TN 50 (09-13)

GN 02602.630 Unable to Locate Procedures for the Medicare Non-utilization Project (MNUP)

A. Appointment letter returned undeliverable

1. Undeliverable mail

If the appointment letter is undeliverable, follow the instructions in GN 02605.055B.

2. Unable to locate the beneficiary

  1. If you are unable to locate the beneficiary, add the following message to the Master Beneficiary Record (MBR):

    “MNUP interview needed. Payments suspended for failure to keep MNUP interview appointments. Immediately remove suspense once MNUP interview is conducted.”

  2. Suspend benefits per undeliverable mail procedures in GN 02605.055B.

  3. After the MBR shows the ledger account file (LAF) code as suspended for address development (S6), update the LAF code in the “Medicare Non-Utilization Project (MNUP)” section on the MNUP Website to show you suspended the beneficiary’s benefits.

  4. When you suspend benefits, immediately refer the case to the Office of the Inspector General (OIG) using form e8551 (Reporting Form for Programmatic Fraud). Annotate in remarks on the website the date you referred the case to OIG.

    Provide as much information as available on the e8551. For more information on referring a potential violation using the e8551, see GN 04124.001.

    NOTE: When completing the e8551 form for the MNUP, select program option “Medicare Non-Utilization” and place the term MNUP in the description.

B. Beneficiary is not available at time of interview

Call the beneficiary at the telephone number shown on the MBR and take the following steps:

  • If the beneficiary answers the telephone, inform him or her you are calling to conduct the scheduled telephone interview. If asked to reschedule the interview, do so and inform the beneficiary that you will send a letter informing him or her of the new time and date. Remind the beneficiary of the importance of being available at the time of the scheduled interview.

  • If you reach a voicemail, leave a detailed message that includes your name, the office you are from, that you called for the scheduled appointment, and your office phone number.

  • If the beneficiary resides in a nursing home, call the nursing home to verify the beneficiary is alive before suspending benefits. If the nursing home alleges the beneficiary is alive, begin representative payee development, if necessary. If the nursing home alleges the beneficiary is deceased, process the report of death. For instructions on how to process a death report, see GN 02602.640.

    Send a new appointment notice to the beneficiary. Allow the beneficiary two rescheduled appointments. Include the following language in the appointment letter when scheduling the final (third) appointment:

    “We have tried to schedule an appointment with you twice. Each time we rescheduled, you were not available. It is very important that you keep this appointment. If you do not keep this appointment, we may suspend your benefits until we speak with you.”

    Add a remark to the MNUP website worksheet stating the beneficiary was not available for the scheduled interview; include any actions taken to contact the beneficiary at the time of the interview. Also, include the date and time of the rescheduled appointment.

    If the beneficiary fails to keep the third appointment, follow instructions in GN 02602.610B.4.

    If you suspend benefits, immediately refer the case to the Office of the Inspector General (OIG) using Form e8551 (Reporting Form for Programmatic Fraud). Provide as much information as available in the e8551. Annotate the online worksheet that you referred the case to OIG. For more information on the e8551, see GN 04124.001.

    NOTE: When completing the e8551 form for the MNUP, select program option “Medicare Non-utilization” and place the term MNUP in the description.

C. Beneficiary fails to respond to letters

We will attempt to contact the beneficiary three times.

Send the first letter and allow 2 weeks for the beneficiary to respond before sending a follow-up request.

NOTE: If the beneficiary resides in a nursing home, call the nursing home to verify the beneficiary is alive before suspending benefits.

If the nursing home alleges the:

  • beneficiary is alive,</