L Controls – Non-MSP Debt Collection

50.12 – L Controls – Non-MSP Debt Collection (Rev. 10614, Issued: 03-23-21, Effective: 10-01-20, Implementation: 04-22-21) L – Control Number Control Objective – Non-MSP Debt Collection L.1 All overpayments that meet the applicable threshold should be demanded. Demand letters initiate the collection of a provider debt as well as inform the provider of the existence of the debt, their appeal rights with respect to the debt, and the ramifications if the debt is not paid or an ERS agreement is not reached within a specified time period in accordance with CMS instructions. The content of manually created demand letters are reviewed and approved according to CMS guidelines. The demand letter shall be issued, printed mailed timely, and maintained, in accordance with CMS instructions at Pub 100-06, chapters 3 and 4. L.2 Extended Repayment Schedules (ERSs) shall be analyzed for approval or denial by a supervisor in accordance with CMS instructions. The supervisor’s review includes monitoring all approved ERSs, the complete financial analysis of the provider’s application, compliance with the ERS, and the referral to CMS when necessary in accordance with CMS instructions at Pub 100- 06, Chapters 3 and 4. L.3 Interest is calculated and applied correctly and timely in accordance with CMS instructions at Publication 100-06, Chapters 3 and 4. The interest rate is updated in accordance with the notice of the new interest rate for Medicare Overpayments and Underpayments notification. Interest changes are updated in all applicable systems. L.4 Bankruptcy cases are handled in accordance with CMS instructions and instructions given by the Office of General Counsel (OGC). An audit trail of the overpayment shall exist before and after the bankruptcy filing to ensure that Medicare’s best interest can be represented by OGC. Contractors shall maintain, track, and update the status of a bankruptcy in accordance with CMS instructions at Pub 100-06, Chapters 3 and 4. L.5 Provider debt is collected timely, completely, and accurately with an appropriate audit trail of all collection activity and attempts of collection activity in accordance with CMS instructions at Pub 100- 06, Chapters 3 and 4. L.6 Control number L.6 reserved. Control not in use as of IOM revision number 214. L.7 Timely review and processing of all 838 Credit Balance Reports. Ensure that all reported credit balances are collected and properly processed in accordance with CMS instructions in accordance with CMS instructions at Pub 100-06, Chapter 12. L – Control Number Control Objective – Non-MSP Debt Collection L.8 For overpayments subject to the limitation on recoupment under the Medicare Modernization Act (MMA), recoupment is stopped within the set timeframes for the receipt of requests filed for the redetermination and reconsideration levels of appeal. Once both levels of appeal are completed and CMS prevails, collection activities, including revised demand letters and internal recoupment may resume within the timeframes set forth in accordance with 42 CFR section 405.379 and Publication 100-06 Chapter 3, Section 200. L.9 Contractors shall calculate the 935 interest on favorable and/or partially favorable decisions determined by the ALJ and subsequent appeal levels. The calculations shall be completed within the set timeframes on the recouped amounts that were applied to the principal balance only. Voluntary payments are excluded for purposes of the calculation of 935 interest. After the amount is calculated, the Contractor shall issue a refund check to the provider. Contractors shall update, track, and maintain the appeal status on overpayments in the applicable systems in accordance with 42 CFR section 405.379 and Publication 100-06 Chapter 3, Section 200. End Section 50.12 – L Controls – Non-MSP Debt Collection: Back to Table of Contents