Provider Reimbursement Determinations and Appeals

  1. Law
  2. CFR 42
  3. Public Health
  4. Centers for Medicare & Medicaid Services, Department of Health and Human Services
  5. Medicare Program
  6. Federal Health Insurance for the Aged and Disabled
  7. Provider Reimbursement Determinations and Appeals

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Section
405.1801

Introduction.

Section
405.1803

Contractor determination and notice of amount of program reimbursement.

Section
405.1804

Matters not subject to administrative and judicial review under prospective payment.

Section
405.1805

Parties to contractor determination.

Section
405.1807

Effect of contractor determination.

Section
405.1809

Contractor hearing procedures.

Section
405.1811

Right to contractor hearing; contents of, and adding issues to, hearing request.

Section
405.1813

Good cause extension of time limit for requesting a contractor hearing.

Section
405.1814

Contractor hearing officer jurisdiction.

Section
405.1815

Parties to proceedings before the contractor hearing officer(s).

Section
405.1817

Hearing officer or panel of hearing officers authorized to conduct contractor hearing; disqualification of officers.

Section
405.1819

Conduct of contractor hearing.

Section
405.1821

Prehearing discovery and other proceedings prior to the contractor hearing.

Section
405.1823

Evidence at contractor hearing.

Section
405.1825

Witnesses at contractor hearing.

Section
405.1827

Record of proceedings before the contractor hearing officer(s).

Section
405.1829

Scope of authority of contractor hearing officer(s).

Section
405.1831

Contractor hearing decision.

Section
405.1832

Contractor hearing officer review of compliance with the substantive reimbursement requirement of an appropriate cost report claim.

Section
405.1833

Effect of contractor hearing decision.

Section
405.1834

CMS reviewing official procedure.

Section
405.1835

Right to Board hearing; contents of, and adding issues to, hearing request.

Section
405.1836

Good cause extension of time limit for requesting a Board hearing.

Section
405.1837

Group appeals.

Section
405.1839

Amount in controversy.

Section
405.1840

Board jurisdiction.

Section
405.1842

Expedited judicial review.

Section
405.1843

Parties to proceedings in a Board appeal.

Section
405.1845

Composition of Board; hearings, decisions, and remands.

Section
405.1847

Disqualification of Board members.

Section
405.1849

Establishment of time and place of hearing by the Board.

Section
405.1851

Conduct of Board hearing.

Section
405.1853

Board proceedings prior to any hearing; discovery.

Section
405.1855

Evidence at Board hearing.

Section
405.1857

Subpoenas.

Section
405.1859

Witnesses.

Section
405.1861

Oral argument and written allegations.

Section
405.1863

Administrative policy at issue.

Section
405.1865

Record of administrative proceedings.

Section
405.1867

Scope of Board's legal authority.

Section
405.1868

Board actions in response to failure to follow Board rules.

Section
405.1869

Scope of Board's authority in a hearing decision.

Section
405.1871

Board hearing decision.

Section
405.1873

Board review of compliance with the reimbursement requirement of an appropriate cost report claim.

Section
405.1875

Administrator review.

Section
405.1877

Judicial review.

Section
405.1881

Appointment of representative.

Section
405.1883

Authority of representative.

Section
405.1885

Reopening a contractor determination or reviewing entity decision.

Section
405.1887

Notice of reopening; effect of reopening.

Section
405.1889

Effect of a revision; issue-specific nature of appeals of revised determinations and decisions.