Scheme Nickname:
Provider Reimbursement Certification
This schemes involves regulations for a certified Medicare provider of services to appeal decisions regarding healthcare insurance reimbursements to the Provider Reimbursement Review Board pursuant to 42 C.F.R. ยงยง 405.1835-.1841. A decision of the Provider Reimbursement Review Board may be affirmed, modified, reversed or vacated and remanded by the CMS Administrator within 60 days of notification to the provider of that decision.
Adjudication Levels:
| Level | Name of Office | Sub-Agency/Bureau/Division: | Are administrative appeals permitted from final decisions at this stage? |
|---|---|---|---|
Hearing Level | Centers for Medicare and Medicaid | Yes (All Types of Cases) | |
Appeal Level 1 | Centers for Medicare and Medicaid | No |
Types of Adjudication:
Type B
Verified by Agency:
Verified
Is this a Major Adjudication:
Yes
