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Home Health & Hospice Week

Reimbursement:

Don't Ignore PRRB Filing Deadlines

Published on Thu Mar 18, 2004

Review board isn't forgiving of filing lapses, decision shows. 

A home health agency punished for challenging cost report settlements and winning had its day in court -- but not over the alleged payback by intermediary auditors.

High Country Home Health Inc., owned by husband and wife Reed and Marilyn Pedrick, won a Provider Reimbursement Review Board hearing over reduced physical therapy costs in their 1994 cost report.

A few months after that PRRB case was decided in 1997, then-intermediary Wellmark reopened the cost report and disallowed excessive administrator compensation to the Pedricks, according to March 3 Tenth Circuit U.S. Court of Appeals decision in High Country v. Thompson.

High Country filed its notice of appeal of the second adjustment in July 1997, but failed to file its final position paper by June 1999. Whether High Country failed to file its preliminary position paper by March 1999 is disputed, the decision notes.

But because High Country missed the final filing deadline, the PRRB dismissed the appeal, and the district court upheld the dismissal.

High Country made numerous arguments against Wellmark's reopening of its cost report in its appeals filing, but the court looked at only one issue -- whether the PRRB's dismissal was justified.

High Country pursued four strategies in arguing against the dismissal based on the deadline:

  • A valid excuse. Extenuating circumstances should apply because High Country's legal counsel's office manager "disappeared" in mid-June 1999. The manager, who stole computer equipment containing firm files, "may have acted to intentionally create exactly this type of problem for our firm" by failing to submit filings, the attorneys told the appeals court.

    But the court doesn't buy it. It rejects High Country's claim of "selective sabotage" because other related papers were filed timely. And "the theft cannot excuse missing a deadline that had expired two weeks earlier," the court says. Plus, legal counsel is responsible for any negligence on the part of its staff.

  • Equivalent filing. High Country's preliminary position paper and parallel arguments raised in an appeal for the agency's fiscal year 1995 cost report should have served in place of the missing final position paper. Again, the court disagrees. Even if the preliminary paper were filed, "if filing the preliminary position paper always satisfied the final, there would effectively be no need to file a final position paper," the decision notes.

    As for the parallel case, "the PRRB was under no duty to hunt around in the record, let alone in the records for other cases, in an attempt to discern the nature of High Country's legal claims," the court says.

  • No proper notice. Even though a clear notice of the final position paper deadline was in the initial notice of a hearing, High Country argues that the policy had just switched from a system where a notice was also sent as the deadline approached, and it should have been notified under the old policy. High Country got its initial warning, and the new policy applied, the court upheld.

  • Inconsistent application. High Country offers examples of cases where the PRRB allowed the filing deadline to slide. But none of the cases were similar to High Country's, so "its attempt fails," the court says.

    Thus, the appeals court affirms the lower court's decision, which upheld the PRRB's dismissal of the case. High Country can appeal to the U.S. Supreme Court if it wishes. The HHA's legal counsel didn't respond to a request for comment.

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