CMS Pub. 100-06, ch. 5, § 400.8

See Exhibit 3, above.

400.9 - Exhibit 9 - Status of MSP Debt - CNC - HI - (Rev. 5, 08-30-02)

See Exhibit 5 – Status of Non-MSP Debt – CNC – HI.

400.10 - Exhibit 10 - Status of MSP Debt - CNC - SMI - (Rev. 5, 08-30-02)

See Exhibit 5 – Status of Non MSP Debt – CNC –SMI.

400.11 - Exhibit 11 - Medicare Contractor Account Definitions - Data Element

Definitions - (Rev. 5, 08-30-02)

Medicare Contractor Account Definitions

Data Element Definitions

Account Number Title

1000 Assets

1100 Cash

1100.01 Part A and Part B

1100.01.01 Benefit Account

1100.01.02 Time Account

1110 Undeposited Collections

Medicare Contractor Account Definitions

Data Element Definitions

Account Number Title

1110.01 Part A and Part B

1110.01.01 Undeposited Collections

1310 Accounts Receivable

1310.01 Part A and Part B

1310.01.01 Non-MSP Overpayments

1310.01.01.01 Provider

1310.01.01.01.01 Cost Report Settlements (FI)

1310.01.01.01.02 Claims Accounts Receivable (FI)

1310.01.01.01.03 PIP Accrual (FI)

1310.01.01.01.04 Credit Balance (FI)

1310.01.01.01.05 Other (FI)

1310.01.01.02 Beneficiaries

1310.01.01.03 Physicians/Suppliers

1310.01.04 Medicare Secondary Payer (MSP)

1310.01.04.01 Group Health Plan

1310.01.04.01.01 Data Match

1310.01.04.01.02 Non-Data Match

1310.01.04.02 Liability MSP

1310.01.04.02.01 MSP Beneficiary

1310.01.04.02.02 MSP Provider/Physician Supplier

1310.01.04.03 Other MSP

1310.01.99 Other

1311 Advances to Others

1311.01 Part A and Part B

1311.01.01 Advance Payments

1311.01.02 Accelerated Payments

1330 Interest Receivable

1330.01 Part A and Part B

1990 Other Assets

1990.01 Part A and Part B

2000 Liabilities

2110 Accounts Payable

2110.01 Part A and Part B

2110.01.01 Unprocessed Claims

2110.01.02 Benefits Payable

2110.01.02.01 Provider

2110.01.02.01.01 -PIP Provider Cost Report Settlements

2110.01.02.01.02 -PIP Provider Estimated Payable Accrual

Medicare Contractor Account Definitions

Data Element Definitions

Account Number Title

2110.01.02.01.03 -Non-PIP Provider Underpayments Interim Rate

2110.01.02.01.04 -Non-PIP Provider Underpayments (Cost Report Settlement)

2110.01.02.01.05 Claims Withheld for Non-receipt of Cost Reports

2110.01.02.02 Beneficiaries

2110.01.02.03 Physicians/Suppliers

2110.01.02.04 Claims on the Payment Floor

2110.01.03 Suspended Payments

2110.01.03.01 Claims

2110.01.03.02 Common Working File (CWF)

2110.01.03.03 MR/UR Prepayment Review

2110.01.03.0 Medicare Secondary Payer (MSP)

2140 Accrued Interest Payable

2140.01 Part A and Part B

2990 Other Liabilities

2990.01 Part A and Part B

2990.01.01 Unapplied Receipts

2990.01.02 Excess Recoupments

2990.01.03 Due Medicaid

2990.01.04 Other

3010 Fund Account Balance

3310 Cumulative Results of Operations

3310.01 Part A and Part B

5000 Revenue

5303 Interest Revenue

5303.01 Part A and Part B

5303.01.01 Adjustments/Waivers (Contra Account)

5303.01.02 Write-off Closed/Transfers

5303.01.02.01 Bad Debt (Contra Account)

5303.01.02.02 Transfers Out to Other CMS Locations (Contra Account)

5303.01.02.02.01 Transfers In from Other CMS Locations

5303.01.02.03 Transfers Out to CNC (Contra Account)

5303.01.02.03.01 Transfers In from CNC

5303.01.02.04 Transfers Out to Other Medicare Contractors (Contra Account)

5303.01.02.04.01 Transfers In from Other Medicare Contractors

5700 Appropriated Capital Used

5700.01 Part A and Part B, Draws on Letter of Credit

5900 Other Revenue

Medicare Contractor Account Definitions

Data Element Definitions

Account Number Title

5900.01 Part A and Part B

5900.01.01 Other

6000 Expense

6100 Operating/Program Expense

6100.01 Part A and Part B

6101 Waivers

6101.01 Part A and Part B

6101.01.02 Transfers Out to Other CMS Locations (Contra Account)

6101.01.02.01 Transfers In from Other CMS Locations

6101.01.03 Transfers Out to CNC (Contra Account)

6101.01.03.01 Transfers In from CNC

6101.01.04 Transfers Out to Other Medicare Contractors (Contra Account)

6101.01.04.01 Transfers In from Other Medicare Contractors

6106 Write Offs/Transfers

6106.01 Part A and Part B

6106.01.01 Bad Debts

6330 Interest Expense

6330.01 Part A and Part B

6330.01.01 CPT Interest

6330.01.02 Other Interest

6909 Other Expense

6909.01 Part A and Part B

7400 Prior Period Adjustments

7400.01 Part A and Part B

Medicare Contractor Account Definitions

Data Element Definitions

The account numbers used in this chart are for reference purposes only. They are not mandated for use by

Medicare contractors.

Account Number Title

1000 Assets

The contractor reports amounts of physical items or rights to ownership

1100 Cash

The contractor reports monetary resources on hand or on deposit with banks or

other financial institutions. Balances are the end of quarter amounts per the

contractor's books.

Account Number Title

1100.01 Part A and Part B

The contractor reports cash allocable for Hospital Insurance (HI) and

Supplementary Medical Insurance (SMI) activities. HI data must reconcile to

Column E, Line 1, on Form CMS-1522, Monthly Contractor Financial Report.

SMI data must reconcile to Column E, Line 2. Prorate the Time Account by the

number of checks and electronic funds transfers (EFTs) issued for HI or SMI

services. (See Exhibit 15 Protocol for Prorating Intermediary Time Account

Balances between HI and SMI.)

1100.01.01 Benefits Account

The contractor reports the Federal Health Insurance Benefits Account by HI and

SMI

1100.01.02 Time Account

The contractor reports the balance as of the end of the quarter in the Federal

Health Insurance Time Account by HI and SMI.

1110 Undeposited Collections

1110.01 Part A and Part B

The contractor reports undeposited collections for HI and SMI activities

1110.01.03 Undeposited Collections

The contractor reports collections on hand not deposited within the accounting

period. Undeposited collections include those items received by the last day of

the quarter that will be deposited during the subsequent quarter. The contractor

prorates undeposited collections on the basis of Column D, Funds Expended, on

Form CMS-1522, Monthly Contractor Financial Report for Part A (HI) and Part

B (SMI). Report deposits in transit as part of the book balance for either

1100.01.01, Benefits Account, or 1100.01.02, Time Account. It reports amounts

due from others. A receivable is the identification of an overpayment for services

rendered. CMS will only recognize receivables related to Fraud and Abuse once

they are litigated by the Department of Justice (DOJ)

1310.01.01 Overpayments

The contractor accounts receivable for overpayments. It includes amounts that

exceed adjudicated claims processed, cost reports settled, or other authorized

payments. This includes, but is not limited to, overpayments resulting from

adjustment bills. It reclassifies any overpayment when Medicare is deemed as

secondary payer to 1310.01.04, MSP

1310.01.01.01 Provider

The intermediary reports overpayments for institutional providers. This includes,

but is not limited to, those items listed on the Provider Overpayment Report

(POR) and the Credit Balance Summary Report. Include periodic interim

payments (PIP) in excess of PIP bills. Include overpayments resulting from the

receipt of cost reports, tentative settlements or cost settlements when the Notices

of Provider Reimbursement (NPR) are prepared. It includes overpayments from

PRRB settlements when the Notices of Correction (NOC) are prepared. This is

not a carrier function.

1310.01.01.01.01 Cost Report Settlements

Account Number Title

The intermediary reports the accounts receivable as a result of cost report

settlements, interim rate reviews and overpayments as a result of accelerated

payments

1310.01.01.01.02 Claims Accounts Receivable

The intermediary reports the accounts receivable as a result of claims accounts

receivable. This is not a carrier function.

1310.01.01.01.03 PIP Accrual

The intermediary reports the amount accrued for the (estimated) accounts

receivable PIP. (See Exhibit 13 Protocol for Estimating Payables and Receivables

for PIP). This is not a carrier function.

1310.01.01.01.04 Credit Balances

The intermediary reports the accounts receivable as a result of credit balance

reports This is not a carrier function.

1310.01.01.02 Beneficiaries

The contractor reports overpayments for beneficiaries. This includes, but is not

limited to, those items listed on the CMS-2174, Carrier Beneficiary Overpayment

Activity Report.

1310.01.01.03 Physicians/Suppliers

The carrier reports overpayments for physicians and suppliers. This includes, but

is not limited to, those items listed on the Physician/Supplier Overpayment

Report (PSOR) This is not an intermediary function.

1310.01.04 Medicare Secondary Payer

The contractor reports accounts receivable for amounts due as a result of MSP

activity, and based on documented debts due Medicare for all debtors. Debtors

are employers, insurers, providers, beneficiaries or other persons to whom a

demand letter has been issued

1310.01.04.01 Group Health Plan (GHP)

1310.01.04.01.01 Data Match (FI)

The contractor includes the amounts identified (CMS supplied receivables via

tapes with an identified report ID on MPaRTS) as a result of MSP activity for

which a demand letter has been issued for IRS/SSA Data Match cases.

Outstanding receivables are the amount of debt that has been demanded and

payment has not yet been received

1310.01.04.01.02 Non-Data Match (FI)

The contractor includes the amounts identified (debt specific to GHP debt,

working aged, disability, End-Stage Renal Disease (ESRD) as a result of MSP

activity for which a demand letter has been issued. Outstanding receivables are

the amount of debt that has been demanded and payment has not yet been

received

1310.01.04.02 Liability MSP

The contractor includes the amounts (inclusive of all workman's compensation,

automobile/no fault and liability debt, this includes CMS identified cases) due to

Account Number Title

MSP activity for which a settlement has been reached related to liability cases.

Outstanding receivables are the amount of debts that have been demanded,

subsequent to settlement and/or other action, and payment has not yet been

received.

1310.01.04.02.01 MSP Beneficiaries

1310.01.04.02.02

MSP Providers/Physicians/Suppliers Outstanding receivables are the amount of

MSP initiated debts that have been demanded and payment has not yet been

received.

1310.01.04.03 Other MSP

The contractor includes the amounts due as a result of other MSP activity for

which a valid MSP debt has been recognized.

1310.01.99 Other

The contractor reports actual or estimated other accounts receivable. It includes

those receivables not otherwise classified in the categories presented above. It

provides an identifying footnote on CAFM of the nature of this receivable

1311 Advances to Others

The contractor reports payments made to providers, physicians, or suppliers in

anticipation of claims being processed. Advances are not to be considered as

accounts receivable. It does not include them on Form CMS-751A/B, Status of

Account Receivable report

1311.01 Part A and Part B

The contractor reports advance payments and accelerated payments attributable to

HI and SMI activities

1311.01.01 Advance Payments

The contractor the outstanding balance for payments authorized by CMS

instructions for advanced payments based on actual provider claims data. If not

recovered according to CMS instructions, it reclassifies and reports as

overpayments

1311.01.02 Accelerated Payments (FI)

The intermediary reports the outstanding balance for payments authorized by

CMS instructions for accelerated payments based on actual provider claims data.

If not recovered according to CMS instructions, it reclassifies and reports as

overpayments This is not a carrier function.

1330 Interest Receivable

The contractor reports interest receivable on accounts receivable. It accrues

interest through the last day of the reporting period.

1330.01 Part A and Part B

The contractor reports HI and SMI interest receivable on accounts receivable,

including extended repayment plans

1990 Other Assets

Account Number Title

The contractor reports assets that are not otherwise classified. It provides an

identifying footnote in the remarks section of Form CMS-750A/B report.

1990.01 Part A and Part B

The contractor reports HI and SMI unclassified assets.

2000 Liabilities

The contractor reports amounts owed after processing Medicare claims and

related activities

2110

Accounts Payable Report amounts owed after processing Medicare claims or

other authorized expenditures. This includes, but is not limited to, underpayments

resulting from adjustment bills

2110.01 Part A and Part B

The contractor reports accounts payable attributable to HI and SMI activities

2110.01.01 Unprocessed Claims

The contractor reports the value of the accounts payable for unprocessed claims

received in-house that have not yet started processing. The actual value may be

developed after the reporting period but before the required date for reporting. It

uses the 30 day rolling average for the number of claims received and not

processed to determine the number of average unprocessed claims.

2110.01.02 Benefits Payable

The contractor reports accounts payable for those claims that have completed

processing checks, but have not yet been issued nor offsets applied. This includes,

but is not limited to, underpayments resulting from adjustment bills. It includes

claims approved by the Common Working File (CWF) and claims not approved

by the CWF, but approved by the RO for payment outside the CWF.

2110.01.02.01 Provider

The intermediary reports benefits payable to institutional providers of Medicare

services. This includes, but is not limited to the following: accounts receivable

accrual where the periodic interim payment (PIP) bills is in excess of periodic

interim payments (PIP); underpayments from receipt of accepted cost reports,

tentative settlements and final cost settlements, when Notices of Provider

Reimbursement (NPR) are prepared; and underpayments for PRRB settlements,

when Notices of Correction (NOC) are prepared, etc This is not a carrier function.

2110.01.02.01.01 PIP Providers - Cost Report Settlements

The intermediary reports benefits payable to PIP providers as a result of Cost

Report Settlements This is not a carrier function.

2110.01.02.01.02 PIP Providers - Estimated Payable Accrued

The intermediary reports the amount accrued for the (estimated) accounts payable

PIP. (See Exhibit 13 Protocol for Estimating Payables and Receivables for PIP).

This is not a carrier function.

2110.01.02.01.03 Non-PIP Providers - Underpayments (Interim Rate)

The intermediary reports benefits payable to Non-PIP providers as a result of

Interim Rate Reviews This is not a carrier function

Account Number Title

2110.01.02.01.04 Non-PIP Providers - Underpayments (Cost Report Settlement)

The intermediary reports benefits payable to Non-PIP providers as a result of

Cost Report Settlements This is not a carrier function.

2110.01.02.01.05 Claims Payments Withheld for Non-receipt of Cost Reports

The intermediary reports benefits payable for claims withheld for payment for

non-receipt of provider cost reports This is not a carrier function.

2110.01.02.02 Beneficiaries

The contractor reports benefits payable to beneficiaries for reimbursement for

Medicare services.

2110.01.02.03 Physicians/Suppliers

The carrier reports benefits payable to physicians or suppliers of Medicare

services. This includes, but is not limited to, underpayments of quarterly Health

Professional Shortage Area (HPSA) bonus amounts for which a check has not

been issued. Not an intermediary function.

2110.01.02.04 Claims on the Payment Floor Adjudicated claims not yet paid

2110.01.03 Suspended Payments

The contractor reports actual or estimated benefits payable for claims that were

suspended from payment to allow for additional processing.

2110.01.03.01 Claims

The contractor reports estimated benefits payable for claims needing additional

information or further development, including CWF rejects and adjustments

210.01.03.02 Common Working File (CWF)

The contractor reports benefits payable for claims that are pending submission or

were submitted to the CWF for approval.

2110.01.03.03 MR/UR Prepayment Review

The contractor reports estimated benefits payable, based on a developed rate,

suspended for MR/UR before payment. The payables after MR/UR are in

2110.01.02, Benefits Payable

2110.01.03.04 Medicare as Secondary Payer (MSP)

The contractor reports benefits payable that are suspended for investigation of

third party liability for MSP prior to payment

2140 Accrued Interest Payable

The contractor reports actual or estimated interest payable on Medicare liabilities

through the end of the reporting period including, but not limited to, pending

claims, court settlements, claims payment timeliness (CPT), etc.

2140.01 Part A and Part B

The contractor reports HI and SMI interest payable on Medicare liabilities

Account Number Title

2990 Other Liabilities

The contractor reports liabilities not otherwise classified. It provides an

identifying footnote in the remarks section of Form CMS-750A/B report.

2990.01 Part A and Part B

The contractor reports other liabilities attributable to HI and SMI activities.

2990.01.01 Unapplied Receipts

The contractor reports amounts deposited and not yet applied to an accounts

receivable.

2990.01.02 Excess Recoupments

The contractor reports amounts recovered from overpayments or from other

sources in excess of receivables established and which are eligible for refund. It

includes those payables identified as due to third party liability payers, e.g.,

excess recoupment of MSP recoveries being returned to the third party.

2990.01.03 Due Medicaid

The contractor reports Medicare claims reimbursements withheld based on RO

instructions for payment to Medicaid.

2990.01.99 Other

The contractor reports actual or estimated amounts payable not otherwise

classified. These include, but are not limited to, claims payments withheld to

satisfy Internal Revenue Service liens, court liens, unidentified receipts that have

not been applied to an account receivable. It provides an identifying footnote in

CAFM.

3010 Fund Balance Fund balance reflects the cumulative results of program operations

and extraordinary items. It equals the difference between assets and liabilities.

3310 Cumulative Results of Operations

These accounts track the net difference between income and expense activity as

reported on the Statement of Operations. This account is updated with the current

year-to-date net results of operations

3310.01 Part A and Part B

The contractor reports HI and SMI interest revenue from accounts receivable. It

includes current fiscal period earned interest, and any adjustments. It also

includes accrued interest in account 1330, Interest Receivable

5000 Revenue and Other Financing Sources

The contractor reports the amount of income from Medicare activities. Typical

sources are draws on letter of credit, interest and recoveries of amounts expended

in prior periods.

5303 Interest Revenue

The contractor reports interest earned from accounts receivable.

5303.01 Part A and Part B

Account Number Title

The contractor reports HI and SMI interest revenue from accounts receivable.

Include current fiscal period earned interest, and any adjustments. This will also

include accrued interest in account 1330, Interest Receivable.

5303.01.01 Adjustments/Waivers (Interest)

The contractor reports the reduction of the amounts of interest receivable based

on Collections on Delinquent Debt in accordance with §§1862(b) and 1870(c) of

the Social Security Act. It reconciles this with Form CMS-751A/B, Status of

Accounts Receivable, Line 5h, Waivers (Interest).

5303.01.02 Write-offs Closed/Transfers (Interest)

The contractor reports interest receivable for which collection efforts have been

abandoned or that have been transferred to another Medicare contractor or other

CMS location. These accounts must be reconciled with the receiving Medicare

contractor or other CMS location.

5303.01.02.01 Amounts Written-Off Closed (Bad Debts) (Interest)

The contractor reports interest receivables for which collection is no longer being

pursued according to CMS regulations. It reconciles this with Form CMS-

751A/B, Status of Accounts Receivable, Line 6a, Amounts Written-off Closed

(Bad Debts).

5303.01.02.02 Transfers Out to other CMS Locations (POR/PSOR & Not POR/PSOR)

(Interest). POR not applicable to carriers.

The contractor reports interest receivable transferred to other CMS locations.

Reconcile with Form CMS-751A/B, Status of Accounts Receivable, Line 5e,

Transfers Out to Other CMS Locations, POR/PSOR, (interest) and Line 5g,

Transfers Out to Other CMS Locations, Not POR/PSOR, (interest). POR not

applicable to carriers.

5303.01.02.02.01 Transfers In from other CMS Locations (POR/PSOR & Not POR/PSOR)

(Interest). POR not applicable to carriers.

The contractor reports interest receivable that has been transferred to your

location from other CMS locations in the current period. It reconciles this with

Form CMS-751 A/B, Status of Accounts Receivable, Line 5d, Transfers In from

Other CMS Locations, POR, (interest), and Line 5f, Transfers In from Other

CMS Locations, Not POR, (interest). POR not applicable to carriers.

5303.01.02.03 Transfers Out to CNC (Interest)

The contractor reports interest receivable transferred to CNC in accordance with

CMS regulations. It transfers the full amount of interest due on the debt. It

reconciles this with Form CMS-C751, Status of Non-MSP Debt - CNC, Line 2,

New CNC A/R (interest) and Line 6c, Transfers Out to CNC

5303.01.02.03.01 Transfers In from CNC (Interest)

The contractor reports interest receivable that has been transferred in to its

location from CNC.

5303.01.02.04 Transfers Out to other Medicare Contractors (Interest)

The contractor reports interest receivable transferred to other Medicare

contractors. Reconcile with Form CMS-751A/B, Status of Accounts Receivable,

Line 5c, Transfers Out to Other Medicare Contractors.

Account Number Title

5303.01.02.04.01 Transfers in from other Medicare Contractors (Interest)

The contractor reports interest receivable transferred to your location from other

Medicare contractors. It reconciles this with Form CMS-751A/B Status of

Accounts Receivable, Line 5b, Transfers In from Other Medicare Contractors

(Interest)

5700 Appropriated Capital Used

The contractor reports the amount of Medicare funds drawn to be matched against

current period expense. This amount must be consistent with amounts reported on

Form CMS-1521, Contractor Draws on Letter of Credit, and on Form CMS-1522,

Monthly Contractor Financial Report. The contractor does not include

administrative draws through the Payment Management System (PMS),

(Smartlink)

5700.01 Part A and Part B, Draws on Letter-of-Credit

5900 Other Revenue

The contractor reports revenue not otherwise classified. It provides identifying

footnote(s) in the remarks section of Form CMS-750 A/R report

5900.01 Part A and Part B

The contractor reports HI and SMI other revenue

5900.01.01 Other

The contractor reports revenue not otherwise classified

6000 Expense

The contractor reports the outflow of assets or incurrence of liabilities during a

period resulting from rendering Medicare services.

6100 Operating/Program Expense

The contractor reports net benefits costs incurred throughout the FY. The expense

is the adjusted benefits outlay in cash or its equivalent and accrued liabilities

incurred in carrying out the Medicare program. This includes, but is not limited

to, adjustments for MSP recoveries, reconsiderations, and pending litigation.

6100.01 Part A and Part B

The contractor reports HI and SMI benefit program expense.

6101 Waivers (Principal)

The contractor reports HI and SMI waiver expense.

6101.01 Part A and Part B

The contractor reports the reduction of the amounts receivable based on

application of §§1862(b) and 1870(c) of the Social Security Act. It reconciles this

with Form CMS-751A/B, Status of Accounts Receivable, Line 5h, Waivers.

6101.01.02 Transfers Out to other CMS Locations (Principal)

The contractor reports accounts receivable transferred to other CMS locations. It

reconciles this with Form CMS-751A/B, Status of Accounts Receivable, Line 5e,

Account Number Title

Transfers Out to Other CMS Locations, POR/PSOR and Line 5g, Transfers to

Other CMS Locations, Not POR/PSOR. POR not applicable to carriers.

6101.01.02.01 Transfers In from other CMS Locations (Principal)

The contractor reports accounts receivable amounts that have been transferred to

its location from other CMS locations in the current period. It reconciles this with

Form CMS-751 A/B, Status of Accounts Receivable, Line 5d, Transfers In from

Other CMS Locations, POR/PSOR (principal), and Line 5f, Transfers In from

Other CMS Locations, Not POR/PSOR (principal). POR not applicable to

carriers.

6101.01.03 Transfers Out to CNC (Principal)

The contractor reports accounts receivable amounts that have been transferred to

CNC in accordance with CMS regulations. . It reconciles this with Form CMS-C751A/B, Status of Non- MSP Debt - CNC, Line 2, New CNC A/R, and Line 6c

Transfers Out to CNC of Form CMS-751A/B, Status of Accounts Receivable

report. It transfers the full amount of principal due.

6101.01.03.01 Transfers In from CNC (Principal)

The contractor reports accounts receivable amounts that have been re-established

as an active accounts receivable. It reconciles this with Form CMS-751A/B,

Status of Accounts Receivable, Line 6b, Transfers In from CNC

6101.01.04 Transfers Out to other Medicare Contractors (Principal)

The contractor reports HI and SMI accounts receivable transferred out to a

Medicare contractor for collection. It reconciles this with Form CMS-751A/B,

Status of Accounts Receivable, Line 5c, Transfers to Other Medicare Contractors.

6101.01.04.01 Transfers In from other Medicare Contractors (Principal)

The contractor reports HI and SMI accounts receivable transferred to your

location from other Medicare contractors. It reconciles this with Form CMS-751

A/B, Status of Accounts Receivable, Line 5b, Transfers In from Other Medicare

Contractors.

6106 Write-offs Closed/Transfers (Principal)

The contractor reports accounts receivable for which collection efforts have been

abandoned, or that have been transferred to another Medicare contractor or other

CMS location. These accounts must be reconciled with the receiving Medicare

contractor or other CMS location.

6106.01 Part A and Part B

The contractor reports HI and SMI accounts receivable written off or transferred.

6106.01.01 Amounts Written-Off Closed (Bad Debts) (Principal)

The contractor reports receivables for which collection is no longer being pursued

according to CMS rules. It reconciles this with Form CMS-751A/B, Status of

Accounts Receivable, Line 6a, Amounts Written-off Closed (Bad Debts).

6330 Interest Expense

The contractor reports interest expense incurred for claims for Medicare benefits

or accounts payable.

Account Number Title

6330.01 Part A and Part B

The contractor reports HI and SMI interest expense.

6330.01.01 Claims Payment Timeliness (CPT) Interest

The contractor reports interest paid for claims that failed the claims payment

timeliness (CPT) requirement. It reconciles this with Form CMS-1522, interest

paid, claims timeliness.

6330.01.02 Other Interest

The contractor reports interest for other late payments. It reconciles this with

Form CMS-1522, interest paid, provider underpayments.

6909 Other Expense

The contractor reports benefit expenses not reported in named categories or

otherwise classified. It provides an identifying footnote in the remarks section of

Form CMS-750A/B report.

6909.01 Part A and Part B

The contractor reports HI and SMI unclassified benefit expenses.

7400 Prior Period Adjustments

The contractor reports adjustments for prior period activity to restate assets,

liabilities, etc. It provides an identifying footnote in the remarks section of Form

CMS-750 report.

7400.01 Part A and Part B

The contractor reports HI and SMI prior period adjustments.

400.12 - Exhibit 12 - Accounts Payable - Protocol for Estimating Claims - Form CMS-H750A/B, Statement of Financial Position - (Rev. 5, 08-30-02)

A1-1960.12, B1-4960.12

Accounts Payable Protocol for Estimating Claims

Form CMS-H750A/B, Statement of Financial Position

The amounts recorded in accounts payable (A/P) may be estimated based on actual volumes and historical

rates; therefore, the FI or carrier calculates and accrues a new estimated liability each reporting period and

reverses the accrual for the previous period in full. It charges the expense accounts, rather than the A/P, as

actual payments are made.

INTERMEDIARY PROCEDURES

Methodology for Calculating Average Reimbursement Amount and Average Interest for Pricing Claim

Liabilities

To assign an estimated value to claims for which the amount to be paid is unknown, the contractor counts

claims and multiplies the total by the average reimbursement amount (net of interest) and an average interest

amount (CPT), if applicable, determined as follows:

The intermediary calculates the average reimbursement amount by taking a representative sample of the

most recent 12 months of paid claims history. It totals the reimbursement amount minus interest and divides

by the total number of claims processed. It calculates the Claims Payment Timelines (CPT) by adding the

interest from the same claims and divides by the total number of claims (not just those bearing interest).

The intermediary performs these calculations by bill types and will be segregated between Part A and Part

B. (See Intermediary Manual, Part 3, §3894.3.)

GENERAL PROCEDURES

These methods may be used to assign an estimated value to claims in the following categories:

1. In-house, unprocessed claims; and

MR/UR

PRO

2. Claims suspended for prepayment review

Claims

MR/UR

PRO

400.13 - Exhibit 13 - Periodic Interim Payments (PIP) Protocol for Estimating

Payables/Receivables for the Forms CMS-H750/751A/B, Statement of Financial

Position and Status of Accounts Receivable Report (Intermediaries Only) - (Rev. 5, 08-

30-02)

A1-1960.13, B1-4960.13

Periodic Interim Payments (PIP)

Protocol for Estimating Payables/Receivables for the Form CMS-H750/H751A/B, Statement of Financial

Position and Status of Accounts Receivable Reports

It is necessary to report on Form CMS-H750, a cumulative estimated accounts receivable or payable for all

fiscal periods since the provider's last accepted cost report period. To estimate this amount, the intermediary

performs the following steps:

1. It determines the total amount for PIP bills processed for the fiscal period less outlier amounts;

2. It compares the PIP bills amount to the actual PIP cash payment and lump sum payments (checks

issued) made during the fiscal period. This does not include any outlier payments that may have been

issued on the same check with the PIP;

3. It reports the amount that PIP bills exceed the PIP cash payment as an account payable; and

4. It reports the amount that PIP cash payment exceeds the PIP bills as an account receivable.

For example: If the provider's FY ends on December 31, then the cost report should be received and

accepted before the June 30 reporting period. The following demonstrates how the PIP accumulations would

be reported for this provider.

Period Ending Reporting

December 31 Assuming all prior year cost reports have been accepted, the only

entry on the books for this provider would be the estimated accounts

receivable or accounts payable after comparing PIP payments to

claims submitted since January 1st to current.

March 31 Given the same assumption regarding prior cost reports, the PIP

estimate for this provider will include the entire prior FY for the

provider (January 1 - December 31) unless the cost report has been

filed and accepted, and the current FY for the provider (January 1-

March 31).

June 30 Given the same assumption regarding prior cost reports, assuming the

latest cost report has now been received and accepted and the

appropriate accounts receivable or accounts payable are booked, the

PIP estimated for this provider will now include only the current FY

for the provider (January 1- June 30).

Sept 30 Given the same assumption regarding prior cost reports, assuming the

latest cost report has now been received and accepted, the PIP

estimate for this provider will now include only the current FY for

the provider (January 1- September 30).