CMS Pub. 100-06, ch. 7, § 50.12

L – Control

Number

Control Objective – Non-MSP Debt Collection

L.1 All overpayments that meet the applicable threshold should be

demanded. Demand letters initiate the collection of a provider debt

as well as inform the provider of the existence of the debt, their

appeal rights with respect to the debt, and the ramifications if the

debt is not paid or an ERS agreement is not reached within a

specified time period in accordance with CMS instructions. The

content of manually created demand letters are reviewed and

approved according to CMS guidelines. The demand letter shall be

issued, printed mailed timely, and maintained, in accordance with

CMS instructions at Pub 100-06, chapters 3 and 4.

L.2 Extended Repayment Schedules (ERSs) shall be analyzed for

approval or denial by a supervisor in accordance with CMS

instructions. The supervisor’s review includes monitoring all

approved ERSs, the complete financial analysis of the provider’s

application, compliance with the ERS, and the referral to CMS

when necessary in accordance with CMS instructions at Pub 100-

06, Chapters 3 and 4.

L.3 Interest is calculated and applied correctly and timely in accordance

with CMS instructions at Publication 100-06, Chapters 3 and 4. The

interest rate is updated in accordance with the notice of the new

interest rate for Medicare Overpayments and Underpayments

notification. Interest changes are updated in all applicable systems.

L.4 Bankruptcy cases are handled in accordance with CMS instructions

and instructions given by the Office of General Counsel (OGC). An

audit trail of the overpayment shall exist before and after the

bankruptcy filing to ensure that Medicare’s best interest can be

represented by OGC. Contractors shall maintain, track, and update

the status of a bankruptcy in accordance with CMS instructions at

Pub 100-06, Chapters 3 and 4.

L.5 Provider debt is collected timely, completely, and accurately with

an appropriate audit trail of all collection activity and attempts of

collection activity in accordance with CMS instructions at Pub 100-

06, Chapters 3 and 4.

L.6 Control number L.6 reserved. Control not in use as of IOM revision

number 214.

L.7 Timely review and processing of all 838 Credit Balance Reports.

Ensure that all reported credit balances are collected and properly

processed in accordance with CMS instructions in accordance with

CMS instructions at Pub 100-06, Chapter 12.

L – Control

Number

Control Objective – Non-MSP Debt Collection

L.8 For overpayments subject to the limitation on recoupment under the

Medicare Modernization Act (MMA), recoupment is stopped within

the set timeframes for the receipt of requests filed for the

redetermination and reconsideration levels of appeal. Once both

levels of appeal are completed and CMS prevails, collection

activities, including revised demand letters and internal recoupment

may resume within the timeframes set forth in accordance with 42

CFR section 405.379 and Publication 100-06 Chapter 3, Section

200.

L.9 Contractors shall calculate the 935 interest on favorable and/or

partially favorable decisions determined by the ALJ and subsequent

appeal levels. The calculations shall be completed within the set

timeframes on the recouped amounts that were applied to the

principal balance only. Voluntary payments are excluded for

purposes of the calculation of 935 interest. After the amount is

calculated, the Contractor shall issue a refund check to the provider.

Contractors shall update, track, and maintain the appeal status on

overpayments in the applicable systems in accordance with 42 CFR

section 405.379 and Publication 100-06 Chapter 3, Section 200.

End Section 50.12 – L Controls – Non-MSP Debt Collection: Back to Table of Contents