• Common Issue Related Party Appeals
  • December 19, 2008 | Author: Christopher L. Keough
  • Law Firms: King & Spalding LLP - Washington Office; King & Spalding LLP - Atlanta Office
  • The Provider Reimbursement Review Board (PRRB) recently posted on The Centers for Medicare & Medicaid Services (CMS) website a series of Frequently Asked Questions (FAQ) relating to the new PRRB rules that became effective on August 21, 2008. The Board’s release of the FAQ document follows a series of alerts addressing the new PRRB rules.

    The FAQ contains useful guidance on mandatory group appeals by providers that operate under common ownership or control, i.e., Common Issue Related Party (CIRP) groups. In particular, the FAQ addresses the question: What period of time do I use to determine whether providers in a CIRP group appeal are related by common ownership or control? The PRRB’s answer to this question recognizes that the statute and regulations do not “explicitly specify” when the related organization test should be applied. It states, however, that “relatedness” may be determined solely with respect to ownership/control during the cost reporting period at issue in the appeal and need not take into account subsequent changes in ownership and control. The PRRB’s answer also indicates that it is reasonable to look to the home office cost report to identify providers that may be considered to be related for purposes of mandatory CIRP group appeal rules.