Cost Report Appeals
Palmetto GBA provides cost report appeal services for Jurisdiction J for Part A, Independent Organ Procurement Organizations (OPOs) and Histocompatibility Labs (Histo). See article OPO Cost Report Appeals. The current Appeal Support Contractor (ASC) is Federal Specialized Services (FSS).
If there are any questions related to these appeal filing instructions, please contact Cecile Huggins at Cecile.Huggins@PalmettoGBA.com.
For Appeals to the Intermediary
Information and procedures for filing an appeal before the Medicare Administrative Contractor (MAC) are available in Part I of the Provider Reimbursement Manual, Chapter 29 (PRM-1). Reference the chart below for amount in controversy requirement and contacts for filing.
All correspondence/documentation should be submitted to FSS and Palmetto GBA in electronic format. Ensure that any Adobe attachments are legible. Providers should submit Excel spreadsheets where applicable. The subject line of the email should list the case number, provider name, provider number, fiscal year end and the nature of the correspondence: For example: "Subject: Case No., ABC Provider, Provider No. 12-3456, FYE XX/XX/XXXX, Final Paper."
For Appeals to the Provider Reimbursement Review Board (PRRB)
Information and procedures for filing PRRB appeals are available on the PRRB website.
Effective November 1, 2021, all filings must be submitted electronically using the PRRB Electronic Filing System, Office of Hearings Case and Document Management System (OH CDMS) unless an exemption granted under Rule 2.1.2 applies. OH CDMS is a web-based portal for parties to enter and maintain their cases and to correspond with the PRRB. Access to the system is granted to registered users, as needed, based on their roles. Access to specific cases is limited to the parties of each case, including party representatives.
Individuals registering for access to OH CDMS should allow for up to days to complete registration as it is a multi-step process to obtain secure access to the web-based portal itself and to OH CDMS. Follow the link above for the most recent instructions for filing appeals and using OH CDMS.
Parties should review PRRB Rule 1.4 concerning Confidential Information prior to submitting documentation in OH CDMS.
If an exemption to file an appeal in OH CDMS granted under Rule 2.1.2 applies, then hard copy filing must be submitted according to instructions in the chart below.
|
For Medicare Administrative Contractor (MAC) Appeals |
For Provider Reimbursement Review Board (PRRB) Appeals |
|---|---|
|
Amount in controversy: $1,000 – $9,999
|
Amount in controversy: $10,000 or more ($50,000 or more, in aggregate for group appeal)
|
|
Send request to the ASC:
JJAUDIT.APPEAL@palmettogba.com
If filing documents with FSS and Palmetto GBA electronically is not an option for the provider, use the addresses below to file unboud correspondence: U.S. Mail or Courier Service Federal Specialized Services Intermediary Appeals 1701 S. Racine Avenue Chicago, IL 60608-4058 Palmetto GBA Provider Cost Report Appeals Attn: Cecile Huggins Internal Mail Code: AG-380 P.O. Box 100307 Columbia, SC 29202-3307 Palmetto GBA Provider Cost Report Appeals Attn: Cecile Huggins Internal Mail Code: AG-380 2300 Springdale Drive, Bldg. One Camden, SC 29020-1728 |
Only if an exemption from filing in OH CDMS has been granted, submit using the instructions below:
Provider Reimbursement Review Board CMS Office of Hearings 7500 Security Boulevard Mail Stop: B1-01-31 Baltimore, MD 21244-1850
prrb@fssappeals.com JJAUDIT.APPEAL@palmettogba.com
If filing documents with FSS and Palmetto GBA electronically is not an option for the provider, use the addresses below to file unbound correspondence:
Federal Specialized Services PRRB Appeals 1701 S. Racine Avenue Chicago, IL 60608-4058
Copy:
Palmetto GBA Provider Cost Report Appeals Attn: Cecile Huggins Internal Mail Code: AG-380 P.O. Box 100307 Columbia, SC 29202-3307
Palmetto GBA Provider Cost Report Appeals Attn: Cecile Huggins Internal Mail Code: AG-380 2300 Springdale Drive, Bldg. One Camden, SC 29020-1728 |