(a)Definitions. As used in this subpart: Administrator means the Administrator or Deputy Administrator of CMS.
Administrator review means that review provided for in section 1878(f) of the Act (42 U.S.C. 1395oo(f) ) and § 405.1875 .
Board means the Provider Reimbursement Review Board established in accordance with section 1878 of the Act (42 U.S.C. 1395oo ) and § 405.1845 .
Board hearing means that hearing provided for in section 1878(a) of the Act (42 U.S.C. 1395oo(a) ), and § 405.1835 .
CMS reviewing official means the reviewing official provided for in § 405.1834 .
CMS reviewing official procedure means the review provided for in § 405.1834 .
Contractor determination means the following:
(1) With respect to a provider of services that has filed a cost report under §§ 413.20 and 413.24 of this chapter, the term means a final determination of the amount of total reimbursement due the provider, pursuant to § 405.1803 following the close of the provider's cost reporting period, for items and services furnished to beneficiaries for which reimbursement may be made on a reasonable cost basis under Medicare for the period covered by the cost report.(2) With respect to a hospital that receives payments for inpatient hospital services under the prospective payment system (part 412 of this chapter), the term means a final determination of the total amount of payment due the hospital, pursuant to § 405.1803 following the close of the hospital's cost reporting period, under that system for the period covered by the final determination.(3) For purposes of appeal to the Provider Reimbursement Review Board, the term is synonymous with the phrases "intermediary's final determination," "final determination of the organization serving as its fiscal intermediary," "Secretary's final determination" and "final determination of the Secretary," as those phrases are used in section 1878(a) of the Act, and with the phrases "final contractor determination" and "final Secretary determination" as those phrases are used in this subpart.(4) For purposes of § 405.376 concerning claims collection activities, the term does not include an action by CMS with respect to a compromise of a Medicare overpayment claim, or termination or suspension of collection action on an overpayment claim, against a provider or physician or other supplier. Contractor hearing means that hearing provided for in § 405.1809 .
Contractor hearing officer(s) means the hearing officer or panel of hearing officers provided for in § 405.1817 .
Date of receipt means the date a document or other material is received by either of the following:
(1)A party or an affected nonparty. A party or an affected nonparty, such as CMS, involved in proceedings before a reviewing entity. (i) As applied to a party or an affected nonparty, the phrase "date of receipt" in this definition is synonymous with the term "notice," as that term is used in section 1878 of the Act and in this subpart.(ii) For purposes of a contractor hearing, if no contractor hearing officer is appointed (or none is currently presiding), the date of receipt of materials sent to the contractor hearing officer (as permitted under paragraph (d) of this section) is presumed to be, as applicable, the date that the contractor stamps "Received" on the materials, or the date of electronic delivery.(iii) The date of receipt by a party or affected nonparty of documents involved in proceedings before a reviewing entity is presumed to be 5 days after the date of issuance of a contractor notice or a reviewing entity document. This presumption, which is otherwise conclusive, may be overcome if it is established by a preponderance of the evidence that such materials were actually received on a later date.(2)A reviewing entity. For purposes of this definition, a reviewing entity is deemed to include the Office of the Attorney Advisor. The determination as to the date of receipt by the reviewing entity to which the document or other material was submitted (as permitted under paragraph (d) of this section) is final and binding as to all parties to the appeal. The date of receipt of documents by a reviewing entity is presumed to be, as applicable, one of the following dates:(i) Of delivery where the document or material is transmitted by a nationally-recognized next-day courier (such as the United States Postal Service's Express Mail, Federal Express, UPS, DHL, etc.).(ii) Stamped "Received" by the reviewing entity on the document or other submitted material (where a nationally-recognized next-day courier is not employed). This presumption, which is otherwise conclusive, may be overcome if it is established by clear and convincing evidence that the document or other material was actually received on a different date.(iii) Of electronic delivery. In writing or written means a hard copy or electronic submission (subject to the restrictions in paragraph (d) of this section), as applicable throughout this subpart. Reviewing entity means the contractor hearing officer(s), a CMS reviewing official, the Board, or the Administrator.