MAC's Move To Limit Reopenings
On August 21, 2008, the Centers for Medicare and Medicaid Services (CMS) enacted sweeping changes to the Medicare appeals process. These changes have made the appeals process increasingly difficult to navigate. Elements included in the filed Medicare cost report, such as a comprehensive protest list, are imperative for a Provider to preserve their opportunity to pursue specific appeal issues.
Further complicating matters are the positions that the Medicare Administrative Contractors (MAC) are beginning to take regarding filed Medicare cost reports. The official that signs the certification page of the filed cost report is asserting that the report is true, correct, complete, and prepared from the books and records of the provider, in accordance with applicable instructions. Recently, MACs are taking the position that, based on this certification, the cost report reflects all applicable accurate information and that no further additions or changes should be made to the cost report. This effectively eliminates the opportunity to pursue additional Medicaid eligible days or additional Medicare bad debt if the issue is not raised as a protest item.
More discouraging is the recent position that some MACs have taken, in denying cost report reopenings to correct errors or omissions of data, on the basis that cost report reopenings are made solely at the discretion of the MAC. As a result, the Medicare cost report reopening process can no longer be counted on as a viable solution for implementing Provider initiated corrections to audited Medicare cost reports.
In a recently issued email to Providers, a MAC made the following statements regarding Medicare cost report reopenings:
The cost report submission and reopening processes are not intended as vehicles for providers to make claims for Medicare payment on a piece-meal basis, either in the originally submitted cost report, or later in a request for cost report reopening.
The reopening process described in 42 CFR 405.1885 allowing the MAC to reopen and revise specific claims for Medicare payment covered by a cost report is discretionary (or based upon explicit direction from CMS).
The Provider has no right to a reopening.
Only in the exceptional case, where a provider can demonstrate by a preponderance of evidence that true, correct and complete claims for Medicare payments could not otherwise be determined and presented in the originally submitted cost report, will we grant a provider's request for cost report reopening. This does not apply to providers' requests for cost report reopening due to obvious, material and inadvertent errors of omission, or misstatement, which we believe would be isolated and infrequent.
As a result of this changing landscape, it is extremely important to carefully review the protest item listing included with your cost report, to ensure you have protected your appeal rights for all applicable issues. Future revenue streams through the Medicare appeal process, could be forever lost by way of jurisdictional impediments, if appeal protections are not built into your Medicare cost report filing process.
Should you have any questions regarding this matter please contact us at (925) 685-9312.