{"abstract":"Subpart R of 42 CFR part 405 consists of regulations governing Medicare reimbursement determinations, and appeals of those determinations by health care providers. (For sake of simplicity, through this proposed rule we use \"reimbursement\" to refer to Medicare payment under both the reasonable cost and prospective payment systems.) Under section 1878 of the Social Security Act (the Act) and the regulations, the Provider Reimbursement Review Board (Board) has the authority to adjudicate certain substantial reimbursement disputes between providers and fiscal intermediaries. Board decisions are subject to review by the CMS Administrator, and the final agency decision of the Board or the Administrator, as applicable, is reviewable in Federal district court. In addition, under the regulations, fiscal intermediaries have the authority to hold hearings and adjudicate certain other payment and reimbursement disputes with providers. This proposed rule would update, clarify, and revise various provisions of the regulations governing provider reimbursement determinations, appeals before the Board, appeals before the intermediaries (for lesser disputes), and Administrator review of decisions made by the Board.","action":"Proposed rule.","agencies":[{"raw_name":"DEPARTMENT OF HEALTH AND HUMAN SERVICES","name":"Health and Human Services Department","id":221,"url":"https://www.federalregister.gov/agencies/health-and-human-services-department","json_url":"https://www.federalregister.gov/api/v1/agencies/221","parent_id":null,"slug":"health-and-human-services-department"},{"raw_name":"Centers for Medicare & Medicaid Services","name":"Centers for Medicare & Medicaid Services","id":45,"url":"https://www.federalregister.gov/agencies/centers-for-medicare-medicaid-services","json_url":"https://www.federalregister.gov/api/v1/agencies/45","parent_id":221,"slug":"centers-for-medicare-medicaid-services"}],"body_html_url":"https://www.federalregister.gov/documents/full_text/html/2004/06/25/04-13246.html","cfr_references":[{"chapter":null,"citation_url":null,"part":405,"title":42},{"chapter":null,"citation_url":null,"part":413,"title":42},{"chapter":null,"citation_url":null,"part":417,"title":42}],"citation":"69 FR 35716","comment_url":null,"comments_close_on":"2004-08-24","correction_of":null,"corrections":[],"dates":"To be assured consideration, comments must be received at the appropriate address, as provided below, no later than 5 p.m. on August 24, 2004.","disposition_notes":null,"docket_ids":["CMS-1727-P"],"dockets":[],"document_number":"04-13246","effective_on":null,"end_page":35766,"executive_order_notes":null,"executive_order_number":null,"full_text_xml_url":"https://www.federalregister.gov/documents/full_text/xml/2004/06/25/04-13246.xml","html_url":"https://www.federalregister.gov/documents/2004/06/25/04-13246/medicare-program-provider-reimbursement-determinations-and-appeals","images":{},"images_metadata":{},"json_url":"https://www.federalregister.gov/api/v1/documents/04-13246?publication_date=2004-06-25","mods_url":"https://www.govinfo.gov/metadata/granule/FR-2004-06-25/04-13246/mods.xml","not_received_for_publication":null,"page_length":51,"page_views":{"count":327,"last_updated":"2026-09-22 00:15:09 -0400"},"pdf_url":"https://www.govinfo.gov/content/pkg/FR-2004-06-25/pdf/04-13246.pdf","presidential_document_number":null,"proclamation_number":null,"public_inspection_pdf_url":null,"publication_date":"2004-06-25","raw_text_url":"https://www.federalregister.gov/documents/full_text/text/2004/06/25/04-13246.txt","regulation_id_number_info":{"0938-AL54":{"issue":"200804","html_url":"https://www.federalregister.gov/regulations/0938-AL54/provider-reimbursement-determinations-and-appeals-cms-1727-f-","title":"Provider Reimbursement Determinations and Appeals (CMS-1727-F)","xml_url":"http://www.reginfo.gov/public/do/eAgendaViewRule?pubId=200804&RIN=0938-AL54&operation=OPERATION_EXPORT_XML","priority_category":"Substantive, Nonsignificant"}},"regulation_id_numbers":["0938-AL54"],"regulations_dot_gov_info":{"checked_regulationsdotgov_at":"2011-11-12T12:37:32Z"},"regulations_dot_gov_url":null,"significant":false,"signing_date":null,"start_page":35716,"subtype":null,"title":"Medicare Program; Provider Reimbursement Determinations and Appeals","toc_doc":"Health care provider reimbursement determinations and appeals","toc_subject":"Medicare:","topics":["Administrative practice and procedure","Grant programs-health","Health care","Health facilities","Health insurance","Health maintenance organizations (HMO)","Health professions","Kidney diseases","Loan programs-health","Medicare","Puerto Rico","Reporting and recordkeeping requirements","Rural areas","X-rays"],"type":"Proposed Rule","volume":69}