CMS Regional Office (RO) Referral Procedure

50.16 - CMS Regional Office (RO) Referral Procedure (Rev. 10862; Issued: 07-14-21; Effective: 10-14-21; Implementation: 10-14-21) Prior to submitting any materials to the RO, the Medicare contractor will contact the RO to determine how to proceed in referring a potential sanction case for violation of refund requirements. When referring these types of cases to the region, the contractor should include the following: Background of the Subject The subject’s business name, address, Medicare Identification Number, owner’s full name and Social Security Number, Tax Identification Number (if different), and a brief description of the subject’s special field of medical equipment, supplies, or services. Origin of the Case A brief description of how the violations were discovered. Statement of Facts A statement of facts in chronological order describing each failure to comply with the refund requirements. Written Correspondence and Written Summaries Copies of any meetings or telephone contacts with the beneficiary and the supplier regarding the supplier’s failure to make a refund. List of the following for each item or service not refunded to the beneficiary by the supplier (grouped by beneficiary): •Beneficiary Name and Medicare beneficiary identifier; •Claim Control Number; •Procedure Code (CPT-4 or HCPCS) of non-refunded item or service; •Procedure Code modifier; •Date of Service; •Place of Service Code; •Submitted Charge; •Units (quantity) of Item or Service; and •Amount Requested to be refunded. Additional Information Any information that may be of value to the RO.