TN 17 (10-00)
HI 01005.801 Premium Billing and Collection Entities and Responsibilities (Includes Billing for Premium SMI)
A. POLICY - CENTRAL OFFICE (CMS CO)
Selects beneficiaries who are to receive a bill for a particular month or quarter. Records are selected on the 27th of the month (unless it is a weekend or holiday), for the next month. If the 27th falls on a Saturday, the selection is made on the 26th. If the 27th falls on a Sunday, the selection is made on the 28th. HI premium bills are sent out at the same time as the quarterly billings for SMI.
Prepares and releases a billing tape for processing or electronically transmits billing data (English and Spanish) to the Medicare printing and mailing contractor.
Monitors and oversees the daily operations of the printing and mailing contractor and the Medicare Premium Collection Center.
Maintains the billing and collection history for beneficiaries in direct billing status.
Performs the following direct billing operations:
Receives and applies payment information from the Medicare Premium Collection Center. Processes adjustments from MBR changes and direct inputs from SSA’s PSC and CMS's staff.
Reverses terminations and notifies the EDB when remittances are received and processed during the due process period.
Maintains and updates the Direct Billing System on a daily basis.
Maintains premium liability.
Identifies records for potential terminations.
Identifies records for final terminations and passes the termination data to SSA for posting to the MBR via the Title 2 system.
Sends a Part B premium refund file to SSA when a refund is due after direct billing stops and the refund amount is equal to, or less, than three months’ premiums.
Generates "Potential Refund" alerts to SSA PSCs when the Part B premium refund is more than three months of premiums, a death or rep-payee is involved, or a Part A refund is due after direct billing stops. (See SM 00711.090)
B. POLICY - MEDICARE PRINTING AND MAILING CONTRACTOR (BILLING CONTRACTOR)
Receives billing data by tape or through an electronic transmission from CMS CO.
Prints and mails quarterly (SMI only) and monthly (HI and SMI or HI only) (initial, second, delinquent and estate) notices in both English and Spanish from the billing data. NOTE: A one time only estate bill is sent to the beneficiary’s estate after the date of death has been annotated to the beneficiary’s direct billing record.
Prepares billing packages which include a bill, return envelope, and when necessary a special notice, relating to a premium rate increase or a change in the Medicare law.
Returns used magnetic cartridges to CO quarterly. When electronic transmission is applicable, notifies CO of receipt of transmission (upon completion of electronic transmission).
C. POLICY - MEDICARE BENEFICIARY
Receives a Notice of Medicare Premium Payment Due - CMS-500 either monthly or quarterly for Medicare premiums due.
Mails all premium payments to the CMS Medicare Premium Collection Center, PO Box 790355, St. Louis, MO 63179-0355. by the 25th of the month. (See HI 01005. 802)
D. POLICY - SOCIAL SECURITY ADMINISTRATION (SSA) FIELD OFFICE (FO)
Informs the beneficiaries that their payments must be mailed directly to the Medicare Premium Collection Center. If the beneficiary insists on making premium payments at the FO, give the beneficiary a receipt for premium payment, convert cash to money orders, and forward remittances to the Medicare Premium Collection Center. The field office may use their discretion on how to handle the FO copy of the premium receipt.
Establishes payment schedules for installment payments and forwards to the appropriate PSC for disposition. (HI 00830.060)
Processes requests for good cause and forwards to the appropriate PSC for disposition. (HI 01001.360 and HI 01001.365)
E. POLICY - MEDICARE PREMIUM COLLECTION CENTER (REMITTANCE CONTRACTOR)
Receives, processes and deposits all premium remittances. Make daily deposits and adjustments to CMS's Medicare Trust Fund.
Sorts all correspondence and forwards to appropriate CMS components or government agencies.
Prepares a daily microfilm/CD-ROM of all processed remittances. Forwards microfilm or CD-ROM disks to CMS CO for necessary action.
Processes all bank actions for debits/credits and all returned checks and forwards to CMS for disposition.
F. POLICY - SOCIAL SECURITY ADMINISTRATION (SSA) PROGRAM SERVICE CENTER (PSC)
If the FO sends premium payments to the PSC, the PSC should:
Acknowledge receipt of the payment and either process the payment per their instructions or forward the payment to the Medicare Premium Collection Center for processing. (The FO should direct appropriate premium payments, except installment payments, to the Medicare Premium Collection Center.)
Set up and maintain installment payment records.
Review good cause determinations for possible reinstatement of Medicare coverage. Sends notification to the beneficiary when the good cause statement is not sufficient to warrant reinstatement.
Send termination letters to beneficiaries who have been terminated due to failure to pay premiums. This is an automated process.
Investigate and resolve direct billing problems and systems alerts.