List of PRRB Decisions

The Provider Reimbursement Review Board is an independent panel to which a certified Medicare provider of services may appeal if it is dissatisfied with a final determination by its Medicare contractor or by the Centers for Medicare & Medicaid Services (CMS). A decision of the Board may be affirmed, modified, reversed, or vacated and remanded by the CMS Admistrator within 60 days of notification to the provider of that decision.

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Decision #	Case #	Provider #	Issue
Decision # 2025D07	Case # 20-2075	Provider # 44-0061	Issue Whether the Medicare Administrative Contractor, Wisconsin Physicians Service ("WPS") Government Health Administrators, properly calculated the volume decrease adjustment owed to Tennova Healthcare - Volunteer Martin ("Volunteer Martin" or "Provider") for ...
Decision # 2025D06	Case # 18-1201	Provider # 44-0061	Issue Whether the Medicare Administrative Contractor, Wisconsin Physicians Service ("WPS") Government Health Administrators, properly calculated the volume decrease adjustment owed to Tennova Healthcare - Volunteer Martin ("Volunteer Martin" or "Provider") for ...
Decision # 2025D05	Case # 18-1207	Provider # 39-0084	Issue Whether the Medicare Administrative Contractor, Wisconsin Physicians Service ("WPS") Government Health Administrators, properly calculated the volume decrease adjustment owed to Sunbury Community Hospital ("Sunbury" or "Provider") for the significant decr...
Decision # 2025D04	Case # 23-1218	Provider # 15-3045	Issue Whether Community Stroke and Rehabilitation Center ("Community Stroke" or "Provider") should be subject to a two (2) percentage point reduction to its federal fiscal year ("FFY") 2023 inpatient rehabilitation facility annual payment update ("APU") for fai...
Decision # 2025D03	Case # 23-0216	Provider # 15-0072	Issue Whether Logansport Memorial Hospital ("Provider" or "Memorial) should be subject to a one-fourth reduction to its Fiscal Year (FY") 2023 Annual Percentage Update ("APU") for failure to meet the hospital inpatient quality reporting program ("IQR") requirem...
Decision # 2025D02	Case # 22-0373	Provider # 05-0782	Issue Whether the payment penalty imposed by the Centers for Medicare & Medicaid Services ("CMS") under the Inpatient Rehabilitation Facility Quality Reporting Program ("IRF QRP") to reduce Casa Colina Hospital's ("Casa Colina") Inpatient Rehabilitation Facilit...
Decision # 2025D01	Case # 18-1311	Provider # 44-0016	Issue Whether the Medicare Administrative Contractor, Palmetto GBA ("Palmetto"), properly calculated the volume decrease adjustment ("VDA") owed to Baptist Memorial Hospital Huntingdon ("Baptist Memorial" or "Provider") for the significant decrease in inpatient...
Decision # 2024D33	Case # 16-2092	Provider # 37-0078	Issue Whether the fiscal year ("FY") 2008 Medicare Disproportionate Share Hospital ("DSH") payment for the Oklahoma State University Medical Center (the "Provider" or OKSU-MC") was understated because, as required by 42 U.S.C. § 1395ww(d)(5)(F)(vi) and other a...
Decision # 2024D32	Case # 19-2175, 19-2176	Provider # 34-0113	Issue 1. Whether the Provider is entitled to pass-through reimbursement for the net costs of its Nursing, Medical Laboratory Science, Radiologic Technology, and Surgical Technology Programs for fiscal years ("FYs") 2012 and 2013. 2. Whether the Medicare Cont...
Decision # 2024D31	Case # 21-0995	Provider # 52-2005	Issue Whether the Centers for Medicare & Medicaid Services ("CMS") properly imposed a two percent reduction to the Provider's payment update for Fiscal Year ("FY") 2021 because the Provider allegedly failed to meet the requirements of the Long-Term Care Hospita...

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