Wednesday, January 23, 2019

CMS Promotes the New Electronic System for Provider Reimbursement Review Board Appeals

Dan Ciolek

In a January 18, 2019 MLN Matters Article, the Centers for Medicare and Medicaid Services (CMS) promotes the use of a new electronic system for provider reimbursement review board appeals.  The new system, the Office of Hearings Case and Document Management System (OH CDMS) went live on August 16, 2018.  CMS encourages Part A providers such as SNF to learn more about the benefits of using OH CDMS by attending the upcoming MLN event. Register for the New Electronic System for Provider Reimbursement Review Board Appeals Call scheduled for Tuesday, February 5 from 1:30 to 3 pm ET.

Background
The PRRB gives Medicare providers an independent forum for resolving Medicare Part A reimbursement disputes. The PRRB publishes its rules, current alerts, final substantive decisions, and many jurisdictional decisions on the PRRB website. 

To file a PRRB appeal, Part A providers must:
  • Be dissatisfied with a final determination by CMS or a MAC
  • Demonstrate that the amount in controversy is $10,000 or more (or $50,000 for a group)
  • File a request for a hearing within 180 days after receiving the final determination.

Most of the final determinations appealed to the PRRB relate to the Notice of Program Reimbursement (NPR) or revised NPR for the Medicare cost report, but may include other final determinations, such as:
  • Exception decisions
  • Quality reporting program payment reduction decisions
  • Certain provider reimbursement issues addressed through the Federal Register

OH CDMS – The New Electronic System
The OH CDMS is a web-based portal for parties to submit all their appeal materials and for the Board to issue all outgoing correspondence including notices and decisions. The system provides 24/7 real-time access for parties and their designated representatives to view and manage their own cases. Initial entry into OH CDMS requires registration through the CMS Enterprise Portal.

The OH CDMS captures all filings made directly into the system in a Confirmation of Correspondence that is emailed to the parties involved. Confirmations serve two purposes:
  • Summarize the data entry and document uploads for the submitter
  • Notify the opposing party of new actions on the case

All government contractor organizations that participate in appeals before the PRRB (MACs, Cost Report Audit and Appeals Contractor (CRAA) and the Appeal Support Contractors (ASC)) are registered in OH CDMS. System-generated confirmations for portal-based submissions fulfill the requirement for service on these contractors. As such, provider representatives using OH CDMS will no longer have to send a separate copy of the correspondence to the relevant contractor(s).

Note: More information about OH CDMS is available here. To resolve any technical issues, please contact the OH CDMS Help Desk at (833) 783-8255, or email helpdesk_ohcdms@cms.hhs.gov.

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