CMS Pub. 100-05, ch. 5, § 60.1.3.2.3

Pre-payment partial recoveries occur when Medicare makes a secondary payment and the

savings are calculated as the difference between the Medicare allowed amount if primary

and the amount Medicare paid as secondary.

A/B MAC (Part A) Example:

A hospital identifies a GHP as the primary payer, submits its charge to that insurer, and

the GHP makes primary payment, but it does not cover the full cost. The A/B MAC (Part

A) calculates the difference between what Medicare would have paid, if primary, and the

amount Medicare paid as secondary. This amount is recorded as a prepayment partial

recovery.

A/B MAC (Part B) Example:

A physician identifies a GHP as the primary payer, submits the bill to that insurer, and

the GHP makes primary payment, but it does not cover the full cost. The beneficiary

informs the A/B MAC (Part B) of this and submits a copy of the GHP explanation of

benefits. The A/B MAC (Part B) calculates the difference between what Medicare would

have paid, if primary, and the amount Medicare paid as secondary. This amount is

recorded as a prepayment partial recovery.

Line Description Instruction

Line 5 Partial Recovery Report the number of pre-payment partial recoveries

(# of claims) made during the month.

Line 6 Partial Recovery Report the dollar value of pre-payment partial recoveries

($) made during the month.

A/B MAC (Part A) pre-payment partial recoveries are defined by the type of bill

submitted. If a claim submitted to a A/B MAC (Part A) has a bill type code with a third

digit of 0,1,2,3,4 or 5, the A/B MAC (Part A) shall classify this claim as pre-payment

savings.

A/B MAC (Part B) pre-payment partial recovery savings occur when the other insurer’s

payment is less than the Medicare allowed amount, causing a Medicare secondary

payment. The A/B MAC (Part B) shall calculate these savings by determining the

difference between the Medicare allowed amount if primary and the amount Medicare

paid as secondary.

Line 7 is the sum of lines 1, 3 and 5. It represents total pre-payment savings (# of claims).

Line 8 is the sum of lines 2, 4 and 6. It represents total pre-payment savings ($). Lines 7

and 8 are automatically calculated.