Recovery From the Beneficiary

110.2 - Recovery From the Beneficiary (Rev. 13183; Issued: 04-24-25; Effective: 05-27-25; Implementation: 05-27-25) The term Medicare Beneficiary Identifier (MBI) is a general term describing a beneficiary’s Medicare identification number. To recover a non-MSP overpayment from a beneficiary, follow the recovery procedure below. If the beneficiary protests following the receipt of a notification of overpayment, handle the protest in accordance with §110.9 of this chapter. A. Non-MSP Overpayment Is Less Than $50 Take no further recovery action. Do not send a recovery letter, or attempt recoupment. Also do not refer case to CMS for further collection efforts. See §160.2 of this chapter for termination of collection procedures. B. Non-MSP Overpayment Amount Is $50 or More Upon discovering an overpayment of $50 or more, send the beneficiary a recovery letter containing the information in §110.4 of this chapter. If there is no response within 30 days after sending the initial recovery letter and none of the conditions in §110.3 of this chapter are present: 1. Send a follow-up letter to the beneficiary, and 2. Arrange to begin offset of the overpayment against any Medicare payments that become due the beneficiary on day 60. C. Referral to SSA To be considered for SSA referral the overpayment amount must be $1000 or more and the beneficiary must be in current pay status. If, within 90 days of sending the initial demand letter, the overpayment has not been recovered and the individual has not requested a reconsideration, hearing or waiver (see §110.9 of this chapter) Prepare the case for referral to SSA for possible recovery from the individual's social security benefits. However, if the beneficiary is not entitled to monthly social security benefits, do not refer the case to SSA. Offset should be continued in the case of beneficiaries who is not entitled to monthly social security benefits. If appropriate, the instructions for termination of collection action should be followed (See 110.3D of this chapter for additional instructions.). The contractor should not refer an overpayment to SSA if it has knowledge that the beneficiary is deceased. When preparing the case for referral to SSA the following must be included in the case file: • Referral Form- contains the address of the referring agency (The Centers for Medicare and Medicaid Services (CMS) Central Office, CMS Regional Office, or the Medicare Contractor and information pertaining to the case; and • Return Notice- for SSA use in recording information for crediting the CMS Trust Fund; and • Waiver Determination- if the Medicare Contractor or CMS RO determines the beneficiary was at fault for the overpayment. NOTE: The contractor’s file must contain all overpayment notification letters and correspondence from the beneficiary and/or representative. Contractors may retrieve copies of the relevant forms from the servicing regional office or by accessing SSA’s Program Operations Manual System at http://policy.ssa.gov/poms.nsf/poms. Access the HI section for Health Insurance and then the section number HI 022 titled Medicare Overpayments. Then access HI 02201 - Methods of Recovery for Title XVIII Overpayments and finally HI 02201.015 titled Appeal Requests and Refunds. The Beneficiary Overpayment Referral Notice is Exhibit A. When an individual or his/her authorized representative receives notice from SSA that a Medicare overpayment will be withheld from title II benefits and protests the withholding, the protest applies only to the deduction from his/her title II benefits. It does not apply to the Medicare overpayment because the Medicare contractor has determined that the overpayment must be recovered. If SSA receives an appeal and/or waiver request, they must stop the process of recovery. If the Medicare Contractor, CMS RO, or the Administrative Law Judge has previously denied a waiver request, SSA will then process the overpayment in accordance with current operating procedures. If the individual has not requested a waiver with the contractor but files a waiver request with SSA, then SSA must return the overpayment package to the appropriate contractor for processing. When an individual or his/her representative goes to SSA to request a waiver and/or an appeal of the Medicare Overpayment withholding, SSA must complete the following forms, depending on the request: • Waiver- Form 632-BK (Request for Waiver of Overpayment and Recovery of Change in Repayment Rate) • Appeal of Withholding – SSA-795 (Statement or Claimant or Other Person) since the rate of the withholding is not an initial determination, does not use the SSA-561 (Request for Reconsideration) or HA-501 (Request for Hearing). NOTE: The referral of a non-MSP beneficiary debt to SSA occurs regardless of the classification of the debt for financial reporting. Thus, a referral to SSA should occur even if the debt has been reclassified to Currently Not Collectible (CNC). D. Beneficiary “Write-Off” between $50- $999.99 If there has been “No Activity” (i.e. no recoupment) within a 12-month period of a beneficiary non-MSP overpayment that is between $50-$999.99, verify that no collections are being made on any other older debts for the same beneficiary before you make a recommendation for write-off to the Regional Office. At the end of each Quarter compile a list of all beneficiary non-MSP overpayments between $50-$999.99 to the Regional Office for Write-Off. Submit this information, including the status of probate, if applicable, with an explanation for the beneficiary non-MSP overpayment Write-off. Example: Region # Contractor # Medicare beneficiary identifier# Claim # xx xxxxx xxxxxxxxxx xxxxxxxxxxxx Claim paid date Demand letter date Det. date. $ amt. xxxxxxxx xxxxxxxx xxxxxxxx xxxx The RO will be responsible for approval or denial of all recommendations for “write-off”, based on the information submitted by contractor. NOTE: The write-off of a non-MSP beneficiary debt between $50-$999.99 occurs regardless of the classification of the debt for financial reporting. Thus, a request to write off non-MSP beneficiary debt between $50-$999.99 should occur even if the debt has been reclassified to Currently Not Collectible (CNC). NOTE: Beneficiary overpayments that are greater than $1000 may be recommended for write-off following the above instructions if the Medicare contractor has verified from SSA that the beneficiary is not in a current pay status.