PRRB dispute resolution on fast track. Interview by Wendy Herr.
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.
Provider Reimbursement Review Board, Baltimore, MD.
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D006077:Government Agencies / Q000458:organization & administration*; D007349:Insurance, Health, Reimbursement / Q000331:legislation & jurisprudence*; D006278:Medicare / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D017008:Negotiating; D014481:United States