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why is prrb using mediation

2. Mediation of PRRB Appeals.

Jimmy
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why is prrb using mediation

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    1. 1

    2. 2 Mediationof PRRB Appeals “Life is very short, And there’s no time For fussing and fighting my friend. . . We can work it out.” The Beatles, circa 1966

    3. 3 Why Is PRRB Using Mediation? 3 years from appeal to hearing & up to 1 year for a decision to be issued 90% of cases settle before a hearing & 85% of those settle DAYS before scheduled hearing

    4. 4 What kinds of cases will benefit from mediation? Issues involving factual disputes Owner’s compensation Related party Allocation of costs/time studies Establishment of non-reimbursable cost center vs an A-5 or A-8 adjustment Distinct part Interest expense

    5. 5 Issues not appropriate for mediation Strictly legal issues CMS Policy CMS Regional office policy Political

    6. 6 Will Board still require Position Papers (Final & Prelim)? If both parties agree to mediate-No Prelim or final position papers. Dates on hold, pending outcome of mediation Only 1-2 page issue summaries required If mediation unsuccessful-no prelim...go right to final Don’t request mediation to avoid position paper due dates

    7. 7 Who will conduct the mediation? Office of Hearings Co-Mediators (not Board members) Provider owner-Attorney-Reimbursement consultant FI Rep.--auditor may be in attendance Someone on both sides with authority to settle at table

    8. 8 Advantages of Mediation It helps establish a current and future relationship between FI & Provider Parties at table are immensely familiar with case/provider   Parties at the table participate in drafting a resolution rather than 5 individuals removed making a win/lose decision

    9. 9 Advantages of Mediation Non-binding No position papers Usually have revised NPR & $ within 180 days   FI does not need BSBCA (Chicago) approval for mediation resolution (unlike non-mediated administration resolution)

    10. 10 Advantages of Mediation Funds not tied up for years Costly position papers eliminated   Speedy hearing if not successful Conducted at Intermediary site

    11. 11 If mediation is unsuccessful orFI’s offer is minimal Remember, right now parties at table in control of outcome Some of the issues get resolved; others may go forward to Board Parties now have a better understanding of each others position Board will not know the parties positions/strengths

    12. 12 What mediation is not Arbitration or win/lose No deals No 50/50 No precedent for future Not precedent for other providers

    13. 13 TipsHow to Prepare Provider and Intermediary should BOTH screen the issues & request mediation BEFORE position papers are written Some Providers request mediation at the same time appeal is filed

    14. 14 TipsHow to Prepare Suggest mediating Only the important issue-Don’t scare the FI away with numerous “throw away” adjustments (some cases have 100+ adjs.) Representation-Have decision maker at mediation session; owner, attorney, reimbursement specialist

    15. 15 TipsHow to Prepare FI & Mediators KNOW what Providers’ WANT…. before you get to table, know what you NEED Providers should know reimbursement impact of modifying/giving up Adjustments Be prepared to give up some adjustments in exchange for FI reversing/modifying adjustments

    16. 16 TipsHow to Prepare Provide documentation to Intermediary WELL in ADVANCE of mediation Do your own surveys/gather state/local/association info to support your argument Provider has show the FI how to get to what it NEEDS

    17. 17 TipsHow to Prepare Have boiler plate of settlement agreement done ahead of time so parties can sign at table Be prepared to leave “a little unhappy” --Successful if settlement agreement is reached and both parties leave a little unhappy

    18. 18 Decision to go forward with the Appeal Win at Board Reversal by HCFA Adm. District/circuit court 3-5 years Deep pockets

    19. 19 Final Thought Mediation is gaining popularity Provider’s have nothing to lose If Intermediary agrees to mediate, it usually means a willingness to reverse/modify some/all adjustments

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