CMS Proposes Significant Changes to Filing/Pursing Cost Report Appeals

click here to learn more...

On May 15, 2014, the Centers for Medicare and Medicaid Services (“CMS”) issued the fiscal year (FY) 2015 Hospital Inpatient Prospective Payment Systems Proposed Rule (“Proposed Rule”).  This Proposed Rule includes suggested changes to the cost report regulations in 42 CFR Part 413, Subpart B.  This change would require a provider to include an appropriate claim for a specific item in its Medicare cost report in order to receive or potentially qualify for Medicare payment for the specific item.   Under the Proposed Rule, if the claim is not included in the Medicare cost report, payment will not be included in the Notice of Program Reimbursement (“NPR”) or in any decision or order issued by a reviewing entity in an administrative appeal.  The Proposed Rule also suggests adding specific procedures for the Provider Reimbursement Review Board’s (“PRRB”) review of whether the provider’s cost report meets the suggested new requirement that it include an appropriate claim for a specific item.  If these changes are adopted in the Final Rule, it will make the process of filing cost reports and protecting provider appeal rights more complex, with an increased need for attention to ensure appeal rights are fully preserved and protected starting from the point the cost report is filed until the appeal is resolved. 

For more information on these proposed changes, please contact Charles MacKelvie at or Meghan McNab at