the VDA according to the portion of the year during which the Provider maintained sole community hos...
Decision Number 2019-D01	Case Name United Hospital Center vs. Palmetto GBA c/o National Government Services, Inc.	Issue Whether the reduction by one-fourth of the Provider’s fiscal year 2017 Inpatient Prospective Payment System annual payment update for the failure to meet all of the inpatient quality reporting requirements is proper.
Decision Number 2019-D02	Case Name The University of Texas Southwestern Medical Center vs. Novitas Solutions, Inc.	Issue Whether the Medicare Contractor’s audit adjustments to remove Medicare Usable Organs (Heart and Kidney) were fair and proper.
Decision Number 2019-D03	Case Name St. Helena Hospital- Clearlake vs. Noridian Healthcare Solutions	Issue 1. Whether the costs incurred by the Provider for its physician on-call expenses should be allowed for the four cost reporting periods at issue (2005, 2006, 2007, and 2008). 2. Whether the Provider’s costs of meals furnished to outpatients (sometimes re...
Decision Number 2019-D04	Case Name Mackey Family Practice, PA vs. Palmetto GBA	Issue Whether the Medicare Contractor's disallowance of the Medicare bad debts claimed by the Provider was proper.
Decision Number 2019-D05	Case Name Presence St. Joseph Hospital, Inc. vs. National Government Services	Issue Whether the Medicare Administrative Contractor properly determined the count of full-time equivalent residents, used for the purposes of calculating payments for direct graduate medical education, indirect medical education, and IME capital.
Decision Number 2019-D06	Case Name Metroplex Hospital vs. First Coast Service Options, Inc.	Issue Whether the payment penalty under the Hospital Inpatient Quality Reporting Program was properly applied to the Provider.
Decision Number 2019-D07	Case Name North Mississippi Medical Center vs.Novitas Solutions, Inc.	Issue Whether the reduction of the Provider’s Annual Payment Update by 2 percent for fiscal year 2017 was proper.
Decision Number 2019-D08	Case Name Toyon/Dignity Health/Sutter Health 2012 Inpatient and Outpatient Payment CBSA No. 40900 Wage Data Groups vs. Noridian Healthcare Solutions	Issue Whether the Federal Fiscal Year 2012 wage index factor and capital geographic adjustment factor for Core Based Statistical Area No. 40900 used in the calculation of Medicare inpatient and outpatient prospective payments is properly stated.
Decision Number 2019-D09	Case Name Christian Healthcare Center d/b/a Ramapo Ridge vs. Novitas Solutions, Inc.	Issue Whether the Provider is entitled to the full market basket adjustment to its rate for fiscal year 2017.
Decision Number 2019-D10	Case Name Minnesota Hospice, LLC vs. National Government Services, Inc.	Issue Whether CMS properly reduced the Provider's annual payment update for Fiscal Year 2018 by 2 percentage points.
Decision Number 2019-D11	Case Name Tulsa Hospital vs. Novitas Solutions, Inc.	Issue Whether the Medicare Contractor’s determination to reduce the Providers’ indirect medical education and graduate medical education full-time equivalent resident counts to exclude certain resident rotations in nonhospital clinics was proper.
Decision Number 2019-D12	Case Name Dukes Memorial Hospital vs. WPS Government Health Administrators	Issue Whether the Medicare Contractor appropriately disallowed costs to the Provider claimed for physician compensation for emergency room availability services (frequently referred to as “standby services”), administrative/management services, and on-call ...
Decision Number 2019-D13	Case Name Rehabilitation Hospital of the Pacific vs. Noridian Healthcare Solutions c/o Cahaba Safeguard Administrators (J-E)	Issue Whether the reduction to the Provider’s Market Basket Update for the fiscal year 2017 under the Inpatient Rehabilitation Facility Quality Reporting Program was proper.
Decision Number 2019-D14	Case Name Glenbeigh Health Sources vs. CGS Administrators, LLC	Issue Whether the fiscal year 2018 penalty imposed under the hospital inpatient quality reporting program was proper.
Decision Number 2019-D15	Case Name MUSC Medical Center/Medical University Hospital Authority vs. Palmetto GBA c/o National Government Services, Inc.	Issue 1. Whether the Medicare Administrative Contractor’s decision to reclassify the costs and statistics out of the paramedical pass-through cost center was proper. This issue applies to the fiscal years ending June 30, 2007 and June 30, 2008. 2. Whether th...
Decision Number 2019-D16	Case Name Landmark Hospital of Salt Lake City, LLC vs. Cahaba Gov’t Benefit Administrators, LLC c/o National Gov’t Services, Inc.	Issue Whether the payment penalty that CMS imposed under the Long Term Care Hospital Quality Reporting Program to reduce the Provider’s payment update for Fiscal Year 2017 by 2-percent was proper.
Decision Number 2019-D17	Case Name Landmark Hospital of Savannah, LLC vs. Cahaba Gov’t Benefit Administrators, LLC c/o National Gov’t Services, Inc.	Issue Whether the payment penalty that CMS imposed under the Long Term Care Hospital Quality Reporting Program to reduce the Provider’s payment update for Fiscal Year 2017 by 2-percent was proper.
Decision Number 2019-D18	Case Name Silverado 2013 Hospice Cap Sequestration CIRP Group/ProCare 2013 Hospice Cap Sequestration CIRP Group vs. National Government Services (J-6)	Issue Whether the Medicare Contractor erred in calculating the hospice aggregate cap overpayments when it included, in “the amount of payment made,” certain funds that were sequestered and never paid to the Providers.
Decision Number 2019-D19	Case Name Cottonwod Springs LLC vs. WPS Government Health Administrators	Issue Whether the Provider is entitled to the full market basket adjustment to its Inpatient Psychiatric Facility Prospective Payment System rate for fiscal year 2018.
Decision Number 2019-D20	Case Name Silverado 2014 Hospice Cap Sequestration CIRP Group vs. National Government Services	Issue Whether the Medicare Contractor erred in calculating the hospice aggregate cap overpayments when it included, in “the amount of payment made,” certain funds that were sequestered and never paid to the Providers.
Decision Number 2019-D21	Case Name RX Home Health Services, Inc. vs. Palmetto GBA	Issue Whether the Provider should be subject to a two percentage point reduction to its Calendar Year 2018 Annual Payment Update for failure to meet Home Health Quality Reporting Program requirements in accordance with 42 C.F.R. § 484.225(i) (2015).
Decision Number 2019-D22	Case Name Mariners Hospital vs. First Coast Service Options, Inc.	Issue Whether the Medicare Contractor improperly disallowed costs incurred by the Provider under its service agreements with emergency and anesthesiologist physicians groups for availability, standby, and administrative services furnished to the hospital.
Decision Number 2019-D23	Case Name Glendora Community Hospital vs. Noridian Healthcare Solutions c/o Cahaba Safeguard Administrators	Issue Whether the payment penalty imposed by CMS under the Hospital Inpatient Quality Reporting program to reduce the Provider’s payment update for federal fiscal year 2017 by one-fourth of the annual market basket update was proper.
Decision Number 2019-D24	Case Name Springs Memorial Hospital vs. Palmetto GBA c/o National Government Services	Issue Whether the Medicare Contractor properly disallowed all costs and removed all therapy charges relating to the Provider’s use of a Therapy and Management Services subcontractor for its Skilled Nursing Facility and Inpatient Rehabilitation Facility units.
Decision Number 2019-D25	Case Name Abundant Home Health, LLC vs. Palmetto Government Benefit Administrators, LLC c/o National Government Services, Inc.	Issue Whether the Centers for Medicare & Medicaid Services properly reduced the Provider’s home health market basket percentage increase by two percentage points for Calendar Year 2017.
Decision Number 2019-D26	Case Name Novus Health Services, Inc. vs. Palmetto GBA c/o National Government Services	Issue 1. Whether the sequestration amount should be included when calculating the aggregate payment made to the Provider, as the reduction in payment through sequestration does not constitute actual Medicare payments made to the Provider. 2. Whether the Medicar...
Decision Number 2019-D27	Case Name Henry Ford Allegiance Health vs. WPS Government Health Administrators	Issue Whether the Medicare Contractor properly calculated the per-resident amount for Medicare payment of direct graduate medical education.
Decision Number 2019-D28	Case Name Kindred FY 2013 Hospice Cap Sequestration CIRP Group vs. Palmetto GBA c/o National Government Services	Issue Whether the Medicare administrative contractor’s inclusion of the sequestered payments never actually paid to the Providers in its calculation of the Providers’ hospice cap liabilities was improper.
Decision Number 2019-D29	Case Name Select Medical 2011 Dual Eligible Bad Debts CIRP Group vs. Novitas Solutions, Inc.	Issue Whether the MAC’s must-bill policy applies to the Providers’ dual eligible bad debts when the Provider did not participate in the Medicaid program.
Decision Number 2019-D30	Case Name Southwest Medical Associates Hospice and Palliative Care vs. National Government Services, Inc. (J-6)	Issue Whether the imposition of a two percent reduction in the fiscal year 2018 Medicare payments for the Provider was proper.
Decision Number 2019-D31	Case Name Stephens County Hospital vs. Palmetto GBA	Issue Whether the Medicare Administrative Contractor correctly determined the amount of the volume decrease adjustment in accordance with the regulations and Program instructions per 42 C.F.R. § 412.92(e)(3), and the Provider Reimbursement Manual , CMS Pub. 1...
Decision Number 2019-D32	Case Name Stephens County Hospital vs. Palmetto GBA	Issue Whether the Medicare Administrative Contractor (MAC), correctly determined the amount of the volume decrease adjustment (VDA) in accordance with the regulations and Program instructions per 42 C.F.R. § 412.92(e)(3), and the Provider Reimbursement Manual ...
Decision Number 2019-D33	Case Name Trinity Health 2013 Iowa Related Organization Cost Allocation CIRP vs. WPS Government Health Administrators	Issue Whether the Medicare Contractor’s adjustments disallowing the administrative and general costs (A&G) that Mercy Medical Center – Sioux City allocated to the appealing group members (Baum Harmon Mercy Hospital and Oakland Mercy Hospital) were proper.
Decision Number 2019-D34	Case Name HMA 2004-2006 Bad Debt Group Appeals vs. Wisconsin Physicians Service/ Federal Specialized Services, Inc.	Issue Whether the Providers engaged in “reasonable collection efforts,” notwithstanding their differential treatment of Medicare and non-Medicare bad debts, in light of the Board’s decisions in Reed City Hosp. v. BlueCross BlueShield Ass’n and St. Fran...
Decision Number 2019-D35	Case Name National Jewish Health vs. Novitas Solutions, Inc.	Issue Whether the Provider should be subject to a one-fourth reduction to its Federal Fiscal Year (FFY) 2019 Annual Percentage Update (APU) for noncompliance with the Hospital Inpatient Quality Reporting (IQR) Program requirements.
Decision Number 2019-D36	Case Name University of Wisconsin Hospitals and Clinics Authority vs. National Government Services	Issue 1: Whether the Medicare Contractor's adjustments, decreasing the Provider's direct Graduate Medical Education (GME) and Indirect Medical Education (IME) Full Time Equivalent (FTE) Caps to a level below the Provider's audited and adjusted fiscal year endin...
Decision Number 2019-D37	Case Name Seasons Hospice & Palliative Care of Southern Florida vs. Palmetto GBA c/o National Government Services, Inc.	Issue Whether the Medicare Contractor incorrectly determined the cap year 2012 aggregate cap amount for the Provider when the Medicare Contractor used the patient-by-patient proportional method (proportional method) instead of the streamlined method.
Decision Number 2019-D38	Case Name Northeast Regional Medical Center vs. WPS Government Health Administrators	Issue Whether the Provider, as a Sole Community Hospital (SCH), was properly reimbursed for indirect medical education costs for services provided to Medicare Advantage (MA or Part C) patients for the cost reporting period in dispute. In particular, whether the...
Decision Number 2020-D01	Case Name Halifax Regional Medical Center vs. Palmetto GBA	Issue Whether the MAC correctly determined the amount of the volume decrease adjustment (VDA) in accordance with the regulations and Program instructions per 42 C.F.R. § 412.92(e)(3), and the Provider Reimbursement Manual (PRM), CMS Pub. 15-1 at § 28101.1.
Decision Number 2020-D02	Case Name Halifax Regional Medical Center vs. Palmetto GBA	Issue Whether the MAC correctly determined the amount of the volume decrease adjustment (VDA) in accordance with the regulations and Program instructions per 42 C.F.R. § 412.92(e)(3), and the Provider Reimbursement Manual (PRM), CMS Pub. 15-1 at § 28101.1.
Decision Number 2020-D03	Case Name Vitas Healthcare CY 2013-2015 Hospice Cap Sequestration CIRP Group vs. Palmetto GBA c/o National Government Services	Issue Whether the MAC’s inclusion of sequestered payments in the determination of the Providers’ Cap on Overall Medicare Reimbursement was proper.
Decision Number 2020-D04	Case Name Northeast Regional Medical Center vs. WPS Government Health Administrator	Issue Whether the Provider, as a Sole Community Hospital (SCH), was properly reimbursed for indirect medical education costs for services provided to Medicare Advantage (MA or Part C) patients for fiscal year ending May 31, 2009. In particular, whether the Cost...
Decision Number 2020-D05	Case Name Brigham and Women’s Hospital vs. National Government Services, Inc.	Issue 1. Whether the MAC improperly disallowed the Provider’s reasonable costs for the Ultrasound Allied Health Clinical Training Program (UAHCTP) that is not operated by the Provider. 2. Whether the MAC improperly disallowed the Provider’s reasonable costs...
Decision Number 2020-D06	Case Name Woodward Regional Hospital vs. WPS Government Health Administrators	Issue Whether the MAC correctly determined the amount of the volume decrease adjustment (VDA) in accordance with the regulations and Program instructions per 42 C.F.R. § 412.92(e)(3), and the Provider Reimbursement Manual (PRM), CMS Pub. 15-1 at § 28101.1.
Decision Number 2020-D07	Case Name Woodward Regional Hospital vs. WPS Government Health Administrators	Issue Whether the MAC correctly determined the amount of the volume decrease adjustment (VDA) in accordance with the regulations and Program instructions per 42 C.F.R. § 412.92(e)(3), and the Provider Reimbursement Manual (PRM), CMS Pub. 15-1 at § 28101.1.
Decision Number 2020-D08	Case Name Bartlett Regional Medical Center vs. WPS Noridian Healthcare Solutions, LLC/ Federal Specialized Services, Inc.	Issue Whether the contributions made by the State of Alaska can be counted as “reasonable cost” by the Provider for purposes of reimbursement under the Medicare Rural Demonstration Project.
Decision Number 2020-D09	Case Name Baptist Memorial Hospital Booneville vs. Palmetto GBA	Issue Whether the MAC correctly determined the amount of the volume decrease adjustment (VDA) in accordance with the regulations and Program instructions per 42 C.F.R. § 412.92(e)(3), and the Provider Reimbursement Manual (PRM), CMS Pub. 15-1 at § 28101.1.
Decision Number 2020-D10	Case Name Baptist Memorial Hospital Booneville vs. Palmetto GBA	Issue Whether the MAC correctly determined the amount of the volume decrease adjustment (VDA) in accordance with the regulations and Program instructions per 42 C.F.R. § 412.92(e)(3), and the Provider Reimbursement Manual (PRM), CMS Pub. 15-1 at § 28101.1.
Decision Number 2020-D11	Case Name Olympic Medical Center vs. Noridian Healthcare Solutions, LLC	Issue Whether the MAC correctly determined the amount of the volume decrease adjustment (VDA) in accordance with the regulations and Program instructions per 42 C.F.R. § 412.92(e)(3), and the Provider Reimbursement Manual (PRM), CMS Pub. 15-1 at § 28101.1.
Decision Number 2020-D12	Case Name Lake Region Healthcare Corporation vs. National Government Services, Inc.	Issue Whether the MAC correctly determined the amount of the volume decrease adjustment (VDA) in accordance with the regulations and Program instructions per 42 C.F.R. § 412.92(e)(3), and the Provider Reimbursement Manual (PRM), CMS Pub. 15-1 at § 28101.1.
Decision Number 2020-D13	Case Name Good Shepherd Hospice of Mid-America, Inc. vs. CGS Administrators	Issue Whether the Medicare Contractor’s amended hospice cap calculation issued pursuant to the Notice of Reopening properly calculated the Provider’s hospice aggregate cap overpayment when it included in “the amount of payment made” certain funds that w...
Decision Number 2020-D14	Case Name Ozarks Community Hospital of Gravette vs. Novitas Solutions, Inc.	Issue 1. Whether the use of total costs, rather than patient days, as a statistic to allocate home office pooled costs was proper. 2. Whether the use of gross revenues, rather than patient days, as a statistic to functionally allocate business office costs was ...
Decision Number 2020-D15	Case Name Innovis Hospital d/b/a Essentia Health Fargo vs. Noridian Healthcare Solutions, LLC	Issue Whether the MAC’s adjustment to reconcile outlier payments was proper and, since the MAC waited 5 years after discovering the error before notifying the Provider, whether the law bars recovery of the overpayment.
Decision Number 2020-D16	Case Name St. Vincent Charity Medical Center vs. CGS Administrators	Issue 1. Whether the Medicare Contractor’s adjustments for disallowing pass-through costs and managed care payments associated with the Provider’s operation of its pastoral care allied health education program were proper. 2. Whether the Medicare Contractor...
Decision Number 2020-D17	Case Name Sentara Healthcare Bad Debt CIRP Groups vs. Palmetto GBA c/o National Government Services	Issue Whether the MAC properly adjusted Medicare bad debt accounts considered indigent by the Providers and claimed as Medicare bad debt. The Board focused its decision-making on whether the asset-test guideline at §312(B) of the PRM must be applied to determi...
Decision Number 2020-D18	Case Name Good Shepherd Hospice of Mid-America, Inc. vs. CGS Administrators	Issue Whether the Medicare Contractor’s amended hospice cap calculation properly calculated the Provider’s hospice aggregate cap overpayment when it included in “the amount of payment made” certain funds that were sequestered and never paid to the Provi...
Decision Number 2020-D19	Case Name Loyola University Medical Center vs. National Government Services, Inc.	Issue Whether the Medicare Contractor should adjust the direct graduate medical education (GME) cap for the Provider on Worksheet E-3, Part VI of the Provider’s cost reports for fiscal years (FYs) 2006 and 2007, for the addition of new programs.
Decision Number 2020-D20	Case Name UHS 2006-2009 Medicare Bad Debts Still At Agency CIRP Group vs. Novitas Solutions, Inc.	Issue Whether the Providers' Medicare bad debts pending at outside collection agencies are allowable.
Decision Number 2020-D21	Case Name Encompass Home Health of the West, LLC vs. National Government Services, Inc.	Issue Whether the Medicare Contractor’s reduction to the Provider’s home health prospective payment system (HHA PPS) payments for calendar year (CY) 2018 by two percent was proper.
Decision Number 2020-D22	Case Name AnMed Health vs. Palmetto GBA c/o National Government Services, Inc.	Issue Whether the denial of the Provider’s request for sole community hospital (SCH) designation by CMS and the MAC was proper.
Decision Number 2020-D23	Case Name Three Rivers Community Hospital vs. Noridian Healthcare Solutions	Issue Whether the MAC correctly determined the amount of the volume decrease adjustment (VDA) in accordance with the regulations and Program instructions per 42 C.F.R. § 412.92(e)(3), and the Provider Reimbursement Manual (PRM), CMS Pub. 15-1 at § 28101.1.
Decision Number 2020-D24	Case Name Physicians Alliance Hospital vs. WPS Government Health Administrators	Issue Whether the Medicare Contractor’s adjustment to the outlier reconciliation adjustment determination was proper.
Decision Number 2020-D25	Case Name Cherokee Regional Medical Center vs. WPS Government Health Administrators	Issue Whether the Medicare Contractor properly disallowed administrative and general (A&G) costs allocated to Cherokee by St. Luke’s Regional Medical Center.
Decision Number 2021-D01	Case Name Affinis Hospice, LLC vs. Palmetto GBA c/o National Government Services, Inc.	Issue Whether the Medicare Contractor used the correct data and methodology in calculating and applying the “hospice cap” for Cap Years 2013 and 2014.
Decision Number 2021-D02	Case Name Berwick Hospital Center vs. WPS Government Health Administrators	Issue Whether the MAC correctly determined the amount of the volume decrease adjustment (VDA) in accordance with the regulations and Program instructions per 42 C.F.R. § 412.92(e)(3), and the Provider Reimbursement Manual (PRM), CMS Pub. 15-1 at § 28101.1.
Decision Number 2021-D03	Case Name Berwick Hospital Center vs. WPS Government Health Administrators	Issue Whether the MAC correctly determined the amount of the volume decrease adjustment (VDA) in accordance with the regulations and Program instructions per 42 C.F.R. § 412.92(e)(3), and the Provider Reimbursement Manual (PRM), CMS Pub. 15-1 at § 28101.1.
Decision Number 2021-D04	Case Name Henry County Health Center vs. WPS Government Health Administrator	Issue Whether the Medicare Contractor improperly disallowed certain related party costs claimed by the Provider based on its determination that the Provider had not incurred the claimed costs.
Decision Number 2021-D05	Case Name Palo Pinto General Hospital vs. Novitas Solutions, Inc.	Issue Whether the Provider was entitled to a volume decrease adjustment (VDA) for the Fiscal Year Ended September 30, 2012 (FY 2012) greater than the amount determined by the MAC.
Decision Number 2021-D06	Case Name Berwick Hospital Center vs. WPS Government Health Administrators	Issue Whether the Medicare Contractor properly calculated the volume decrease adjustment (VDA) owed to the Provider for the significant decrease in inpatient discharges that occurred in its cost reporting period ending June 30, 2015 (FY 2015).
Decision Number 2021-D07	Case Name Brownwood Regional Medical Center vs. WPS Government Health Administrators	Issue Whether the Medicare Contractor properly calculated the volume decrease adjustment (VDA) owed to the Provider for the significant decrease in inpatient discharges that occurred in its cost reporting period ending September 30, 2007 (FY 2007).
Decision Number 2021-D08	Case Name Brownwood Regional Medical Center vs. WPS Government Health Administrators	Issue Whether the Medicare Contractor properly calculated the volume decrease adjustment (VDA) owed to the Provider for the significant decrease in inpatient discharges that occurred in its cost reporting period ending September 30, 2012 (FY 2012).
Decision Number 2021-D09	Case Name Brownwood Regional Medical Center vs. WPS Government Health Administrators	Issue Whether the Medicare Contractor properly calculated the volume decrease adjustment (VDA) owed to the Provider for the significant decrease in inpatient discharges that occurred in its cost reporting period ending September 30, 2013 (FY 2013).
Decision Number 2021-D10	Case Name Brownwood Regional Medical Center vs. WPS Government Health Administrators	Issue Whether the Medicare Contractor properly calculated the volume decrease adjustment (VDA) owed to the Provider for the significant decrease in inpatient discharges that occurred in its cost reporting period ending September 30, 2014 (FY 2014).
Decision Number 2021-D11	Case Name Brownwood Regional Medical Center vs. WPS Government Health Administrators	Issue Whether the Medicare Contractor properly calculated the volume decrease adjustment (VDA) owed to the Provider for the significant decrease in inpatient discharges that occurred in its cost reporting period ending September 30, 2015 (FY 2015).
Decision Number 2021-D12	Case Name Brownwood Regional Medical Center vs. WPS Government Health Administrators	Issue Whether the Medicare Contractor properly calculated the volume decrease adjustment (VDA) owed to the Provider for the significant decrease in inpatient discharges that occurred in its cost reporting period ending September 30, 2016 (FY 2016).
Decision Number 2021-D13	Case Name ProHealth Home Care, Inc. vs. National Government Services, Inc.	Issue Whether the two-percentage point reduction to the Annual Percentage Update (APU) of the Provider for Fiscal Year (FY) 2019 was proper.
Decision Number 2021-D14	Case Name Hazard ARH Regional Medical Center vs. CGS Administrators, LLC	Issue 1. Whether CMS’ decision to reduce the Provider’s Fiscal Year (FY) 2018 Inpatient Psychiatric Facility Prospective Payment System annual payment update (APU) by 2 percentage points was proper. 2. Whether CMS’ decision to reduce the Provider’s Cale...
Decision Number 2021-D15	Case Name Lamb Healthcare Center vs. Novitas Solutions, Inc.	Issue Whether the Provider is entitled to a Volume Decrease Adjustment (VDA) for Fiscal Year End September 30, 2012 (FY 2012), greater than the amount determined by the Medicare Contractor.
Decision Number 2021-D16	Case Name Jewish Healthcare Center, Inc., d/b/a JHC HomeCare, vs. National Government Services, Inc.	Issue Whether the payment penalty imposed on the Provider’s home health prospective payment system Annual Payment Update (APU) for calendar year (CY) 2019 was proper.
Decision Number 2021-D17	Case Name Rolling Plains Memorial Hospital vs. Novitas Solutions, Inc.	Issue Whether the Provider is entitled to a Volume Decrease Adjustment (VDA) for Fiscal Year End September 30, 2010 (FY 2010).
Decision Number 2021-D18	Case Name Rolling Plains Memorial Hospital vs. Novitas Solutions, Inc.	Issue Whether the Provider is entitled to a Volume Decrease Adjustment (VDA) for Fiscal Year End September 30, 2012 (FY 2012).
Decision Number 2021-D19	Case Name Alta Vista Regional Hospital vs. WPS Government Health Administrators	Issue Whether the Medicare Contractor properly calculated the volume decrease adjustment (VDA) owed to the Provider for the significant decrease in inpatient discharges that occurred in its cost reporting period ending August 31, 2008 (FY 2008).
Decision Number 2021-D20	Case Name Alta Vista Regional Hospital vs. WPS Government Health Administrators	Issue Whether the Medicare Contractor properly calculated the volume decrease adjustment (VDA) owed to the Provider for the significant decrease in inpatient discharges that occurred in its cost reporting period ending August 31, 2010 (FY 2010).
Decision Number 2021-D21	Case Name Rome Memorial Hospital vs. National Government Services, Inc.	Issue Whether the Medicare Contractor properly calculated the volume decrease adjustment (VDA) owed to the Provider for the significant decrease in inpatient discharges that occurred in its cost reporting period ending December 31, 2011 (FY 2011) and whether th...
Decision Number 2021-D22	Case Name Serenity One Hospice & Palliative Care vs. Palmetto GBA c/o National Government Services, Inc.	Issue Whether the Medicare Contractor used the correct number of Medicare beneficiaries in calculating the Cap Year 2018 Hospice Cap.
Decision Number 2021-D23	Case Name HCR Manor Care 2014 Hospice Cap Overpayment CIRP Group vs. National Government Services, Inc.	Issue Whether the Medicare Contractor’s inclusion of sequestered payments in the determination of the Providers’ cap on overall Medicare reimbursement was proper.
Decision Number 2021-D24	Case Name Carthage Area Hospital vs. National Government Services, Inc.	Issue Whether the Provider is entitled to a Volume Decrease Adjustment (VDA) for cost report period ending December 31, 2011 (FY 2011).
Decision Number 2021-D25	Case Name Carthage Area Hospital vs. National Government Services, Inc.	Issue Whether the Provider is entitled to a Volume Decrease Adjustment (VDA) for cost report period ending December 31, 2012 (FY 2012).
Decision Number 2021-D26	Case Name Oswego Hospital vs. National Government Services, Inc.	Issue Whether the Medicare Contractor properly calculated the volume decrease adjustment (VDA) owed to the Provider for the significant decrease in inpatient discharges that occurred in its cost reporting period ending December 31, 2011 (FY 2011) and whether th...
Decision Number 2021-D27	Case Name Universal Health Care / Fletcher, Inc. vs. Palmetto GBA c/o National Government Services, Inc.	Issue Whether the payment penalty imposed by the Centers for Medicare and Medicaid Services (CMS) to reduce the Provider's Fiscal Year (FY) 2019 Medicare payment by two percent was proper.
Decision Number 2021-D28	Case Name Scenic Mountain Medical Center vs. WPS Government Health Administrators	Issue Whether the Medicare Contractor properly calculated the volume decrease adjustment (VDA) owed to the Provider for the significant decrease in inpatient discharges that occurred in its cost reporting period ending December 31, 2012 (FY 2012).
Decision Number 2021-D29	Case Name Scenic Mountain Medical Center vs. WPS Government Health Administrators	Issue Whether the Medicare Contractor properly calculated the volume decrease adjustment (VDA) owed to the Provider for the significant decrease in inpatient discharges that occurred in its cost reporting period ending December 31, 2013 (FY 2013).
Decision Number 2021-D30	Case Name Scenic Mountain Medical Center vs. WPS Government Health Administrators	Issue Whether the Medicare Contractor properly calculated the volume decrease adjustment (VDA) owed to the Provider for the significant decrease in inpatient discharges that occurred in its cost reporting period ending December 31, 2014 (FY 2014).
Decision Number 2021-D31	Case Name Fremont Area Medical Center vs. WPS Government Health Administrators	Issue Whether the Medicare Administrative Contractor (MAC), properly calculated the volume decrease adjustment (VDA) owed the Provider for the significant decrease in in patient discharges that occurred in its cost reporting period ending June 30, 2010 (FY 2010...
Decision Number 2021-D32	Case Name Fremont Area Medical Center vs. WPS Government Health Administrators	Issue Whether the Medicare Administrative Contractor (MAC), properly calculated the volume decrease adjustment (VDA) owed the Provider for the significant decrease in in patient discharges that occurred in its cost reporting period ending June 30, 2013 (FY 2013...
Decision Number 2021-D33	Case Name Fremont Area Medical Center vs. WPS Government Health Administrators	Issue Whether the Medicare Administrative Contractor (MAC), properly calculated the volume decrease adjustment (VDA) owed the Provider for the significant decrease in in patient discharges that occurred in its cost reporting period ending June 30, 2015 (FY 2015...
Decision Number 2021-D34	Case Name Lake Regional Health System vs. WPS Government Health Administrators	Issue Whether the Medicare Contractor properly calculated the volume decrease adjustment (VDA) owed to the Provider for the significant decrease in inpatient discharges that occurred in its cost reporting period ending April 30, 2013 (FY 2013).
Decision Number 2021-D35	Case Name Lake Regional Health System vs. WPS Government Health Administrators	Issue Whether the Medicare Contractor properly calculated the volume decrease adjustment (VDA) owed to the Provider for the significant decrease in inpatient discharges that occurred in its cost reporting period ending April 30, 2014 (FY 2014).
Decision Number 2022-D01	Case Name D. M Cogwell Memorial Hospital vs. Novitas Solutions, Inc.	Issue Whether the MAC properly calculated the volume decrease adjustment (VDA) owed the Provider for the significant decrease in inpatient discharges that occurred in its cost reporting period ending December 31, 2012 (FY 2012).
Decision Number 2022-D02	Case Name D. M Cogwell Memorial Hospital vs. Novitas Solutions, Inc.	Issue Whether the MAC properly calculated the volume decrease adjustment (VDA) owed the Provider for the significant decrease in inpatient discharges that occurred in its cost reporting period ending December 31, 2010 (FY 2010).
Decision Number 2022-D03	Case Name Hebrew Rehabilitation Center vs. National Government Services, Inc.	Issue Whether the payment penalty imposed under the Long Term Care Hospital Quality Reporting Program (LTCH-QRP), which reduced the Provider’s payment update for Fiscal Year 2019 by two percent, was proper.
Decision Number 2022-D04	Case Name Heartland Regional Medical Center (AKA Marion General Hospital/ Marion Memorial) vs. WPS Government Services	Issue Whether the MAC properly calculated the volume decrease adjustment (VDA) owed the Provider for the significant decrease in inpatient discharges that occurred in its cost reporting period ending April 30, 2011 (FY 2011).
Decision Number 2022-D05	Case Name Crossroads Community Hospital vs. WPS – Government Administrative Services	Issue Whether the MAC properly calculated the volume decrease adjustment (VDA) owed the Provider for the significant decrease in inpatient discharges that occurred in its cost reporting period ending December 31, 2013 (FY 2013).
Decision Number 2022-D06	Case Name Blackwell Regional Hospital vs. Novitas Solutions, Inc.	Issue Whether the MAC properly calculated the volume decrease adjustment (VDA) owed the Provider for the significant decrease in inpatient discharges that occurred in its cost reporting period ending March 31, 2012.
Decision Number 2022-D07	Case Name Pitt County Memorial Hospital, dba Vidant Medical Center vs. Palmetto GBA c/o National Government Services, Inc.	Issue Whether the Provider’s disproportionate share hospital (DSH) payment for fiscal year ending September 30, 2009 (FY 2009) should be revised to include additional patient days that were excluded from the numerator of the Medicaid fraction.
Decision Number 2022-D08	Case Name Dickinson County Healthcare System vs. WPS Government Health Administrators	Issue Whether the MAC erred in its determination that the Provider did not qualify for the exception to the per-visit upper payment limit (UPL) for rural health clinics (RHCs) for the fiscal years ending December 31, 2015 and December 31, 2016 (FYs 2015 and 201...
Decision Number 2022-D09	Case Name Medical Arts Hospital vs. Novitas Solutions, Inc.	Issue Whether the MAC properly calculated the volume decrease adjustment (VDA) owed the Provider for the significant decrease in inpatient discharges that occurred in its cost reporting period ending March 31, 2012.
Decision Number 2022-D10	Case Name West Branch Regional Medical Center vs. WPS Government Health Administrators	Issue Whether the MAC properly calculated the volume decrease adjustment (VDA) owed the Provider for the significant decrease in inpatient discharges that occurred in its cost reporting period ending March 31, 2009.
Decision Number 2022-D11	Case Name West Branch Regional Medical Center vs. WPS Government Health Administrators	Issue Whether the MAC properly calculated the volume decrease adjustment (VDA) owed the Provider for the significant decrease in inpatient discharges that occurred in its cost reporting period ending March 31, 2010.
Decision Number 2022-D12	Case Name Kettering Memorial Hospital vs. CGS Administrators, LLC/Federal Specialized Services, Inc.	Issue Whether the MAC erred when it made an adjustment for fiscal year (FY) 2009 to remove the Provider's protested item for the addition of Allied Health Program revenue to the accumulated cost allocation statistic, Audit Adjustment No. 26.
Decision Number 2022-D13	Case Name Chenango Memorial Hospital vs. National Government Services, Inc.	Issue Whether the MAC properly calculated the volume decrease adjustment (VDA) owed the Provider for the significant decrease in inpatient discharges that occurred in its cost reporting period ending December 31, 2012 (FY 2012).
Decision Number 2022-D14	Case Name Skiff Medical Center vs. Wisconsin Physicians Service	Issue Whether the MAC properly calculated the volume decrease adjustment (VDA) owed the Provider for the significant decrease in inpatient discharges that occurred in its cost reporting period ending June 30, 2008 (FY 2008).
Decision Number 2022-D15	Case Name Skiff Medical Center vs. Wisconsin Physicians Service	Issue Whether the MAC properly calculated the volume decrease adjustment (VDA) owed the Provider for the significant decrease in inpatient discharges that occurred in its cost reporting period ending June 30, 2009 (FY 2009).
Decision Number 2022-D16	Case Name EJ Noble Hospital vs. National Government Services, Inc.	Issue Whether the MAC properly calculated the Revised Volume Decrease Adjustment (VDA) owed to the Provider for the significant decrease in inpatient discharges that occurred in its cost reporting period ending December 31, 2011 (FY 2011), and whether the MAC p...
Decision Number 2022-D17	Case Name Tender Loving Care vs. National Government Services, Inc.	Issue Whether the MAC used the correct data and methodology in calculating and applying a hospice cap on the Provider for the 2013 Cap Year.
Decision Number 2022-D18	Case Name Inland Hospital, Maine Coast Memorial Hospital, and Franklin Memorial Hospital vs. National Government Services, Inc.	Issue Whether the MAC’s adjustment for fiscal year (FY) 2012, which reduced the Providers’ allowable Medicare reasonable costs by offsetting a portion of the Providers’ Medicaid payments against the Providers’ Maine Hospital Tax expense, was proper.
Decision Number 2022-D19	Case Name Skiff Medical Center vs. Wisconsin Physicians Service	Issue Whether the MAC properly calculated the volume decrease adjustment (VDA) owed to the Provider for the significant decrease in inpatient discharges that occurred in its cost reporting period ending June 30, 2011 (FY 2011).
Decision Number 2022-D20	Case Name A.O. Fox Memorial Hospital vs. National Government Services, Inc.	Issue Whether the MAC properly calculated the Revised Volume Decrease Adjustment (VDA) owed to the Provider for the significant decrease in inpatient discharges that occurred in its cost reporting period ending December 31, 2012 (FY 2012), and whether the MAC p...
Decision Number 2022-D21	Case Name Carlsbad Medical Center vs. Novitas Solutions, Inc.	Issue Whether the MAC properly calculated the volume decrease adjustment (VDA) owed the Provider for the significant decrease in inpatient discharges that occurred in its cost reporting period ending August 31, 2014 (FY 2014).
Decision Number 2022-D22	Case Name Henry County Memorial Hospital vs. Wisconsin Physicians Service	Issue Whether the MAC properly calculated the volume decrease adjustment (VDA) owed the Provider for the significant decrease in inpatient discharges that occurred in its cost reporting period ending December 31, 2010 (FY 2010).
Decision Number 2022-D23	Case Name Ruston Regional Specialty Hospital vs. WPS Government Health Administrators	Issue Whether the payment penalty imposed under the Long Term Care Hospital Quality Reporting Program (LTCH-QRP) to reduce the Provider’s payment update for federal fiscal year (FFY) 2020 by two percent was proper.
Decision Number 2022-D24	Case Name Raritan Bay Medical Center vs. Novitas Solutions, Inc.	Issue Whether the MAC’s determination of the Provider's disproportionate share hospital (DSH') payment [was accurate] and whether that calculation should be revised to include additional Medicaid patient days that were excluded from the numerator of the Medic...
Decision Number 2022-D25	Case Name St. John Medical Center vs. CGS Administrators, LLC	Issue Whether the MAC erred in disallowing Medicare managed care payments associated with the Provider’s operation of its pastoral care allied health education program.
Decision Number 2022-D26	Case Name Ridgecrest Regional Hospital vs. Noridian Healthcare Solutions, Inc.	Issue Whether the Medicare Contractor properly calculated the volume decrease adjustment (VDA) owed to the Provider for the significant decrease in inpatient discharges that occurred in its cost reporting period ending January 31, 2012 (FY 2012).
Decision Number 2022-D27	Case Name Ridgecrest Regional Hospital vs. Noridian Healthcare Solutions c/o Cahaba Safeguard Administrators	Issue Whether the Medicare Contractor properly calculated the volume decrease adjustment (VDA) owed to the Provider for the significant decrease in inpatient discharges that occurred in its short fiscal year, cost reporting period ending August 7, 2012 (Short P...
Decision Number 2022-D28	Case Name Cedars – Sinai Medical Center vs. Noridian Healthcare Solutions c/o Cahaba Safeguard	Issue Whether the reasonable compensation equivalent (RCE) limits should have been applied at all to pre-transplant time spent by physicians working for the Provider on organ acquisition-related activities and, if the RCE does apply, whether the Medicare Contra...
Decision Number 2022-D29	Case Name St. Anthony Hospital vs. Novitas Solutions, Inc.	Issue Whether Medicaid days attributable to child and adolescent patients who received services in three of the Provider’s inpatient behavioral health units licensed as psychiatric residential treatment facilities (PRTFs) during fiscal year ending December 31...
Decision Number 2022-D30	Case Name Henry County Hospital vs. WPS- Government Administrative Services	Issue Whether the Provider is entitled to receive a volume decrease adjustment (VDA) for a Medicare dependent hospital (MDH).
Decision Number 2022-D31	Case Name Crossroads Hospice vs. Multiple	Issue Whether the sequestration amount reported on the Provider Statistical and Reimbursement (PS&R) report for each hospice should be added to the net reimbursement amount in the Aggregate Cap Limitation Calculation to determine payments in excess of the hospi...
Decision Number 2022-D32	Case Name Galesburg Cottage Hospital vs. Wisconsin Physicians Service	Issue Whether the Medicare Administrative Contractor (MAC), properly calculated the volume decrease adjustment (VDA) owed to the Provider for the for the greater than five percent decrease in inpatient discharges that occurred in its cost reporting period endin...
Decision Number 2022-D33	Case Name Galesburg Cottage Hospital vs. Wisconsin Physicians Service	Issue Whether the Medicare Administrative Contractor (MAC), properly calculated the volume decrease adjustment (VDA) owed to the Provider for the for the greater than five percent decrease in inpatient discharges that occurred in its cost reporting period endin...
Decision Number 2022-D34	Case Name St. Vincent Mercy Medical Center et al. vs. CGS Administrators, LLC – J15 MAC; National Government Services, Inc.; WPS Government Health Administrators	Issue Whether it is appropriate to offset the tuition revenue for Nursing and Allied Health (NAH) programs on Worksheet A-8 or whether it is appropriate to offset the tuition revenue only after the stepdown process.
Decision Number 2022-D35	Case Name QRS 2006 Outlier Reconciliation Group vs. Palmetto GBA c/o National Government Services, Inc.	Issue Whether the Centers for Medicare and Medicaid Services (CMS) was arbitrary and capricious in establishing a 10 percent threshold in 2003 and whether CMS was arbitrary and capricious in using the same 10 percent threshold in 2006 to determine whether Provi...
Decision Number 2022-D36	Case Name Methodist Hospital South, formerly known as South Texas Regional Medical Center vs. WPS- Government Health Administrators	Issue Whether the Medicare Contractor properly calculated the volume decrease adjustment (VDA) owed to the Provider for the significant decrease in inpatient discharges that occurred in its cost reporting period ending June 30, 2013 (FY 2013).
Decision Number 2022-D37	Case Name Eastern New Mexico Medical Center vs. WPS Government Health Administrators	Issue Whether the Provider is entitled to a Volume Decrease Adjustment (VDA) for a sole community Hospital (SCH) for cost reporting period ending May 31, 2008 (FY 2008).
Decision Number 2022-D38	Case Name Northeastern Health System (f/k/a Tablequah City Hospital) vs. Novitas Solutions, Inc.	Issue Whether the Medicare Administrative Contractor (MAC), properly calculated the volume decrease adjustment (VDA) owed to the Provider for the greater than five percent decrease in inpatient discharges that occurred in its cost reporting period ending June 3...
Decision Number 2022-D39	Case Name Riverside Shore Memorial Hospital vs. Palmetto GBA c/o National Government Services, Inc.	Issue Whether the Medicare Contractor properly calculated the volume decrease adjustment (VDA) owed to the Provider for the significant decrease in inpatient discharges that occurred in its cost reporting period ending December 31, 2010 (FY 2010).
Decision Number 2022-D40	Case Name Riverside Shore Memorial Hospital vs. Palmetto GBA c/o National Government Services, Inc.	Issue Whether the Medicare Contractor properly calculated the volume decrease adjustment (VDA) owed to the Provider for the significant decrease in inpatient discharges that occurred in its cost reporting period ending December 31, 2013 (FY 2013).
Decision Number 2023-D01	Case Name Galesburg Cottage Hospital vs. WPS Government Administrators	Issue Whether the Medicare Administrative Contractor (MAC), properly calculated the volume decrease adjustment (VDA) owed to the Provider for the for the significant decrease in inpatient discharges that occurred in its cost reporting period ending April 30, 20...
Decision Number 2023-D02	Case Name Galesburg Cottage Hospital vs. WPS Government Administrators	Issue Whether the Medicare Administrative Contractor (MAC), properly calculated the volume decrease adjustment (VDA) owed to the Provider for the for the significant decrease in inpatient discharges that occurred in its cost reporting period ending April 30, 20...
Decision Number 2023-D03	Case Name Cary Medical Center vs. National Government Services, Inc.	Issue Whether the Provider is entitled to a Volume Decrease Adjustment (VDA) for cost report period ending December 31, 2007 (FY 2007).
Decision Number 2023-D04	Case Name Cary Medical Center vs. National Government Services, Inc.	Issue Whether the Provider is entitled to a Volume Decrease Adjustment (VDA) for cost report period ending December 31, 2009 (FY 2009).
Decision Number 2023-D05	Case Name Integris Health 2007 DSH Inpatient Behavior Health Days CIRP Group vs. Novitas Solutions, Inc.	Issue Whether to include Medicaid days of children and adolescents for the hospital’s inpatient behavioral health departments in the Medicaid fraction of the Medicare disproportionate share hospital (DSH) calculation for fiscal year 2007 for each of the parti...
Decision Number 2023-D06	Case Name West Branch Regional Medical Center vs. Wisconsin Physician Services	Issue Whether the Medicare Contractor properly calculated the volume decrease adjustment (VDA) owed to the Provider for the significant decrease in inpatient discharges that occurred in its cost reporting period ending March 31, 2011.
Decision Number 2023-D07	Case Name West Branch Regional Medical Center vs. Wisconsin Physician Services	Issue Whether the Medicare Contractor properly calculated the volume decrease adjustment (VDA) owed to the Provider for the significant decrease in inpatient discharges that occurred in its cost reporting period ending March 31, 2013.
Decision Number 2023-D08	Case Name St. Vincent Randolph Hospital, Inc. vs. Novitas Solutions, Inc.	Issue Whether the Medicare Contractor’s disallowance of the interest expense proper for the Provider for the fiscal years (FYs) 2004 through 2009 was proper.
Decision Number 2023-D09	Case Name Galesburg Cottage Hospital vs. WPS Government Administrators	Issue Whether the Medicare Administrative Contractor (MAC), properly calculated the volume decrease adjustment (VDA) owed to the Provider for the for the significant decrease in inpatient discharges that occurred in its cost reporting period ending April 30, 20...
Decision Number 2023-D10	Case Name St. James Healthcare vs. Noridian Health Solutions, Inc.	Issue Whether the Medicare Contractor properly calculated the volume decrease adjustment (VDA) owed to the Provider for the significant decrease in inpatient discharges that occurred in its cost reporting period ending December 31, 2015 (FY 2015).
Decision Number 2023-D11	Case Name Southwestern Vermont Medical Center vs. National Government Services, Inc.	Issue Whether the Medicare Administrative Contractor (MAC), properly reopened the original Volume Decrease Adjustment (VDA) approval and whether the MAC properly calculated the revised VDA owed to the Provider for the significant decrease in inpatient discharge...
Decision Number 2023-D12	Case Name Regency Hospital of Meridian vs. Novitas Solutions, Inc.	Issue Whether the payment penalty that CMS imposed under the Long Term Care Hospital Quality Reporting Program to reduce the Provider's payment update for Federal Fiscal Year 2020 by two percent was proper.
Decision Number 2023-D13	Case Name Cheyenne Regional Medical Center vs. Noridian Healthcare Solutions	Issue Whether the Medicare Contractor properly calculated the volume decrease adjustment (VDA) owed to the Provider for its cost reporting period ending June 30, 2014 (FY 2014).
Decision Number 2023-D14	Case Name St. Mary’s Hospital & Medical Center vs. Novitas Solutions, Inc.	Issue Whether the Medicare Contractor properly calculated the volume decrease adjustment (VDA) owed to the Provider for the significant decrease in inpatient discharges that occurred in its cost reporting period ending December 31, 2010 (FY 2010).
Decision Number 2023-D15	Case Name Florida Hospital of Flagler vs. First Coast Service Options, Inc.	Issue Whether the Medicare Contractor’s determination to classify the Provider as a Medicare dependent hospital (MDH) effective June 6, 2013, as opposed to October 1, 2012, was proper.
Decision Number 2023-D16	Case Name Mimbres Memorial Hospital vs. WPS Government Health Administrators	Issue Whether the Medicare Administrative Contractor (MAC), properly determined the sole community hospital (SCH) volume decrease adjustment (VDA) granted for the fiscal year ending March 31, 2010 (FY 2010).
Decision Number 2023-D17	Case Name JFK Medical Center vs. WPS Government Health Administrators	Issue Whether the MAC correctly determined the Graduate Medical Education (GME) and Indirect Medical Education (IME) full-time equivalent (FTE) resident cap for the new Internal Medicine residents training program at JFK Medical Center for the fiscal year (FY) ...
Decision Number 2023-D18	Case Name Sunnyside Community Hospital vs. WPS Government Health Administrators	Issue Whether the Provider is entitled to certain emergency room availability costs including costs for mid-level providers for the fiscal years ending December 31, 2011; December 31, 2012; and December 31, 2013.
Decision Number 2023-D19	Case Name Mercy Medical Center vs. Novitas Solutions, Inc.	Issue Whether the Provider is entitled to a Volume Decrease Adjustment (VDA) for cost report period ending June 30, 2010 (FY 2010).
Decision Number 2023-D20	Case Name Comfortbrook Hospice LLC d/b/a Grace Middleburg, OH vs. Palmetto GBA c/o National Government Services, Inc.	Issue Whether the imposition of a two percentage point reduction to the fiscal year 2020 Medicare annual percentage update (APU) for the Provider was proper.
Decision Number 2023-D21	Case Name Comfortbrook Hospice LLC d/b/a Grace Cincinnati, OH Hospice vs. Palmetto GBA c/o National Government Services, Inc.	Issue Whether the imposition of a two percentage point reduction to the fiscal year 2020 Medicare annual percentage update (APU) for the Provider was proper.
Decision Number 2023-D22	Case Name University of Arkansas for Medical Sciences Medical Center vs. Novitas Solutions, Inc.	Issue Whether the Provider’s disproportionate share hospital (DSH) payment for the fiscal year ending June 30, 2011 should be revised to include additional Medicaid patient days that were excluded from the numerator of the Medicaid fraction.
Decision Number 2023-D23	Case Name University of Arkansas for Medical Sciences Medical Center vs. Novitas Solutions, Inc.	Issue Whether the Provider’s disproportionate share hospital (DSH) payment for the fiscal year ending June 30, 2012 should be revised to include additional Medicaid patient days that were excluded from the numerator of the Medicaid fraction.
Decision Number 2023-D24	Case Name Kaweah Delta Health Care District vs. Noridian Healthcare Solutions c/o Cahaba Safeguard Administrators	Issue Whether the Provider is entitled to reasonable cost reimbursement for its graduate medical education (GME) start-up costs for the fiscal year ending June 30, 2013.
Decision Number 2023-D25	Case Name Carson Tahoe Continuing Care Hospital vs. Noridian Healthcare Solutions, LLC c/o Cahaba Safeguard Administrators	Issue Whether CMS properly imposed the penalty, under the Long Term Care Hospital Quality Reporting Program (LTCH QRP), to reduce the Provider's Federal fiscal year 2021 Medicare annual payment update (APU) by 2.0 percentage points.
Decision Number 2023-D26	Case Name Brazosport Regional Health System vs. Novitas Solutions, Inc.	Issue Whether the Provider complied with the Affordable Care Act (ACA) Inpatient Rehabilitation Facility (IRF) Quality Reporting Program (QRP) requirements for submission of quality data for the period at issue and, therefore, is not subject to a 2 percentage p...
Decision Number 2023-D27	Case Name Touro Infirmary vs. WPS Government Health Administrators	Issue Whether the Medicare Contractor’s adjustments to remove Full Time Equivalents (FTEs) from the Graduate Medical Education (GME) Cap for fiscal years 2010 and 2011 was proper.
Decision Number 2023-D28	Case Name Bergen Regional Medical Center vs. Novitas Solutions, Inc.	Issue Whether the Medicare Contractor properly excluded a lump sum payment of $4,991,315 from the interim payments included on the Provider's notice of program reimbursement (NPR) for fiscal year (FY) 2014 and, if so, whether the Provider is entitled to have th...
Decision Number 2023-D29	Case Name Brigham and Women’s Hospital vs. National Government Services, Inc.	Issue Whether the Provider timely claimed the $316,565 at issue in the initial fiscal year (FY) 1989 cost report and, if timely claimed, whether those expenses included Ultrasound and Nuclear Medicine Clinical training costs.
Decision Number 2023-D30	Case Name Ellis Hospital vs. National Government Services, Inc.	Issue Whether the Medicare Contractor properly determined the Provider’s unweighted direct graduate medical education (GME) and indirect medical education (IME) full time equivalent (FTE) resident caps for the fiscal years (FYs) 2010 and 2012-2016.
Decision Number 2023-D31	Case Name University of Missouri Health Care vs. Wisconsin Physician Services, Inc.	Issue Whether CMS correctly refused to exclude the Psychiatric Center unit of the Provider from the inpatient prospective payment system (IPPS) for the cost reporting period ending June 30, 2010 (FY 2010), allowing it to be paid instead under the inpatient psy...
Decision Number 2023-D32	Case Name Bon Secours Memorial Regional Medical Center vs. Palmetto GBA c/o National Government Services	Issue Whether the Provider is entitled to receive reimbursement for its Medicare Part C Managed Care costs incurred through its nursing and allied health (NAH) program, based on the requirements in 42 C.F.R § 413.87, when the Provider submitted no-pay bills t...
Decision Number 2023-D33	Case Name Flowers Hospital vs. Palmetto GBA	Issue Whether the Medicare Contractor improperly calculated the Provider’s Disproportionate Share Hospital (DSH) reimbursement due to sampling errors in review of the Medicaid-eligible patient days.
Decision Number 2023-D34	Case Name Lubbock Heart Hospital LP vs. Novitas Solutions, Inc.	Issue Whether, in connection with the hospital Inpatient Quality Reporting (IQR) program, CMS' decision to reduce the Annual Percentage Update (APU) to the FFY 2021 Inpatient Prospective Payment System (IPPS) for the Provider by one-fourth was correct.
Decision Number 2023-D35	Case Name AdventHealth Connerton vs. First Coast Service Options, Inc.	Issue Whether the payment penalty that CMS imposed under the Long-Term Care Hospital Quality Reporting Program (LTCH-QRP) which reduced the Provider’s payment update for Federal Fiscal Year (FFY) 2020 by two percent was proper.
Decision Number 2023-D36	Case Name Memorial Hermann 2002-2012 Bad Debt Not Returned from Collection Agency CIRP Groups vs. Novitas Solutions, Inc.	Issue Whether the Medicare Contractor's disallowance of Medicare Bad Debts claimed by the Providers for the fiscal years at issue, on the grounds that they had not been returned from a collection agency, was proper.
Decision Number 2024-D01	Case Name Sacred Heart Hospital vs. Novitas Solutions, Inc.	Issue Whether the Medicare Contractor’s determination of the Provider’s disproportionate share hospital (DSH) payment for FY 2010 should be revised to include additional Medicaid patient days that were excluded from the numerator of the Medicaid fraction.
Decision Number 2024-D02	Case Name Southwest Consulting Christus vs. Novitas Solutions, Inc.	Issue Whether the disproportionate share hospital (DSH) payments for the fiscal year ending June 30, 2009 of each of the Christus Health Providers should be revised to include additional Medicaid labor and delivery room (LDR) patient days that were excluded fro...
Decision Number 2024-D03	Case Name Banner-University Medical Center South Campus vs. Noridian Healthcare Solutions, LLC	Issue Whether CMS properly imposed a two percentage point reduction to the Provider’s FFY 2020 Annual Payment Update (APU) under the Inpatient Psychiatric Facility Quality Reporting (IPFQR) Program was proper.
Decision Number 2024-D04	Case Name Hospice of Washington County vs. CGS Administrators	Issue Whether CMS properly imposed a two percentage point reduction to the FY 2021 Medicare annual payment update (APU) for the Provider.

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