CMS Pub. 100-04, ch. 30, § 100.7

After the contractor has reviewed the claim for indemnification and the indemnification

amount has been determined, it notifies the provider or physician/supplier of the

proposed indemnification action. (A sample letter for these situations is contained in

§100.10, Exhibit l.) The essential elements of this written notice are:

• An explanation of the items and services for which the provider or

physician/supplier is liable with reference to the original notice to the provider or

physician/supplier;

• A statement of the provision of §1879 which allows the program to indemnify the

beneficiary and recover an overpayment from the provider, practitioner, or

supplier;

• An explanation of the amount determined payable to the requester for

indemnification;

• A statement that the amount the contractor has determined to be payable is paid to

the requester and that it constitutes an overpayment to the provider, practitioner,

or supplier which is to be recovered from future Medicare payments made to it;

• A statement encouraging the provider, practitioner, or supplier to refund any

amount(s) already collected; and

• A reminder to the provider, practitioner, or supplier of his/her/its Medicare appeal

rights.

If the provider, practitioner, or supplier does not respond to this notice within 15 days, the

contractor makes payment to the requester in accordance with §100.8. If the provider,

practitioner, or supplier disputes the indemnification or the amount to be paid, the

contractor resolves any discrepancies before making payment. The payment process takes

place even if the provider, practitioner, or supplier might appeal the contractor’s initial

determination which held the provider, practitioner, or physician liable and that appeal is

still pending at the time payment of the indemnification amount is to take place. If the

appeal decision reverses the initial determination, then adjustments are to be made at that

time in the contractor and provider, practitioner, or supplier records. In all cases, the

contractor encourages the provider, practitioner, or supplier to refund any and all amounts

collected to this point. If the provider, practitioner, or supplier chooses to refund any

money collected, the contractor verifies that such a refund has actually been made to the

requester.