CMS Pub. 100-05, ch. 5, § 60.1.3.2.5

Post-payment partial recoveries are those savings realized when a primary payer makes a

payment which covers only a part of Medicare’s payment for the services at issue. This

includes situations where Medicare compromises its recovery claim or waives recovery

of part of its claim. Part A and Part B recovery savings are sometimes recorded manually

without a claim’s adjustment.

Line Description Instruction

Line 11 Partial Recovery Report the number of post -payment partial recoveries

(# of claims) made during the month.

Line 12 Partial Recovery Report the dollar value of post-payment partial recoveries

($) made during the month.

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

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

is classified as a post-payment savings.

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

done for less than Medicare’s original payment. The amount adjusted is classified as a

post-payment savings.

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

NOTE: The amount of savings taken/recorded for group health plan’s 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.

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

DME MAC count recovery savings in the month they are received. Please note that partial

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.