Instructions for Completing Form CMS-751 A/B, Status of

240 - Instructions for Completing Form CMS-751 A/B, Status of Accounts Receivable - (Rev. 5, 08-30-02) A1-1920, A1-1940, B1-4920, B1-4960 Forms CMS-H751A/B and CMS-M751A/B are similar data entry screens used to report the following receivables. • Form CMS-H751A to report debt under Part A (HI) by intermediaries • Form CMS-H751B to report debt under Part B (SMI) by intermediaries and carriers • Form CMS-M751A to report MSP debt under HI by intermediaries; • Form CMS-M751B to report MSP debt under SMI by intermediaries and carriers; MSP accounts receivable data reported on CMS-M751A/B is a subset of total accounts receivable data reported on Form CMS-H751A/B (e.g., 751A/B includes the data reported on the CMS M751A/B and non-MSP data. The screen heading indicates whether the report is for the MSP subset. Samples of the screens are shown in Exhibits 3 - 9. There are separate reports and data screens for Part A, HI, and for Part B, SMI in the CAFM system. The intermediary enters data in both HI and SMI data screens (Exhibits 3 and 4). The carrier enters data in only the SMI data screens (Exhibit 4). The intermediary or carrier reports the accounts receivable activity for fiscal year-to-date (FYTD) for the period of the report. In order to facilitate reconciliation, balancing and error resolution, it reports the accounts receivable in dollars and cents. The reports require information both for the amount and the number of accounts receivable. To provide standardization, CMS suggests that contractors use their collection process as a guide when reporting the number of accounts receivable. For example, a separate, stand alone accounts receivable collected would be reported as a quantity in the number column. EXAMPLES: 1. (Intermediaries only). A cost report is one receivable. Even though several claims are associated with the cost report, the collection activity would be against the entire cost report rather than each claim. 2. A demand letter issued in a Medicare Secondary Payer (MSP) case to one debtor with several claims listed on the letter. If the collection is made and posted against an individual claim, each claim on the demand letter would be an individual receivable. 3. A demand letter issued to a physician based on adjustments projected from sampling claims equals one. Even though many claims are represented by projection of the sample. Once the principal number is established, the contractor shall report the interest associated with the principal amount in the same manner. There can be a difference between the principal number and the interest number because some receivables are not subject to interest.