CMS Pub. 100-06, ch. 3, § 110.2

The term Medicare Beneficiary Identifier (MBI) is a general term describing a beneficiary’s Medicare

identification number.

To recover a non-MSP overpayment from a beneficiary, follow the recovery procedure below. If the

beneficiary protests following the receipt of a notification of overpayment, handle the protest in

accordance with §110.9 of this chapter.

A. Non-MSP Overpayment Is Less Than $50

Take no further recovery action. Do not send a recovery letter, or attempt recoupment. Also do not refer

case to CMS for further collection efforts. See §160.2 of this chapter for termination of collection

procedures.

B. Non-MSP Overpayment Amount Is $50 or More

Upon discovering an overpayment of $50 or more, send the beneficiary a recovery letter containing the

information in §110.4 of this chapter.

If there is no response within 30 days after sending the initial recovery letter and none of the conditions

in §110.3 of this chapter are present:

1. Send a follow-up letter to the beneficiary, and

2. Arrange to begin offset of the overpayment against any Medicare payments that become due the

beneficiary on day 60.

C. Referral to SSA

To be considered for SSA referral the overpayment amount must be $1000 or more and the beneficiary

must be in current pay status. If, within 90 days of sending the initial demand letter, the overpayment

has not been recovered and the individual has not requested a reconsideration, hearing or waiver (see

§110.9 of this chapter) Prepare the case for referral to SSA for possible recovery from the individual's

social security benefits.

However, if the beneficiary is not entitled to monthly social security benefits, do not refer the case to

SSA. Offset should be continued in the case of beneficiaries who is not entitled to monthly social

security benefits. If appropriate, the instructions for termination of collection action should be followed

(See 110.3D of this chapter for additional instructions.).

The contractor should not refer an overpayment to SSA if it has knowledge that the beneficiary is

deceased.

When preparing the case for referral to SSA the following must be included in the case file:

• Referral Form- contains the address of the referring agency (The Centers

for Medicare and Medicaid Services (CMS) Central Office, CMS Regional Office, or the

Medicare Contractor and information pertaining to the case; and

• Return Notice- for SSA use in recording information for crediting the CMS

Trust Fund; and

• Waiver Determination- if the Medicare Contractor or CMS RO determines

the beneficiary was at fault for the overpayment.

NOTE: The contractor’s file must contain all overpayment notification letters and

correspondence from the beneficiary and/or representative. Contractors may retrieve copies of

the relevant forms from the servicing regional office or by accessing SSA’s Program Operations

Manual System at http://policy.ssa.gov/poms.nsf/poms. Access the HI section for Health

Insurance and then the section number HI 022 titled Medicare Overpayments. Then access HI

02201 - Methods of Recovery for Title XVIII Overpayments and finally HI 02201.015 titled

Appeal Requests and Refunds. The Beneficiary Overpayment Referral Notice is Exhibit A.

When an individual or his/her authorized representative receives notice from SSA that a Medicare

overpayment will be withheld from title II benefits and protests the withholding, the protest applies only

to the deduction from his/her title II benefits. It does not apply to the Medicare overpayment because

the Medicare contractor has determined that the overpayment must be recovered.

If SSA receives an appeal and/or waiver request, they must stop the process of recovery. If the

Medicare Contractor, CMS RO, or the Administrative Law Judge has previously denied a waiver

request, SSA will then process the overpayment in accordance with current operating procedures. If the

individual has not requested a waiver with the contractor but files a waiver request with SSA, then SSA

must return the overpayment package to the appropriate contractor for processing.

When an individual or his/her representative goes to SSA to request a waiver and/or an appeal of the

Medicare Overpayment withholding, SSA must complete the following forms, depending on the

request:

• Waiver- Form 632-BK (Request for Waiver of Overpayment and Recovery of Change in

Repayment Rate)

• Appeal of Withholding – SSA-795 (Statement or Claimant or Other Person) since the rate of the

withholding is not an initial determination, does not use the SSA-561 (Request for

Reconsideration) or HA-501 (Request for Hearing).

NOTE: The referral of a non-MSP beneficiary debt to SSA occurs regardless of the classification of the

debt for financial reporting. Thus, a referral to SSA should occur even if the debt has been reclassified

to Currently Not Collectible (CNC).

D. Beneficiary “Write-Off” between $50- $999.99

If there has been “No Activity” (i.e. no recoupment) within a 12-month period of a beneficiary non-MSP

overpayment that is between $50- $999.99, verify that no collections are being made on any other older

debts for the same beneficiary before you make a recommendation for write -off to the Regional Office.

At the end of each Quarter compile a list of all beneficiary non-MSP overpayments between $50-$999.99

to the Regional Office for Write-Off.

Submit this information, including the status of probate, if applicable, with an explanation for the

beneficiary non-MSP overpayment Write-off.

Example:

Region # Contractor # Medicare beneficiary identifier# Claim #

xx xxxxx xxxxxxxxxx xxxxxxxxxxxx

Claim paid date Demand letter date Det. date. $ amt.

xxxxxxxx xxxxxxxx xxxxxxxx xxxx

The RO will be responsible for approval or denial of all recommendations for “write -off”, based on the

information submitted by contractor.

NOTE: The write -off of a non -MSP beneficiary debt between $50- $999.99 occurs regardless of the

classification of the debt for financial reporting. Thus, a request to write off non- MSP beneficiary debt

between $50-$999.99 should occur even if the debt has been reclassified to Currently Not Collectible

(CNC).

NOTE: Beneficiary overpayments that are greater than $1000 may be recommended for write -off

following the above instructions if the Medicare contractor has verified from SSA that the beneficiary is

not in a current pay status.