Appeal Rights/Filing Instructions
Notice of Amount of Medicare Program Reimbursement
If you disagree with the cost report adjustments, you have the right to appeal those adjustments. Should you need additional information regarding appeals, as well as the requirements for an appeal request, information is available at 42 CFR 405.1809, 405.1811, 405.1815, 405.1835, 405.1843 and the PRRB Rules at PRRB Rules
Contractor Appeals
Amount of Controversy: $1,000-$9,999
If you disagree with adjustments aggregating at least $1,000 but less than $10,000 in program reimbursement, your appeal is a Contractor Appeal and must be addressed to Federal Specialized Services (FSS) via email "intermediary@fssappeals.com". A copy of the appeal request and any subsequent correspondence should also be sent to CGS via email at J15.CR.APPEALS@cgsadmin.com.
When email is not an option, providers filing a Contractor appeal should send unbound correspondence via U.S. mail or express delivery services to the following CGS and FSS addresses:
Yu Zhao-Kattner, Supervisor
J15 Audit and Reimbursement
Attn: Cost Report Appeals
26 Century Blvd, Suite ST610
Nashville, TN 37214
and
PRRB Appeals
Federal Specialized Services
1701 Racine Avenue
Chicago, IL 60608-4058
Please do not send any protected health information (PHI) or personally identifiable information (PII). Files containing PHI or PII will be returned to the sender.
Provider Reimbursement Review Board (PRRB) Appeals
Amount of Controversy: $10,000 for individual providers or $50,000 for group of providers appealing a common issue
If you disagree with the adjustments aggregating at least $10,000 for individual providers ($50,000 for a group of providers appealing a common issue) in program reimbursement, your appeal goes to the Provider Reimbursement Review Board (PRRB).
Effective November 1, 2021, all PRRB appeals must be filed electronically using Office of Hearings Case and Document Management System (OH CDMS) unless an exemption is granted under PRRB Rule 2.1.2. For information on how to register and access OH CDMS refer to PRRB Electronic Filing. The Webpage includes a link to the CMS Enterprise Portal as well as current registration and user manuals.
To request an exemption to mandatory electronic filing using OH CDMS, refer to PRRB Rule 2.1.2 PRRB Rules
Please do not send any protected health information (PHI) or personally identifiable information (PII). Files containing PHI or PII will be returned to the sender.