Department of Health & Human Services (DHHS) Centers for Medicare & Medicaid Services (CMS) Transmittal 198 Date: October 27, 2011

Transcription

1 anual ystem Pub edicare inancial anagement Department of ealth & uman ervices (D) enters for edicare & edicaid ervices () Transmittal 198 Date: October 27, 2011 hange equest 7311 UBJET: edicare inancial anagement anual, hapter 4 - Debts eturned to gency (T) by Treasury. UY O NGE: To update O hapter 4, section of Pub EETVE DTE: November 1, 2011 PLEENTTON DTE: November 28, 2011 Disclaimer for manual changes only: The revision date and transmittal number apply only to red italicized material. ny other material was previously published and remains unchanged. owever, if this revision contains a table of contents, you will receive the new/revised information only, and not the entire table of contents.. NGE N NUL NTUTON: (N/ if manual is not updated) =EVED, N=NEW, D=DELETED /N/D N N N N N PTE / ETON / UBETON / TTLE 4/Table of ontents 4/70.17/Debts eturned to gency (T) by the United tates Department of the Treasury (Treasury) 4/ /Debts T by Treasury Due to Bankruptcy (B) 4/ /Debts T By Treasury as Uncollectible (U) or Out of Business (N) 4/ /Debts T by Treasury as Dispute esponse not eceived Timely (X) 4/ /Debts T by Treasury as a iscellaneous Dispute, a anual T, omplaint or as ecall pproved (D) 4/ /Debts T by Treasury as paid in ull (P), atisfied Payment greement () or atisfied ompromise ()

2 . UNDNG: or iscal ntermediaries (s), egional ome ealth ntermediaries (s) and/or arriers: No additional funding will be provided by ; ontractor activities are to be carried out within their operating budgets. or edicare dministrative ontractors (s): The edicare dministrative ontractor is hereby advised that this constitutes technical direction as defined in your contract. does not construe this as a change to the tatement of Work. The contractor is not obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the ontracting Officer. f the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the ontracting Officer, in writing or by , and request formal directions regarding continued performance requirements. V. TTENT: Business equirements anual nstruction *Unless otherwise specified, the effective date is the date of service.

3 ttachment - Business equirements Pub Transmittal: 198 Date: October 27, 2011 hange equest: 7311 UBJET: edicare inancial anagement anual, hapter 4 Debts eturned to gency (T) by Treasury Effective Date: November 1, 2011 mplementation Date: November 28, GENEL NOTON. Background: hange equest () 6083, Transmittal 143, addressed various reasons the United tates Department of Treasury (Treasury) returns to agency (T) debts to the enters for edicare & edicaid ervices (). This will clarify some of the instructions in 6083 and provide additional instructions related to debts T by Treasury as uncollectible or out of business. ll other instructions in 6083 will remain the same. B. Policy: The Debt ollection mprovement ct of 1996 (D) requires ederal agencies to refer debt that is 180 days delinquent to the Treasury or a Treasury designated Debt ollection enter for cross servicing. The policy clarifies the process for recommending debts for Termination of ollection ction and Write- Off-losed (WO) in conjunction with (e).. BUNE EQUEENT TBLE Number equirement esponsibility (place an X in each applicable column) / D hared- ystem OTE B E aintainers The contractors are responsible for obtaining bankruptcy documentation for debts T for bankruptcy. f the contractors are unsuccessful in obtaining bankruptcy documentation through established procedures, including asking their O for assistance, then the contractors shall request bankruptcy documentation from Treasury. ontractors will request this information via to rosservicing.questions@fms.treas.gov. The subject line of the request shall be entitled, equest for Bankruptcy nformation The contractors shall consider whether all other appropriate actions to collect debts have been taken before recommending debts for WO (refer to Pub , edicare inancial anagement anual, chapter 4, section 70.17B). E X X X X X X X X X X V W

4 Number equirement esponsibility (place an X in each applicable column) / D hared- ystem OTE B E aintainers The contractors shall determine whether there have X X X X X been any collections on the debts within the past year f so, the contractors shall not recommend the debts X X X X X for WO and shall continue collection efforts The contractors shall determine if the debtors X X X X X submitted any edicare claims in the last 6 months f so, the contractors shall not recommend the debts X X X X X for WO and shall continue collection efforts The contractors shall determine if the debtors are X X X X X receiving edicaid funds f so, the contractors shall not recommend the debts X X X X X for WO and shall continue collection efforts The contractors shall contact the egional Office (O) to institute an offset against the debtors edicaid funds. X X X X X f applicable, the contractors shall determine if the X X X debtors have had a hange of Ownership (OW). (The new owner must have accepted the assignment of the provider agreement) f so, the contractors shall determine whether it X X X pursued collection from the new owner f contractors did not pursue collection from the new X X X owner, the contractors shall update all applicable records and follow normal collection procedures to collect from the new owner f the contractors did pursue collection from the new X X X owner, the contractors shall follow normal procedures to recommend the debts for WO f applicable, the contractors shall research to see if X X X they have any unsettled cost reports for the debtors before recommending debts for WO f so, the ontractors shall not recommend the debts X X X for WO The contractors shall await settlement of the cost X X X report to determine whether it results in an underpayment f the cost report results in an underpayment, the X X X contractors shall apply the underpayment to recover the debts f applicable, the contractors shall research to see if there are any outstanding unfiled cost reports less X X X E V W

5 Number equirement esponsibility (place an X in each applicable column) / D hared- ystem OTE B E aintainers than 1 year overdue f so, the contractors shall not recommend the debts for WO (repeat above & 7.1.3). X X X The contractors shall research to see if the debtors terminated from the edicare Program. X X X X X f applicable, the contractors shall check for X X X edicare funds that maybe in suspense due to an unfiled cost report f applicable, the contractors shall apply any X X X collections held in suspense to recover outstanding debts determined from an unfiled cost report f applicable, the contractors shall not recommend X X X outstanding debts for WO if there are cost reports subject to re-opening f so, the contractors shall wait until the expiration X X X of the reopening period has passed before recommending the debts for WO f a cost report reopening results in an underpayment, the contractors shall apply the underpayment to recoup all outstanding debts before releasing any funds. X X X The contractors shall not recommend outstanding X X X X X debts for WO if there are claims subject to reopening The contractors shall not recommend debts for X X X X X WO if the debtors have an active claims or cost report appeal pending The contractors shall not recommend debts for X X X X X WO if the debtors have an active fraud case The contractors shall forward the debt to the X X X X X appropriate Program afeguard ontractor or Zone Program ntegrity ontractor or the enters for Program ntegrity area that has the open fraud case The contractors shall submit a request to O X X X X X for debts in the U (eturn by Treasury as Uncollectible) status when making a recommendation for WO The contractors shall submit two separate reports for X X X X X U status debts in the Debt ollection ystem (D) The contractors shall submit one report for debts in U status with a principal balance of $500,000 or less. X X X X X E V W

6 Number equirement esponsibility (place an X in each applicable column) / D hared- ystem OTE B E aintainers The contractors shall submit another report for debts X X X X X in U status with a principal balance greater than $500, The contractors shall also submit two separate X X X X X reports for debts in N (eturn by Treasury as Out of Business) status in the D: The contractors shall submit one report for debts in X X X X X N status with a principal balance of $100,000 or less The contractors shall submit another report for debts X X X X X in N status with a principal balance greater than $100, The O will review the contractors X X X X X recommendation to WO debts The contractors shall submit one report for debts X X X X X with a principal balance greater than $25,000; they must have the concurrence of the egional Office of General ounsel (OG) The contractors shall submit debts with a principal X X X X X balance less than $25,000 in a separate report to the O for approval, since OG concurrence is not required The contractors shall include the ontractors X X X X X validation statement with each submission (ee Pub , chapter 4, section ) The contractors shall update the D using the codes X X X X X in Pub , chapter 4, section , The contractors shall analyze the payments received X X X X X and determine if they should issue a refund when the principal balance in the D and the contractors internal systems has a negative balance. (ee Pub , chapter 4, section ) The contractors shall follow procedures for applying X X X X X excess collections, if it is determined a refund is valid (ee Pub , chapter 4, section ) The contractors shall not change the status code if the X X X X X principal balance of the debts in D and in the contractors internal system is greater than $ The contractors shall follow normal procedures for all X X X X X other debts affected. (ee Pub , chapter 4, section 70.17) The contractors shall add a comment on the D comment screen reflecting any action taken, the date X X X X X E V W

7 Number equirement esponsibility (place an X in each applicable column) / D hared- ystem OTE B E aintainers of the T report in which the debts appear on and the financial statement reporting quarter in which the debts were closed. E V W. POVDE EDUTON TBLE Number equirement esponsibility (place an X in each applicable column) / D hared- ystem OTE B E aintainers None. E V W V. UPPOTNG NOTON ection : or any recommendations and supporting information associated with listed requirements, use the box below: N/ Use "hould" to denote a recommendation. X-ef equirement Number ecommendations or other supporting information: ection B: or all other recommendations and supporting information, use this space: N/ V. ONTT Pre-mplementation ontact(s): Gwendolyn Lennon, onica Potee, Post-mplementation ontact(s): ontact your ontracting Officer s Technical epresentative (OT) or ontractor anager, as applicable. V. UNDNG

8 ection : or iscal ntermediaries (s), egional ome ealth ntermediaries (s), and/or arriers: No additional funding will be provided by ; contractor activities are to be carried out within their operating budgets. ection B: or edicare dministrative ontractors (s): The edicare dministrative ontractor is hereby advised that this constitutes technical direction as defined in your contract. does not construe this as a change to the tatement of Work. The contractor is not obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the ontracting Officer. f the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the ontracting Officer, in writing or by , and request formal directions regarding continued performance requirements.

9 edicare inancial anagement hapter 4 - Debt ollection Table of ontents (ev. 198, ) Debts eturned to gency (T) by the United tates Department of the Treasury (Treasury) Debts T by Treasury due to Bankruptcy (B) Debts T by Treasury as Uncollectible (U) or Out of Business (N) Debts T by Treasury as Dispute esponse not eceived Timely (X) /Debts T by Treasury as a iscellaneous Dispute, a anual T, omplaint or as ecall pproved (D) /Debts T by Treasury as paid in ull (P), atisfied Payment greement () or atisfied ompromise ()

10 Debts eturned to gency (T) by the United tates Department of the Treasury (Treasury) (ev. 198, ssued: , Effective: , mplementation: ) During the collection process, Treasury either collects debts or makes a final determination as to the status of the debts. The Treasury returns to agency (T) debts to the enters for edicare & edicaid ervices () using the following reasons: n Bankruptcy Uncollectible Out of Business Dispute Timer Expired iscellaneous Dispute anual eturn to gency ecall pproved omplaint Paid in ull atisfied through Payment greement atisfied through ompromise The will send monthly reports of these debts to the edicare contractors (contractors) for final resolution. The reports will state the reasons Treasury T the debts. The has developed new status codes in the Debt ollection ystem (D) for each of the reasons the debts were T. The T reports, prepared by entral Office (O), will reflect the new status codes. f Treasury returns debts and the D already shows the debts in a recall status, the system will not update the status code. owever, the T reports will include the debts showing the existing D recall status codes and the reason for the Treasury T. The T reports are sent out in Excel format so the contractors may sort them as appropriate. The contractors shall address all debts on the T reports and forward the completed report to O within 30 days after receipt. The following sections will give a detailed description of the new status codes in D for debts T by Treasury: Debts T by Treasury due to Bankruptcy (B) (ev. 198, ssued: , Effective: , mplementation: ) Debts in bankruptcy status are ineligible for cross servicing. f debts, T by Treasury due to bankruptcy are already status code 2B (Bankruptcy) in D; the debts will still appear on the T report but the status code will not change. The changes the status code of debts, T by Treasury, in D to B (T Bankruptcy). The B status code indicates that these debts were T by Treasury due to bankruptcy. The contractor shall not make any further updates to the debts in D. The T debts, which appear on the monthly report, will remain in B status in D. The contractors are responsible for obtaining bankruptcy documentation to support the

11 bankruptcy status code listed on the T report. Once the contractors obtain the documentation, they shall update their internal records to reflect the appropriate code for bankruptcy. The contractors shall follow established procedures regarding debts in bankruptcy status. The contractors shall properly report the status of these debts in their quarterly financial reports to O. (ee Pub , chapter 3, section 140.) The Treasury no longer routinely sends bankruptcy documents to creditor agencies. Therefore, contractors shall follow established procedures, including contacting the egional Office (O), to obtain bankruptcy documentation. t is the contractor s responsibility to obtain the bankruptcy documentation. f the contractors cannot obtain bankruptcy documentation through established procedures, including asking the O for assistance, the contractors may contact Treasury to obtain documentation for T debts in bankruptcy. f the contractors are unable to obtain bankruptcy documentation through established procedures or through the assistance of the O, they shall request bankruptcy documentation from Treasury via to rosservicing.questions@fms.treas.gov. The subject line of the request shall be entitled, equest for Bankruptcy nformation. f the contractors do not receive a confirmation from Treasury within 2 business days of the request, the contractor shall re-send the or make another request to Treasury via fax number The contractors shall include the following information; the eddebt number, debtor name and the contractor s contact information on each request via or fax. f the egional Office of General ounsel (OG) advises the contractor that debts are not discharged in bankruptcy and are still eligible for referral, the contractor shall submit a new referral to Treasury. The contractors shall change the status code from B to 2 (T Debt eentered into D) and re-enter the debts into D as a new referral to Treasury. (ee Exhibit 4 of this section, the D User Guide, ection 2.1) The contractors shall not change the status code of a debt in B status back to status code UJ (ent to P for ross-ervicing). The contractors shall add a comment on the D comment screen reflecting any action taken, the date of the T report in which the debts appear on and the financial statement reporting quarter in which the debts were resolved Debts T by Treasury as Uncollectible (U) or Out of Business (N) (ev. 198, ssued: , Effective: , mplementation: ) f debts are T for one of the above reasons, will update the D with the new codes unless the D is already showing the debts in a recall status. The T report will reflect the recall status along with the reason for the T by Treasury. The contractors shall use the T report to research the debts in order to determine the current status or final disposition. The debts already in a recalled status are included so that the contractors will know that Treasury considers the debts uncollectible or out of business. The contractors shall determine whether collection by litigation is a viable option for debts showing a status code of U (T Uncollectible) or N (T Out of Business). f so, follow established procedures for referring the debts for litigation (ee Pub , chapter 3, section 120).

12 The contractors shall also consider whether all other appropriate actions to collect debts have been taken before recommending debts for Write-Off losed (WO), including the criteria listed below 1. ave there been any collections or payments on this debt in the last year? f so, and the contractor believes further collections are possible, the contractor shall not recommend the debt for WO, but shall continue collection efforts for P and Non-P debts. 2. as the debtor submitted any edicare claims in the last 6 months? f so, and the contractor believes further collections are possible, the contractor shall not recommend the debt for WO, but shall continue collections efforts. 3. s the debtor receiving edicaid funds? f so, the contractor shall not recommend the debt for WO. The contractor shall instead contact the O to institute an offset, and shall continue collection efforts. 4. f applicable, did the debtor undergo a hange of Ownership (OW) (a new owner who opts to receive automatic assignment of the old owner s provider agreement)? f so, the contractor shall determine if collection efforts were pursued from the new owner. (a) f so, the contractor shall recommend for WO (b) f not, the contractor shall follow the normal policies and procedures for debts collection. 5. f applicable, did the debtor file any cost reports that the contractor has not yet settled? f so, the contractor shall not recommend the debt for WO. nstead, the contractor shall await settlement of the cost report to determine whether it results in an underpayment. f it does result in an underpayment, the contractor shall apply any funds due to the provider to any outstanding debts first, before releasing any funds to the debtor 6. f applicable, does the debtor have any outstanding unfiled cost reports less than 1 year overdue? f so, the contractor shall not recommend the debt for WO. nstead, the contractor shall await filing and settlement of the cost report to determine whether it results in an underpayment. f it does result in an underpayment, the contractor shall apply any funds due to outstanding debts first, before releasing any funds. 7. f applicable, does the debtor have any funds in suspense due to an unfiled cost report? f so, and the provider has been terminated from the edicare Program, the contractor shall apply the funds in suspense to recover the debt or any other outstanding debts for the provider.

13 8. f applicable, does the debtor have any claims or cost reports subject to re-opening? f so, the contractor shall not recommend the debt for WO. nstead, the contractor shall wait until the expiration of the reopening period. f a cost report reopening during this period results in an underpayment, the contractor shall apply the underpayment to recover the debt or any other outstanding debts for the debtor, before releasing any funds. 9. Does the debtor have any open appeal(s)? f so, the contractor shall not recommend the debt for WO. nstead, the contractor shall await the final determination on the appeal(s), and apply any funds due from a favorable decision to any outstanding debts first, before releasing any funds. 10. Does the debtor have an active fraud case? f so, the contractor shall not recommend the debt for WO. nstead, the contractor shall forward the debt to the appropriate Program afeguard ontractor (P) or the Zone Program ntegrity ontractor (ZP) or enters for Program ntegrity that has the open fraud case. f the contractors have considered all of the above criteria above and are recommending the debts for WO, the contractors shall submit a request to the O for approval. The contractor shall submit two separate reports for debts in U status: 1) Debts in U status with a principal balance of $500,000 or less and 2) Debts in U status with a principal balance greater than $500,000. The contractor shall also submit two separate reports to the O for debts in N status: 1) Debts in N status with a principal balance of $100,000 or less and 2) Debts in N status with a principal balance greater than $100,000. The O will review the contractor s recommendation and proceed as follows: 1) ll debts with a principal balance greater than $25,000 must have the concurrence of the O OG before approval for WO by the O is granted and 2) ll debts with a principal balance less than $25,000 maybe approved by the O; these debts do not require OG concurrence to WO. The above criteria allow the contractors to confirm that all appropriate methods of collection were completed before recommending debts for WO. The contractors may use the suggested format or choose a similar format of their own to submit WO information. ny format used shall include the ontractor Validation statement below with each submission: ontractor Validation: We recommend these debts for termination of collection action, close out and write-offclosed. We considered all criteria in section in making this recommendation. Total debts recommend for Write-Off-losed: Number of Debts: Principal Balance: nterest Balance: ignature of edicare ontractor O: Date:

14 The Debts recommended for WO that do not meet the above criteria shall remain open until the criteria for WO has been met. The contractors shall report these debts on the appropriate line of the orms 751 or the Treasury eport on eceivables (TO) to indicate Treasury has T the debts but the WO process has not been completed. (ee Pub , chapter 4, section ) The contractors shall submit a report of the debts recommended for WO to the O using established procedures for recommending debts for WO. Once approves the debts for WO, the contractors shall complete the WO process and make all appropriate adjustments on orm 751 or the TO. The contractors shall update debts approved for WO to status code 2W (Non-P WO) in D. The contractors shall add a comment on the D comment screen reflecting the date of the T report in which the WO debts appear on and the financial statement reporting quarter in which the debts were closed Debts T by Treasury as Dispute esponse not eceived Timely (X) (ev. 198, ssued: , Effective: , mplementation: ) The Treasury returns debts with this status code because the dispute response was not received timely. The debts in this status will update to X (T - Dispute Timer Expired) in D, if the debt was still in a dispute status code or was updated to UJ or UX (Dispute esolved, Debt eturned for ross-ervicing). The contractor shall research and resolve the debts in X status in order to determine the current status of the debts. No further action is necessary if the debts are already in a recalled status. The contractors shall add a comment on the D comment screen reflecting any action taken, the date of the T report in which the debts appear on and the financial statement reporting quarter in which the debts were resolved. f the debts are still valid and eligible for referral to Treasury, the contractors shall re-enter debts as new entries in D, even if a response to the disputes were previously submitted to Treasury. The contractors shall not issue a second ntent to efer letter (L). owever, the contractors shall change the status code of the original debt in D from X to 2 (ee Exhibit 4 of this section, the D User Guide, ection 2.1). f the final determination indicates that the debts should be in recall status, the contractors shall update the original debts in D from X to the appropriate recall status code Debts T by Treasury as a iscellaneous Dispute, a anual T, omplaint or as ecall pproved (D) (ev. 198, ssued: , Effective: , mplementation: ) The updates the D to status code D if the debts are not already in a recalled status. The contractors shall research and resolve debts in status code D and update the D with the final disposition of the debts. f any debts are still valid and eligible for referral to Treasury, the contractors shall change the status code of the debts from D to 2 and re-enter the debts as new entries in the D to be resubmitted to Treasury. The contractors shall not issue a second ntent to efer letter (L) for the debts. (ee Exhibit 4 of this section, the D User Guide, ection 2.1). Lastly, the contractors shall add a comment on the D comment screen reflecting any action taken, the date of the T report in which the debts appear on and the financial statement reporting quarter in which the debts were resolved.

15 Debts T by Treasury as Paid in ull (P), atisfied Payment greement (P) or atisfied ompromise () (ev. 198, ssued: , Effective: , mplementation: ) The updates debts in the D to the above status codes unless the debts are already in a paid in full status. f the principal balance of the debts in D and in the contractor s internal systems are $100 or less, the contractors shall update the D status code from P to 2Q (ross-ervicing ollection Paid-in-ull) or to 2 (ross ervicing ollection ystem ompromise) as applicable. The contractors shall close out the debts in their internal systems and any balance shall be adjusted to zero. f the principal balance of the debts in the D and the contractors internal systems has a negative balance, the contractors shall update the D using the codes listed above. The contractors shall analyze the payments received and determine if a refund should be issued (ee Pub , chapter 4, section ). f it is determined a refund is valid, the contractors shall follow procedures for applying excess collections and update their internal systems as well as the D to reflect any refund given (ee Pub , chapter 4, section ). f the principal balance of the debts in D and in the contractors internal system is greater than $100, these debts shall remain in status codes P or in D. The will issue additional instructions regarding the debts for this workload in the future. The contractor shall consider these debts as paid in full and shall annotate their internal systems accordingly so that no additional collections are applied to these debts. The contractors shall add a comment on the D comment screen reflecting any action taken, the date of the T report in which the debts appear on and the financial statement reporting quarter in which the debts were resolved.