2024D28

Whether the Medicare Contractor ("Medicare Contractor") determined the Medicare reimbursement of the operating and capital outliers, and the corresponding time value of money ("TVM"), through the outlier reconciliation process properly. This issue relates to the Provider's fiscal year ending June 30, 2007 ("FY 2007") and has the following four (4) subparts:

1. Whether the Medicare Contractor's use of non-patient specific data (which was not run through the Lump Sum Utility in the Fiscal Intermediary Shared System ("FISS") in the calculation of the outlier reconciliation amount and the corresponding TVM amount for FY 2007 was made in accordance with 42 C.F.R. § 412.84(i)(4) and Medicare Claims Processing Manual, CMS Pub. 100-04 ("MCPM"), Ch. 3, § 20.1.2.7;

2. Whether the Medicare Contractor's selection of the Provider for the outlier reconciliation process for FY 2007 and the Medicare Contractor's calculation of the Outlier Reconciliation amount with the corresponding TVM amount was proper and in accordance with 42 C.F.R. § 412.84(i)(4) and MCPM Ch. 3, § 20.1.2;

3. Whether the FY 2007 TVM amount established and assessed under the outlier regulation at 42 C.F.R. § 412.84(m) for FY 2007 is invalid; and

4. Whether the Medicare Contractor's calculation of the FY 2007 TVM was overstated due to the delay of the Centers for Medicare & Medicaid Services ("CMS") in publishing the Revised 2006 SSI ratios.