CMS Pub. 100-04, ch. 30, § 150.13

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.

Prior to submitting any materials to the RO, the contractor will contact the RO to

determine how to proceed in referring a potential sanction case. When referring a

sanction case to the region, include in the sanction recommendation (to the extent

appropriate) the following:

Background of the Subject

The subject’s business name, address, Medicare beneficiary identifier, owner’s full name

and Social Security Number, Tax Identification Number (if different), and a brief

description of the subject’s special field of medical equipment and supplies business.

Origin of the Case

A brief description of how the violations were discovered.

Statement of Facts

A statement of facts in chronological order describing each failure to comply with the

refund requirements.

Documentation

Include copies of written correspondence and written summaries of any meetings or

telephone contacts with the beneficiaries and the supplier regarding the supplier’s failure

to make refunds. Include a listing of the following for each item or service not refunded

to the beneficiary by the supplier (grouped by beneficiary):

• Beneficiary Name and Medicare beneficiary identifier;

• Claim Control Number;

• Procedure Code (CPT-4 or HCPCS) of nonrefunded item or service;

• Procedure Code modifier;

• Date of Service;

• Place of Service Code;

• Submitted Charge;

• Units (quantity) of Item or Service; and

• Amount Requested to be Refunded.

Other Significant Issues

Include any information that may be of value to the RO while they review and possibly

develop a case to impose sanctions.