Recovery of Claims Accounts Receivables from the Provider - FI

40 – Recovery of Claims Accounts Receivables from the Provider - FI (Rev. 12946, Issued:11-08-24; Effective: 12-10-24; Implementation:12-10-24) Part A claims A/R arises from adjustments in the Contractor’s claim processing systems (this type of adjustment may also be referred to as a carryover adjustment). Some of the reasons these adjustments occur include the duplicative processing of a claim, payment of a claim at the wrong Diagnostic Related Group (DRG) rate, a request from a provider, a determination by the Contractor that an adjustment was required, or an adjustment created from a credit balance report, CMS-838 in accordance to Chapter 12, Credit Balance Reporting. These adjustments are normally recovered through the recoupment of future claims and the recovered amounts are included in the remittance advices to the providers. For additional information see Chapter 4, §70.15.2.