The Final Rule also contains other clarifications and revisions in areas such as:

  • Calculating time periods and deadlines
  • Provider hearing rights
  • Requests for a good cause extension for requesting a hearing
  • Group appeals
  • Amount in controversy
  • PRRB jurisdiction
  • Expediting judicial review
  • Parties to the proceeding
  • Quorum requirements
  • Discovery and subpoenas
  • Record of administrative proceedings
  • Actions in response to the failure to follow PRRB rules
  • Scope of PRRB's authority in hearing decisions
  • Administrator review
  • Judicial review
  • Reopening procedures

Finally, in the preamble to the Final Rule, CMS indicates that, to the extent there is a conflict between the provisions of the Final Rule and the PRRB's current instructions, the former will control.

Excerpted from "Medicare Update: Medicare Compliance, Reimbursement, and Enforcement Resource" by Michael Apolskis. In the course of his legal practice, Apolskis works with health care providers, suppliers and companies on a variety of legal and regulatory matters, including Medicare compliance, reimbursement and enforcement matters.

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Publication Date: Friday, September 11, 2009