FI Issuance of a Credit Balance Demand Letter

10.6 - FI Issuance of a Credit Balance Demand Letter (Rev. 99, Issued: 06-30-06; Effective/Implementation Dates: 10-02-06) When a Medicare credit balance is not fully recovered to the Medicare Trust Fund through the adjustment bill process (or through check submission) and this balance remains outstanding 60 days after the due date of the CMS-838, the FI shall issue a demand letter to the provider. • The FI shall issue demand letters within 60 calendar days from the due date of the CMS-838 report. • If a full payment is not received 15 days after the date of the first demand letter, the FI shall start the 100% withholding of claims payment up to the total amount owed on day 16, (if they haven’t already placed providers on 100% from their 1st Notification/Rejection letter) Refer to Pub. 100-06, Chapter 4, §§40 and 40.1. • If no response is received from the provider within 30 days after the date of the first demand letter, follow the existing instructions in Pub. 100-06, Chapter 4, §§10 and 20. • If the provider believes that prompt repayment of the amount owed Medicare is so large that it will cause financial hardship, the provider may complete a request for an extended repayment schedule in accordance with Pub. 100-06, Chapter 4, §50. • Contact your Regional Office (RO) for guidance on specific provider issues as needed. Refer to Pub. 100-06, Chapter 3, §40.2 for sample Demand Letter for Claims Accounts Receivables. For MSP, refer to Pub. 100-05, Chapter 7, §60.10.1 “Intent to Refer” letter.