CMS Pub. 100-05, ch. 5, § 60.1.2

A/B MACs, DME MACs, and the MSP Contractor, shall report savings on the Forms CMS-1563

and CMS-1564 only for the actual amount (principal dollars only) of savings realized, plus

Medicare’s share of the procurement costs. Under no circumstances shall the MSP Contractor,

A/B MACs and DME MACs claim more savings than Medicare actually paid in benefits. The

MSP Contractor, A/B MACs and DME MACs shall not claim interest dollars recovered as

savings. Interest collected goes to the General Revenue Fund and is not returned to the Medicare

Trust Funds.

A/B MACs and DME MACs shall report cost-avoided savings through their shared systems.

However, A/B MACs and DME MACs shall not update the claims history in connection with

post pay recoveries received except when the re-establishment of exhaustible benefits is

required. This rule applies to GHPs as well as non-GHPs

The MSP contractor and A/B MACs and DME MACs for non-GHP cases shall report savings

attributable to the recoveries (regardless of who the processing contractor is) associated with a

liability, no fault or workers compensation case recovery. A/B MACs and DME MACs shall not

update the shared systems paid claims history (via claims adjustments) with the recovery

amounts, unless there is a need to re-establish exhaustible benefits. The MSP contractor, A/B

MACs and DME MACs pursuing recovery of GHP debts or DPPs, shall, upon case closure,

report savings associated with the GHP recoveries in the appropriate categories.

A/B MACs and DME MACs shall re-establish exhaustible benefits for post pay recoveries

associated with GHP and non-GHP cases if the restoration of benefits will be beneficial to the

beneficiary. The A/B MACs and DME MACs shall take the necessary actions to restore

exhaustible benefits and claim the savings with respect to the claims associated with the

exhaustible benefits. If the A/B MACs and DME MACs determines that restoration of benefits

is not beneficial, the A/B MACs and DME MACs shall still report savings on the claims

referred to them. The recovery MSP contractor, or A/B MAC and DME MAC, shall not report

the savings associated with the claims referred for possible restoration of benefits.

Exception to reporting manual savings: A/B MACs and DME MACs having responsibility for

a provider, physician, or other supplier DPP recovery shall recover and update their paid claims

history files (via a claims adjustment) with information regarding the collection and subsequent

MSP savings.

When notified by CMS, the MSP contractor, A/B MACs and DME MACs shall report additional

savings manually, as requested by CMS.

A/B MACs and DME MACs and the MSP Contractor utilize the HIGLAS system to determine

MSP Savings. These reports detail all debts that have been closed and collected on for MSP

Contractor, A/B MAC and DME MAC. These reports will be inclusive of the original demand

amount, Medicare’s procurement costs where applicable (that is, the pro rata share of the

procurement costs associated with the actual amount recovered), collected amounts (principal

and interest), etc. The MSP Contractors, A/B MACs and DME MACs must use these reports to

enter the savings figures recovered via HIGLAS, as applicable, into the CROWD/MDX system.

A. Savings Priority

A/B MACs and DME MACs shall report MSP savings in the following order: (1) exhaustible

Part A benefits, (2) exhaustible Part B benefits, (3) the remaining (non-exhaustible) Part A

benefits, and (4) the remaining (non-exhaustible) Part B benefits. In each separate type of

benefit listed above, savings are applied to the highest dollar claim first.

Exhaustible Benefits are benefits where their restoration would affect payment for a

subsequent claim of the same type. Some examples of exhaustible benefits include: hospital

inpatient lifetime reserve days (60 days), inpatient skilled nursing facility care, and inpatient

lifetime reserve psychiatric days (190 days).

Additionally, claims adjustments for exhaustible benefits are not necessary if it is clear that

their restoration could have no beneficial effect for the beneficiary; for example, if the issue is

lifetime reserve days where the beneficiary is deceased and did not exhaust his lifetime reserve

days without taking into account such restoration.

B. Reporting Dollar Values

The MSP contractor, A/B MACs and DME MACs shall round all dollar values to the nearest

whole dollar.

C. Checking Reports/Report Equations

• Line 7 must equal the sum of lines 1 + 3 + 5 for all columns;

• Line 8 must equal the sum of lines 2 + 4 + 6 for all columns;

• Line 13 must equal the sum of lines 9 + 11 for all columns;

• Line 14 must equal the sum of lines 10 + 12 for all columns;

• Line 15 equals line 1 for all columns;

• Line 16 equals line 2 for all columns;

• Line 17 equals the sum of lines 3 + 9 for all columns;

• Line 18 equals the sum of lines 4 + 10 for all columns;

• Line 19 equals the sum of lines 5 + 11 for all columns;

• Line 20 equals the sum of lines 6 + 12 for all columns;

• Line 21 equals the sum of lines 15 + 17 + 19 for all columns;

• Line 22 equals the sum of lines 16 + 18 + 20 for all columns.