CMS Pub. 100-04, ch. 37, § 1

Current law permits the VA to collect appropriate Medicare coinsurance and deductible

amounts from supplemental insurers for claims for supplies and services ordinarily

covered by Medicare but furnished:

• At VA facilities; and

• For veterans eligible to receive both VA health and Medicare benefits and also

having Medicare supplemental insurance.

To facilitate this process, the Centers for Medicare & Medicaid Services (CMS) entered

into an interagency agreement with the VA whereby CMS will help the VA work with

the designated CMS MAC to adjudicate claims for these services to produce remittance

advices equivalent to those ordinarily produced for Medicare claims. Medicare does not

pay these claims, but the remittance advices show how much Medicare would have paid

had the claims been payable by Medicare along with the applicable deductibles and

coinsurance. In adjudicating a claim and generating these remittance advice notices, the

CMS MAC must verify that the services provided are covered benefits, certify admission

where appropriate, conduct prepayment utilization screening, and authorize payment.

CMS has a single A/B MAC (A) and (B) to process these claims. The remittance

advices, sent by the VA to the supplemental insurers, will help the insurers determine

payment amounts they owe to the VA.

The VA funds all of the work on this project, including systems changes.