Medicare Paid for Services Which Should Have Been Paid for by WC

30.5 – Medicare Paid for Services Which Should Have Been Paid for by WC (Rev. 12438; Issued: 01-04-24; Effective: 02-06-24; Implementation: 02-06-24) In any case in which it is clear that Medicare paid for services that should have been paid for by the WC carrier, the MSP Contractor shall request that the Medicare program be reimbursed for the amounts conditionally paid by Medicare. The MSP Contractor includes in the request the amount that Medicare paid but should not have. In addition, it explains that the Medicare law excludes payments for services covered under WC, and requires WC carriers to refund the Government where Medicare has paid for services that are reimbursable under WC. If the beneficiary requests a waiver or an appeal of the overpayment determination, the beneficiary will be held responsible for the interest on the debt if the agency prevails and a refund is later collected. See 42 C.F.R. § 411.24(m). If the beneficiary is represented by an attorney, the MSP Contractor should copy the attorney on any correspondence. The MSP Contractor sends copies of all correspondence to the WC carrier when the WC carrier is the identified debtor, and issues courtesy copies to the WC state agency. 42 C.F.R. § 411.24(h) requires that a beneficiary or other entity repay CMS within 60 calendar days of receiving a primary payment. See 42 C.F.R. § 411.24(h). Medicare assesses interest on MSP debts by exercising common law authority that is consistent with the FCCA and implementing regulations. See 42 C.F.R. § 411.24(m). If CMS does not receive a full refund, or adequate proof that no overpayment exists, within 60 calendar days of notifying the beneficiary of CMS’s demand, the MSP Contractor begins assessing interest as of the date of the mailing of the demand letter. 42 C.F.R. § 411.24(h) and 42 C.F.R. § 411.24(m) provide express authority to assess interest on MSP debts. Interest is calculated on MSP debts using the method applicable to Non-MSP Medicare overpayments and underpayments as stated in 42 C.F.R. § 405.378. For Medicare overpayments and underpayments and MSP debts, interest is calculated in full 30-day periods. Interest instructions for Medicare overpayments and underpayments are found in Pub. 100-06, Medicare Financial Management Manual, Chapter 4.