42 C.F.R. 413.24 - Adequate cost data and cost finding

Cite as42 C.F.R. 413.24
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219 practice notes
  • US v. Carell, Civil Action No. 3:09-cv-445.
    • United States
    • United States District Courts. 6th Circuit. United States District Court of Middle District of Tennessee
    • October 13, 2009
    ...each fiscal year, the provider must give the fiscal intermediary a statement of its actual costs along with supporting documentation. 42 C.F.R. § 413.24(a). To ensure the timely reimbursement of providers 681 F. Supp.2d 887 who may have been underpaid, the fiscal intermediary, upon receipt ......
  • Lenox Hill Hospital v. Shalala, Civil Action No. 99-CV03087SSH.
    • United States
    • United States District Courts. United States District Court (Columbia)
    • November 14, 2000
    ...total amount of reimbursement, and sets forth this amount in a notice of program reimbursement ("NPR"). See 42 C.F.R. §§ 405.1803, 413.20, 413.24, and 413.60 (1998). If a provider is dissatisfied with the final determination of reimbursement, it may obtain a hearing before the Provider Reim......
  • Cove Associates Joint Venture v. Sebelius, No. 1:10-cv-01316 (BJR)
    • United States
    • United States District Courts. United States District Court (Columbia)
    • March 26, 2012
    ...issued regulations regarding the financial documentation that providersPage 6must maintain for reimbursement purposes. 42 C.F.R. §§ 413.20, 413.24. The regulations require providers to "maintain sufficient financial records and statistical data for proper determination of costs payable unde......
  • University Medical Center, In re, No. 91-1407
    • United States
    • United States Courts of Appeals. United States Court of Appeals (3rd Circuit)
    • October 21, 1992
    ...to a distinct annual audit, which follows the submission of a separate cost report for each fiscal year. See 42 C.F.R. §§ 413.20(b), 413.24(f) (1991). These regulations indicate that reimbursement payments made for any one year arise from transactions wholly distinct from reimbursement paym......
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178 cases
  • US v. Carell, Civil Action No. 3:09-cv-445.
    • United States
    • United States District Courts. 6th Circuit. United States District Court of Middle District of Tennessee
    • October 13, 2009
    ...each fiscal year, the provider must give the fiscal intermediary a statement of its actual costs along with supporting documentation. 42 C.F.R. § 413.24(a). To ensure the timely reimbursement of providers 681 F. Supp.2d 887 who may have been underpaid, the fiscal intermediary, upon receipt ......
  • Lenox Hill Hospital v. Shalala, Civil Action No. 99-CV03087SSH.
    • United States
    • United States District Courts. United States District Court (Columbia)
    • November 14, 2000
    ...total amount of reimbursement, and sets forth this amount in a notice of program reimbursement ("NPR"). See 42 C.F.R. §§ 405.1803, 413.20, 413.24, and 413.60 (1998). If a provider is dissatisfied with the final determination of reimbursement, it may obtain a hearing before the Provider Reim......
  • Cove Associates Joint Venture v. Sebelius, No. 1:10-cv-01316 (BJR)
    • United States
    • United States District Courts. United States District Court (Columbia)
    • March 26, 2012
    ...issued regulations regarding the financial documentation that providersPage 6must maintain for reimbursement purposes. 42 C.F.R. §§ 413.20, 413.24. The regulations require providers to "maintain sufficient financial records and statistical data for proper determination of costs payable unde......
  • University Medical Center, In re, No. 91-1407
    • United States
    • United States Courts of Appeals. United States Court of Appeals (3rd Circuit)
    • October 21, 1992
    ...to a distinct annual audit, which follows the submission of a separate cost report for each fiscal year. See 42 C.F.R. §§ 413.20(b), 413.24(f) (1991). These regulations indicate that reimbursement payments made for any one year arise from transactions wholly distinct from reimbursement paym......
  • Request a trial to view additional results
10 firm's commentaries
  • Changes Proposed to PRRB Dissatisfaction Requirement
    • United States
    • JD Supra United States
    • June 5, 2014
    ...this “must claim or protest” requirement from the appeals section of the regulations and placing it in the cost reporting section, 42 C.F.R. § 413.24(j). CMS is also revising the Board appeals regulations at Part 405, Subpart R to delete this requirement. 79 Fed. Reg. Notably, CMS’s propose......
  • CMS Changes to Cost Report and Appeal Rules Are Now in Effect
    • United States
    • JD Supra United States
    • January 8, 2016
    ...in the OPPS final rule, CMS has moved this requirement from the appeal section of the regulations to the cost reporting section at 42 C.F.R. § 413.24(j). The new regulations contain language of which providers should take note. First, in order to potentially qualify for reimbursement for a ......
  • Fiscal Year 2022 IPPS Proposals Related to GME Payments
    • United States
    • JD Supra United States
    • May 18, 2021
    ...etc. to determine the point at which the requisite threshold of FTE residents are trained. As required under 42 C.F.R. §§ 413.20 and 413.24, hospitals must provide sufficient documentation to ensure proper payment (for GME this includes, but is not limited to, rotation schedules and trainin......
  • D.C. Circuit Determines that Physical Possession of Medicare Records Not Required in Implied-Certification Claim Against the District of Columbia
    • United States
    • JD Supra United States
    • July 16, 2015
    ...cost data available for audit when it presented its year-end cost report, in contravention of federal regulations (42 C.F.R. §§ 413.20, 413.24) that were incorporated into the District of Columbia’s Medicaid State Plan. In reversing the decision of the lower court, the D.C. Circuit found th......
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