Provider Reimbursement Determinations and Appeals | Midpage

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Code of Federal Regulations

Subpart R

Provider Reimbursement Determinations and Appeals

405.1801Introduction.405.1803Contractor determination and notice of amount of program reimbursement.405.1804Matters not subject to administrative and judicial review under prospective payment.405.1805Parties to contractor determination.405.1807Effect of contractor determination.405.1809Contractor hearing procedures.405.1811Right to contractor hearing; contents of, and adding issues to, hearing request.405.1813Good cause extension of time limit for requesting a contractor hearing.405.1814Contractor hearing officer jurisdiction.405.1815Parties to proceedings before the contractor hearing officer(s).405.1817Hearing officer or panel of hearing officers authorized to conduct contractor hearing; disqualification of officers.405.1819Conduct of contractor hearing.405.1821Prehearing discovery and other proceedings prior to the contractor hearing.405.1823Evidence at contractor hearing.405.1825Witnesses at contractor hearing.405.1827Record of proceedings before the contractor hearing officer(s).405.1829Scope of authority of contractor hearing officer(s).405.1831Contractor hearing decision.405.1832Contractor hearing officer review of compliance with the substantive reimbursement requirement of an appropriate cost report claim.405.1833Effect of contractor hearing decision.405.1834CMS reviewing official procedure.405.1835Right to Board hearing; contents of, and adding issues to, hearing request.405.1836Good cause extension of time limit for requesting a Board hearing.405.1837Group appeals.405.1839Amount in controversy.405.1840Board jurisdiction.405.1842Expedited judicial review.405.1843Parties to proceedings in a Board appeal.405.1845Composition of Board; hearings, decisions, and remands.405.1847Disqualification of Board members.405.1849Establishment of time and place of hearing by the Board.405.1851Conduct of Board hearing.405.1853Board proceedings prior to any hearing; discovery.405.1855Evidence at Board hearing.405.1857Subpoenas.405.1859Witnesses.405.1861Oral argument and written allegations.405.1863Administrative policy at issue.405.1865Record of administrative proceedings.405.1867Scope of Board's legal authority.405.1868Board actions in response to failure to follow Board rules.405.1869Scope of Board's authority in a hearing decision.405.1871Board hearing decision.405.1873Board review of compliance with the reimbursement requirement of an appropriate cost report claim.405.1875Administrator review.405.1877Judicial review.405.1881Appointment of representative.405.1883Authority of representative.405.1885Reopening a contractor determination or reviewing entity decision.405.1887Notice of reopening; effect of reopening.405.1889Effect of a revision; issue-specific nature of appeals of revised determinations and decisions.