United States Government Publishing Office publisher pbl distributor dst United States National Archives and Records Administration Office of the Federal Register author aut Government Organization text government publication eng FR Regulatory Information 2008_register executive 2014-05-29 article Part II Rules and Regulations D09002ee1c808b578 D09002ee1c808b688 United States Department of Health and Human Services originator org United States Government Agency or Subagency United States Centers for Medicare & Medicaid Services originator org United States Government Agency or Subagency Subpart R of 42 CFR part 405 consists of regulations governing Medicare reimbursement determinations, and appeals of those determinations, by health care providers. (For the sake of simplicity, throughout this final rule, we use "reimbursement" to refer to Medicare payment under both the reasonable cost and prospective payment systems.) Under section 1878 of the Social Security Act (the Act) and the subpart R regulations, the Provider Reimbursement Review Board (the Board) has the authority to adjudicate certain substantial reimbursement disputes between providers and fiscal intermediaries (intermediaries). Board decisions are subject to review by the CMS Administrator, and the final agency decision of the Board or the Administrator, as applicable, is reviewable in Federal district court. In addition, under the subpart R regulations, intermediaries have the authority to hold hearings and adjudicate certain other payment and reimbursement disputes with providers. This final rule updates, clarifies, and revises various provisions of the regulations governing provider reimbursement determinations, appeals before the Board, appeals before the intermediaries (for lesser disputes), and Administrator review of decisions made by the Board. 73 FR 30190 https://www.govinfo.gov/app/details/FR-2008-05-23/E8-11227 E8-11227 fr23my08-9 RIN 0938-AL54 4120-01-P CMS-1727-F https://www.govinfo.gov/app/details/FR-2008-05-23/E8-11227 https://www.govinfo.gov/content/pkg/FR-2008-05-23/html/E8-11227.htm https://www.govinfo.gov/content/pkg/FR-2008-05-23/pdf/E8-11227.pdf Administrative Practice and Procedure Health Facilities Health Professions Kidney Diseases Medical Devices Medicare Reporting and Recordkeeping Requirements Rural Areas X-Rays Grant Programs-Health Health Care Health Insurance Health Maintenance Organizations (Hmo) Loan Programs-Health 78 p. 30190 30267 73 FR 30190 Title 42 Part 405 42 CFR Part 405 Title 42 Part 413 42 CFR Part 413 Title 42 Part 417 42 CFR Part 417 RIN 0938-AL54 Medicare Program; Provider Reimbursement Determinations and Appeals; Federal Register Vol. 73, Issue RULE E8-11227 II DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 2008-08-21 CMS-1727-F 4120-01-P E8-11227 Final rule.

Subpart R of 42 CFR part 405 consists of regulations governing Medicare reimbursement determinations, and appeals of those determinations, by health care providers. (For the sake of simplicity, throughout this final rule, we use "reimbursement" to refer to Medicare payment under both the reasonable cost and prospective payment systems.) Under section 1878 of the Social Security Act (the Act) and the subpart R regulations, the Provider Reimbursement Review Board (the Board) has the authority to adjudicate certain substantial reimbursement disputes between providers and fiscal intermediaries (intermediaries). Board decisions are subject to review by the CMS Administrator, and the final agency decision of the Board or the Administrator, as applicable, is reviewable in Federal district court. In addition, under the subpart R regulations, intermediaries have the authority to hold hearings and adjudicate certain other payment and reimbursement disputes with providers. This final rule updates, clarifies, and revises various provisions of the regulations governing provider reimbursement determinations, appeals before the Board, appeals before the intermediaries (for lesser disputes), and Administrator review of decisions made by the Board.

Effective Date: These regulations are effective August 21, 2008. Morton Marcus, (410) 786-4477; Donald Romano, (410) 786-1401. Administrative Practice and Procedure Health Facilities Health Professions Kidney Diseases Medical Devices Medicare Reporting and Recordkeeping Requirements Rural Areas X-Rays Grant Programs-Health Health Care Health Insurance Health Maintenance Organizations (Hmo) Loan Programs-Health Medicare Program: Provider Reimbursement Determinations and Appeals, http://www.cms.hhs.gov/PRRBReview Vol. 73, no. 101 Office of the Federal Register, National Archives and Records Administration 2008-05-23 continuing daily deposited born digital 303 p. Table of Contents: AE 2.7: GS 4.107: AE 2.106: KF70.A2 https://www.govinfo.gov/app/details/FR-2008-05-23 P0b002ee1892c7a72 0097-6326 0042-1219 0364-1406 769-004-00000-9 000582072 f:fr23my08 https://www.govinfo.gov/app/details/FR-2008-05-23 https://www.govinfo.gov/content/pkg/FR-2008-05-23/pdf/FR-2008-05-23.pdf https://www.govinfo.gov/content/pkg/FR-2008-05-23/xml/FR-2008-05-23.xml fdlp 29977 30267 DGPO 2014-05-29 2024-06-05 FR-2008-05-23 machine generated eng FR FR-2008-05-23 73 101