Debts RTA by Treasury as Paid in Full (RP), Satisfied Payment Agreement (RP) or

70.17.5 - Debts RTA by Treasury as Paid in Full (RP), Satisfied Payment Agreement (RP) or Satisfied Compromise (RC) (Rev. 11787; Issued:01-19-23; Effective: 04-21-23; Implementation:04-21-23) • If a debt is returned to agency (RTA) as paid in full (RP), satisfied payment agreement (RP), or compromise (RC) and a principal balance less than $100 remains after the receipt has been applied, contractors not utilizing HIGLAS shall adjust down the remaining balance. HIGLAS shall systematically adjust down these balances to $0.00 for contractors utilizing HIGLAS. • If a debt is returned to agency (RTA) as paid in full (RP) or satisfied payment agreement (RP), and a principal balance greater than or equal to $100 remains after the receipt has been applied, the contractor shall research all activity on the debt to determine if the receipts were appropriately applied and take any action, if needed. If all receipts were applied appropriately, the contractor shall then adjust down the remaining balance to $0.00. • If a debt is returned to agency (RTA) as satisfied compromise (RC) the contractor shall research all activity on the debt to determine if the receipts were appropriately applied and take any action, if needed. The contractor shall adjust down the balance to $0.00 using the appropriate adjustment/write-off code. If it is determined a refund is valid, the contractors shall follow procedures for applying excess collections and update HIGLAS or their internal systems to reflect any refund given (see CMS Pub. 100-06, chapter 4, section 70.14.8). Exhibit 1- Intent to Refer (ITR) Letter (Rev. 294, Issued: 10-06-17, Effective: 07-03-17, Implementation: 07-03-17) Intent to Refer Letter Background The DCIA requires Federal agencies to refer debt that is 120 days delinquent to the Department of Treasury or a Treasury designated Debt Collection Center for cross servicing. Prior to debt transfer, the DCIA requires agencies to inform the debtor of the agency’s intent to refer the debt, and to provide debtor information regarding the referral process. Attached are specific paragraphs that explain the process and debtor rights. These paragraphs shall be included in the intent to refer letter sent to the debtor. Medicare contractors should use their own language in the opening paragraphs to explain the reason for the overpayment and the current balance, including interest accrued and the interest rate. Subject in Bold: Notice of Intent to Refer Debt to the Department of Treasury’s Debt Collection Center for Cross Servicing and Offset of Federal Payments and Certain Eligible State Payments Contractor opening paragraphs concerning the reason for the overpayment, date of determination and amount due. May refer to previous demand letters or other forms of contact regarding the debt. Your debt to the Medicare Program is delinquent and, by this letter, we are providing notice that your debt will be referred to the Department of Treasury’s Debt Collection Center (DCC) for Cross Servicing and Offset of Federal Payments. Your debt will be referred under provisions of Federal law, title 31 of the United States Code, Section 3720A and the authority of the Debt Collection Improvement Act of 1996. The Debt Collection Improvement Act of 1996 (DCIA) requires Federal agencies to refer delinquent debts to the Department of Treasury and/or a designated Debt Collection Center (DCC) for collection through cross servicing and/or the Treasury Offset Program. Under the offset program, delinquent Federal debts are collected through offset of other Federal agency payments you may be entitled to, including the offset of your income tax return through the Internal Revenue Service (IRS). The TOP offsets can also be taken from eligible state payments to which you are entitled. The Debt Collection Center will use various tools to collect the debt, including offset, demand letters, phone calls, referral to a private collection agency and referral to the Department of Justice for litigation. Other collection tools available, which may be used, include Federal salary offset and administrative wage garnishment. If the debt is discharged, it may be reported to the IRS as potential taxable income. During the collection process, interest will continue to accrue on the debt and you will remain legally responsible for any amount not satisfied through the collection efforts. For Individual Debtors Filing a Joint Federal Income Tax Return The Treasury Offset Program automatically refers debts to the IRS for offset. Your Federal income tax refund is subject to offset under this program. If you file a joint income tax return, you should contact the IRS before filing your tax return to determine the steps to be taken to protect the share of the refund which may be payable to the non-debtor spouse. Federal Salary Offset If the facility ownership is either a sole proprietorship or partnership, your individual salary(s) may be offset if you are or become a federal employee. Medicaid Offset As authorized at 42 CFR 447.30, (Subsection 1885 of the Social Security Act), CMS may instruct the State Medicaid Agency to offset the Federal share of any Medicaid payment due you, your agency and/or related facilities. At that time, the offset will remain in effect until the Medicare overpayment is paid in full. Please read the following instructions carefully to determine what action you may take to avoid referral for cross servicing/offset. Due Process You have the right to request an opportunity to inspect and copy records relating to the debt. This request must be submitted in writing to the address listed below. You have a right to present evidence that all or part of your debt is not past due or legally enforceable. In order to exercise this right, this office must receive a copy of the evidence to support your position, along with a copy of this letter. You must submit any evidence that the debt is not owed or legally enforceable within 60 days of the date of this letter. If, after sixty days from the date of this letter, we have not received such evidence, your debt, if it is still outstanding and eligible for referral, will be referred to the Department of Treasury or its designated Debt Collection Center for cross servicing/offset. Repayment Your debt will not be referred to the Department of Treasury if you make payment in full. The past due amount of $____________owed to the Medicare Program as of _____________ includes interest accrued through _____________. (Note: Medicare contractors may alter this sentence to read: The past due amount owed to the Medicare Program as of the date of this letter includes current accrued interest. This sentence may be omitted for debts that do not accrue interest.) Interest is accrued monthly and is added to the balance of the debt. Your check or money order for the amount due should be made payable to: Medicare Contractor Address 000 Street Anywhere, USA 00000-0000. Include a copy of this letter with your payment. If you cannot make payment in full, you may be allowed to enter into an extended repayment agreement. If you are interested in an extended repayment agreement, please contact this office. Bankruptcy If you have filed for bankruptcy and an automatic stay is in effect, you are not subject to offset while the automatic stay is in effect. Documentation supporting your bankruptcy status, along with a copy of this notice, must be forwarded to this office at the above address. If you have any questions concerning this debt, please contact ________________ at ________________. Sincerely, ____________________ Signature of Certifying Official Official Position Exhibit 5 (Rev. 315, Issued: 05-17-19, Effective: 06-18- 19, Implementation: 06-18-19) The term Medicare beneficiary identifier (Mbi) is a general term describing a beneficiary's Medicare identification number. For purposes of this manual, Medicare beneficiary identifier references both the Health Insurance Claim Number (HICN) and the Medicare Beneficiary Identifier (MBI) during the new Medicare card transition period and after for certain business areas that will continue to use the HICN as part of their processes. Treasury Cross-Servicing Dispute Resolution DMS Request Date: Total Number of Pages: _____ SBU FedDebt Case ID.: Principal Amt: $ Creditor Agency Debt ID: PCA Code: Debtor: Program: For CMS Use Only: Creditor Agency Contact Name: Medicare beneficiary identifier: Creditor Agency Contact Phone: Beneficiary Name: Creditor Agency Facsimile: Dispute Number: Dispute request reason: Miscellaneous Dispute Additional comments: If you have any questions regarding the dispute, please call Valencia Thompson at 205-912-6327. Creditor Agency must return response to Bosch Stanley via facsimile 205-912-6374 with 60 days of request date. Creditor Agency (CA) Dispute Resolution Section: Please indicate a response by checking one of the following reasons: Please attach supporting documentation. DAIC ___ CA agrees. Debt amount is incorrect. Requires financial adjustment. DACC ___ CA disagrees. Debt amount is correct. Continue collection efforts. MDAA ___ CA agrees. Miscellaneous dispute, stop collection activity. MDFF ___ CA agrees. Miscellaneous dispute. Requires financial adjustment, continue collection efforts. MDDD ___ CA disagrees. Miscellaneous dispute. Continue collection efforts. VDWD ___ CA agrees. Wrong debtor, stop collection activity. VDRD ___ CA disagrees. This is not the wrong debtor, continue collection efforts. VDPP ___ CA agrees. Previously paid, stop collection activity. VDNP ___ CA disagrees. Not previously paid, continue collection efforts. VDPR ___ CA agrees. Previously resolved, stop collection activity. VDNR ___ CA disagrees. Not previously resolved, continue collection efforts. Financial Adjustment Information (To Be Completed By Creditor Agency): Principal Amount $_______________ Interest Amount $_______________ Penalty Amount $_______________ Admin Cost Amount $_______________ Total Balance Owed $_______________ Please check one of the following: □ Adjustment reflects the total balance currently owed by the debtor, and has been made by our Agency. □ Adjustment has not been made in FedDebt by the Agency, and should be made by DMS. Creditor Agency Response Date: __________ Creditor Agency Response Contact: __________________ Additional Comments By Creditor Agency: ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________