Beginning with cost report periods ended on or after December 31, 2008, in order to establish jurisdiction that would allow a hospital to appeal a matter it believes may be incorrectly settled, according to PRRB guidelines, the hospital must either “claim or protest” the matter in its cost report filing. Until recently, this “claim or protest” requirement was only part of the PRRB regulations. In its 2016 Outpatient Prospective Payment System Final Rule, CMS recently codified the need to properly “claim or protest” cost reporting matters within the cost reporting guidelines.
Because “claim or protest” is now part of the cost report guidelines, hospitals must protect their rights to pending reimbursement revenue by properly protesting issues on the cost report, compiling detailed documentation to support the protest, and ultimately timely filing and processing appeals.
McKay consults with and supports hospital efforts to protest and appeal DSH matters and to receive properly settled cost reports. We do this by:
- Providing guidance when the cost report is initially filed relating to the treatment of DSH matters, including protest language and DSH effects relating to expected to-be-appealed DSH matters.
- Responding to MAC data requests at cost report settlement.
- Assessing proposed MAC adjustments when our work is audited and settled.
- Interacting with the MAC to better ensure appropriate resolution of contentious matters in the settlement process, when feasible.
- Suggesting appeals of contentious DSH matters, if any, that were either protested at filing or were inappropriately adjusted by the MAC at audit.
- Preparing appeal applications including appeal language, related support and estimated reimbursement effects.
- Preparing appeal position papers as they come due.
- Responding to PRRB data requests, if any, during the appeal process.
- Responding to scheduled appeal hearings, if any.
McKay Consulting assists its provider partners in documenting eligible days and in developing and supporting DSH arguments to be pursued via either the PRRB and/or the U.S. Court system. McKay Consulting enjoys long-standing, mutual working relationships with law firms that are widely regarded as the leading experts in hospital reimbursement and payment systems. We work with legal counsel to ensure the viability and jurisdictional propriety of protest and appeal matters.
McKay Consulting has a proven history of successful Medicare appeal resolutions for hundreds of client years.
McKay Consulting enjoys long-standing, mutual working relationships with law firms that are widely regarded as the leading experts in hospital reimbursement and payment systems.
Our goal is, and has always been, to provide our clients with the best finance and reimbursement consulting services in compliance with all applicable laws and regulations, while positioning providers for optimal reimbursement.
