CMS Pub. 100-04, ch. 30, § 120.4

Contractors

(Rev. 1186, Issued: 02-23-07; Effective: 01-01-06; Implementation: 05-23-07)

The contractor adds MSN Limitation of Liability Message 50.36.2 to the MSN sent to the

beneficiary (who is presumed not to have knowledge of nonpayment by Medicare) at the

time of the initial determination.

To message 50.36.2, it also adds the following language:

Do not apply if your (doctor/supplier) told you in writing, before

furnishing the service, that Medicare would not pay.

The contractor adds MSN Limitation of Liability Message 50.36.1 to the MSN

sent to the beneficiary (who is held to have had knowledge of nonpayment by

Medicare) at the time of the initial determination.

The contractor adds, from the Remittance Advice Remarks Codes, the Justification for

Services Remark M25 to the RA sent to the physician/supplier (who is presumed to have

knowledge of nonpayment by Medicare) at the time of the initial determination.

The contractor adds, from the Remittance Advice Remarks Codes, the Justification for

Services Remark M38 to the RA sent to the physician/supplier who is held to be not

liable because the beneficiary is held liable at the time of the initial determination.

In addition to the above, as appropriate, the contractor notifies both the beneficiary and

the physician/supplier at the time of the initial determination of their appeal rights (this is

contained on the back of the MSN and the RA).