TN 22 (11-01)

HI 01001.030 Billing Process

Any Supplementary Medical Insurance (SMI) enrollee whose SMI premiums are not deducted from a Social Security, Railroad Retirement (RR) or Civil Service Retirement (CSR) monthly benefits or paid by a State government or under an approved group-payment arrangement by a private organization, must pay premiums directly to the Centers for Medicare & Medicaid Services (CMS).

Railroad Retirement beneficiaries should pay premiums directly to the Railroad Retirement Board. These payments should be sent to:

U.S. Railroad Retirement Board

P.O. Box 4276

Carol Stream, IL 60197-4276

A. POLICY - PREMIUM NOTICES

Generally, those individuals who are required to pay their premiums by direct remittance are sent a Notice of Medicare Premium Payment Due (CMS-500) which reflects the months covered by the bill and the amount of premiums due. A "Billing Notice Date" appears in the upper left-hand portion of the CMS-500. This date is the billing selection date. All premium payments received up to that date have been included on the direct billing record. If any premiums are due, the period and the amount owed are reflected on the bill and, where appropriate, the potential termination date. (See HI 01005.800 for an exhibit of the CMS-500.)

No premium billing notice will be mailed when the premium amount owed is less than $10.00. Instead, the balance owed will be added to the next regular monthly or quarterly bill.

Example: If an enrollee receives a quarterly premium bill for $131.40 and pays only $125.00, the additional $6.40 will be added to the bill he receives for the next quarter. He will then owe $137.80.

B. POLICY - CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS) ROLE

Once a month, CMS furnishes billing files to a private printing and mailing contractor to prepare the Notice of Medicare Premium Payment Due (CMS-500). CMS is responsible for managing the contracts for both the printing and mailing of the Medicare premium billing notices (CMS-500) and the daily operations of the Medicare Premium Collection Center (MPCC).

C. PROCEDURE - SOCIAL SECURITY PROGRAM SERVICE CENTER (PSC) ROLE

The SSA PSCs prepare manual bills for beneficiaries whose direct billing records will not permit electronic billing and for the beneficiaries who are paying premium arrearages by installments. All direct billed remittances other than installments should be forwarded to the Medicare Premium Collection Center. The PSC should not process premium remittances. Premium billing notices (CMS-500) and remittances received in the PSCs should be forwarded to:

Centers for Medicare & Medicaid Services

Medicare Premium Collection Center

P.O. Box 790355

St. Louis, MO 63179-0355

D. POLICY - MEDICARE PREMIUM COLLECTION CENTER ROLE (MPCC)

All Medicare premium remittances along with the bottom portion of the Notice of Medicare Premium Payment Due (CMS-500) are processed by a contractor selected by CMS. The current contractor is called the Medicare Premium Collection Center (MPCC). Upon completion of the daily processing of remittances, the MPCC transmits the payment information to CMS for daily updating of the direct billing system.

E. POLICY - FIELD OFFICE (FO) INVOLVEMENT IN THE COLLECTION PROCESS

After a premium notice is received by an enrollee, he/she may contact the FO for an explanation of the billing information (refer to the Health Insurance Query Response (HIQR) and MSOM QUERIES 008.001) or to obtain assistance in making premium payment arrangements. HI 01001.100 discusses delinquent notices and HI 01001.075 discusses the circumstances under which monthly premium payments are permitted. Premium billing notices (CMS-500) received in the FOs should be forwarded to the Centers for Medicare & Medicaid Services, Medicare Premium Collection Center, P.O. Box 790355, St. Louis, MO 63179-0355. The Medicare claim number should be clearly shown on the check and the billing notice.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0601001030
HI 01001.030 - Billing Process - 03/25/2008
Batch run: 01/27/2009<