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PRRB dispute resolution on fast track. Interview by Wendy Herr
1Provider Reimbursement Review Board, Baltimore, MD.
Abstract:
Administrative changes are trimming the Provider Reimbursement Review Board's (PRRB's) considerable case backlog, and procedures are being devised to resolve cases before they get to the hearing stage, relates Jack Martin, chairman of the PRRB, Baltimore, Md. Appointed by the Secretary of the Department of Health and Human Services (HHS) in May 1991, Martin has a unique perspective on the workings of the five-member board that serves as a quasi-judicial panel for appeals of Medicare payment disputes. Congress created the PRRB in 1972 to provide an administrative appeals forum for Medicare payment disputes, a forum where providers who are dissatisfied with the reimbursement determination made by their intermediary may request and be afforded a hearing to adjudicate the issues involved. As late as 1975, the board was seeing only 107 appeals a year. But subsequently, volume mushroomed. In fiscal year 1991, the PRRB received 3,062 appeals, the highest number ever. This year, for the first time, however, the board is forecasting a decrease in its appeals (See Exhibit). Nevertheless, implementation of new laws promises more volume growth down the road. In an interview with Wendy Herr, HFMA vice president for policy and government relations, Martin discussed changes, procedural equity, and the potential for an increase in appeals submitted to the board.
Insights
The Provider Reimbursement Review Board (PRRB) is reducing its case backlog through administrative changes and new procedures. Despite recent decreases, future legislation may increase Medicare payment dispute appeals.
Area of Science:
- Healthcare Administration
- Public Policy
Background:
- The Provider Reimbursement Review Board (PRRB) was established by Congress in 1972 as a quasi-judicial panel for Medicare payment disputes.
- Initially handling a low volume of appeals, the PRRB experienced significant growth, receiving a record 3,062 appeals in fiscal year 1991.
Discussion:
- Administrative reforms and procedural adjustments are being implemented to decrease the PRRB's substantial case backlog.
- Efforts focus on resolving cases prior to formal hearing stages to improve efficiency.
Key Insights:
- The PRRB is actively working to manage and reduce its extensive caseload.
- The board anticipates a decrease in appeals for the current year, a reversal of the previous upward trend.
Outlook:
- New legislation is expected to influence future appeal volumes, potentially leading to increased submissions to the PRRB.
- The PRRB continues to adapt its processes to manage Medicare payment dispute resolution effectively.