CMS Pub. 100-05, ch. 5, § 60.1.3.2.4

Post-payment full recoveries are recorded when Medicare recovers the full amount

demanded minus any adjustments. Part A and Part B savings are sometimes recorded

manually without a claim’s adjustment.

Line Description Instruction

Line 9 Full Recovery (# Report the number of post-payment full recoveries made

of claims) during the month.

Line 10 Full Recovery ($) Report the dollar value of post-payment full recoveries

made during the month.

Part A post-payment full recoveries are recorded by the type of bill submitted. If a claim

adjustment has a bill type code with a third digit of 7, 8, or F - P, the adjustment is

classified as post-payment savings.

Part B post-payment full recovery savings are recorded when a claims adjustment is

taken to completely adjust off Medicare’s payment.

NOTE: Part A savings are always taken first before Part B savings.

NOTE: The amount of savings taken/recorded for group health plan’s (GHP) is equal to

the amount of principal recovered. The amount of savings taken/recorded for liability, no-fault, and WC is always equal to the actual amount of repayment of principal received

plus, where applicable, the amount of pro-rata reduction for attorney fees and costs

associated with the actual recovery amount. Remember that interest shall not be counted

as savings.

MSP Savings may be recorded only after receipt of payment. MSP Contractor, A/B

MACs and DME MACs count recovery savings in the month they are received. Please

note that full recoveries pursuant to an extended repayment plan (i.e., formal

installment/repayment request) are an exception and are not counted until all monies

have been received.

NOTE: For GHP debt, full recoveries are counted on a claim-by-claim basis. Count the

full recovery of each individual claim in a GHP debt as a full recovery. For liability/no-fault/WC debt, full recoveries are counted on a debt-by-debt basis. Do not count a

recovery as a full recovery unless the full principal for the entire debt is recovered.

Part B post-payment full recoveries savings occur when the adjustment is taken to

completely adjust off Medicare’s primary payment, since the claim should have been

fully paid by the primary insurer.