CMS Pub. 100-06, ch. 5, § 270.22

A1-1923.22, A1-1943.22, B1-4923.22, B1-4943.22

The contractor enters the number and amount of collections on receivables that were

delinquent upon collection. The total amount should be less than total collections for the

FY.

Section D - Transferred Receivables

The contractor enters the distribution of debts transferred to Medicare contractors or other

CMS locations.

For Form CMS-H751A/B, the data in this section is also reported in Section A, Status of

Accounts Receivable Transfers Out to other Medicare contractors or other CMS

locations, and will be used by the contractor and other CMS locations to reconcile its

books and records.

For Form CMS-M751A/B, the data in this section is also reported in Section A

Outstanding Receivables, Line 5c, Transfers Out to other Medicare Contractors; Line 5e,

Transfers Out to other CMS locations on the POR/PSOR; and Line 5g, Transfers Out to

other CMS Locations, Not POR/PSOR.

270.23 - Line 5c, Transfers Out to other Medicare Contractors

(Principal & Interest) - (Rev. 5, 08-30-02)

A1-1923.23, A1-1943.23, B1-4923.23, B1-4943.23

The contractor enters the distribution to Medicare contractor locations of the debts,

entered in Line 5c, Transfers Out to other Medicare Contractors, reflected in Section A of

this report.

270.24 - Line 5e, Transfers Out to other CMS Locations, POR/PSOR

(Principal & Interest) - (Rev. 5, 08-30-02)

A1-1923.24, A1-1943.24, B1-4923.24, B1-4943.24

The contractor enters the distribution to the various regional offices (ROs) or CO of the

debts on the POR, entered in Line 5e, Transfers Out to other CMS Locations,

POR/PSOR, reflected in Section A of this report.

270.25 - Line 5g, Transfers Out to other CMS Locations, Not POR

(Principal & Interest) - (Rev. 5, 08-30-02)

A1-1923.25, A1-1943.25, B1-4923.25, B1-4943.25

The contractor enters the distribution to the various ROs or CO of the debts not reported

on the POR/PSOR, entered in Line 5g,Transfers Out to other CMS Locations, Not

POR/PSOR, reflected in Section A of this report. POR is applicable to FIs. PSOR is

applicable to carriers.

280 - Instructions for Completing the Form CMS-C751A/B, Status of

Debt - Currently Not Collectible (CNC), and Form CMS-MC751A/B,

Status of MSP Debt - Currently Not Collectible (CNC) - (Rev. 5, 08-30-

02)

A1-1930, A1-1950, B1-4930, B1-4950

Form CMS-C751A/B and Form CMS-M751A/B are similar data entry screens used to

report the following.

• Form CMS-C751A to report non-MSP debt under Part A (HI) by intermediaries;

• Form CMS-C751B to report non-MSP debt under Part B (SMI) by intermediaries

and carriers;

• Form CMS-MC751A to report MSP debt under HI by intermediaries; and

• Form CMS-MC751B to report MSP debt under SMI by intermediaries and

carriers;

Note that currently not-collectible debt reported by Forms CMS-C751 and CMS-MC751

is reported separately for non-MSP and MSP accounts receivables.

The screen heading indicates whether the CNC report is for the non-MSP or MSP subset.

Samples of the screens are shown in Exhibits 5 and 6. Note that intermediaries must

prepare separate reports for each category by trust find.

There are separate reports and data screens for Part A, HI, and for Part B, SMI in the

CAFM system. The intermediary enters data in both HI and SMI data screens (Exhibits 5

and 6). The carrier enters data in only the SMI data screens (Exhibit 6).

The data for each of these reports are essentially the same.

The contractor reports the CNC accounts receivable activity for FYTD for the period of

the report. In order to facilitate reconciliation, balancing and error resolution, it reports

the CNC accounts receivable in dollars and cents.

The reports require information both for the amount and the number of accounts

receivable. To provide standardization, CMS suggests the contractor use its collection

process as a guide when reporting the number of accounts receivable. For example, a

separate, stand alone accounts receivable collected would be reported as a quantity in the

number column.

Once the principal number is established, the contractor reports the interest associated

with the principal amount in the same manner. There can be a difference between the

principal number and the interest number because some receivables are not subject to

interest.

290 - Due Date - (Rev. 5, 08-30-02)

A1-1931, A1-1951, B1-4931, B1-4951

This report is due on January 21, April 21, July 21, October 21 (21 days after the end of

each quarter) via the CAFM system. If that date occurs on a holiday or a weekend, the

report is due the following Federal workday.

300 - Certification - (Rev. 5, 08-30-02)

A1-1932, A1-1952, B1-4932, B1-4952

Medicare contractor certification by the CFO is required. The CFO must input their

password on the CAFM system (see Exhibit 16). Failure to record the official's password

is a serious error that will prevent acceptance of the report by the CAFM system. The

following statement appears at the end of the Form CMS-C751A/B (as well as the Form

CMS-MC751A/B):

I hereby CERTIFY that I have examined the Status of Non-MSP Debt - CNC prepared by

name of contractor for the period beginning (first day of FY) and ending (last day of

quarter), and that to the best of my knowledge and belief, it is a true, correct and

complete statement prepared from the books and records of the contractor in accordance

with applicable instructions.

NAME _____________________ DATE _______ TITLE _________

NOTE: In the above statement, "MSP" replaces "Non-MSP" for the MSP report.

310 - Line Item Instructions Form CMS-C751A/B - Non-MSP and Form

CMS-MC751A/B - MSP - (Rev. 5, 08-30-02)

A1-1933, A1-1953, B1-4933, B1-4953

The following instructions are to be used by Medicare contractors to report the status of

Non-MSP or MSP, as applicable, CNC debt. Medicare contractors must develop and

maintain transaction level detail (at a minimum, this would include the provider name,

provider number, date of determination, outstanding balance, and any adjustments or

recoupments) by debt to support the amounts reported for each line outlined below (see

Exhibits 5 and 6). Medicare contractors must reclassify MSP or Non-MSP debt as CNC

in accordance with CMS policy (see Exhibit 19 and Exhibit 20).

Within this subset of instructions, the designation "MSP" or "Non-MSP" is implied,

depending on which report is being submitted, MSP or Non-MSP.

Section A - CNC Debt