The surcharge agency is responsible for supplying CMS with a file that contains records
for individuals that it intends to remove from its premium surcharge billing account.
The file must be sent in the format specified by CMS. Requirements pertaining to the
methods of data exchange, record formats, including the type of file and data elements,
are contained in the Premium Surcharge Handbook. Where the surcharge agency is removing
an individual because the individual died, the removal record must contain the date
of death. The effective date of the removal will be the month after the month in which
the individual died. The surcharge agency will receive a credit refund for surcharges
that were paid on the individual’s behalf for any months after the month in which
the individual died. In instances where the surcharge agency is removing an individual
for reasons other than death, the removal record should not contain a date. When the
removal record is received by CMS by the 26th day of a month, the effective date of the removal will be the next month. No surcharge
will be due for the next month and the surcharge agency will receive a credit refund
for surcharges that were paid on the individual’s behalf for that month.
When a surcharge payer discontinues payment of the surcharge on behalf of an individual
for any reason other than death, the surcharge agency must notify the individual that
he or she is liable for Part B surcharges. CMS will resume collecting the surcharge
from the individual for whom the premium surcharge arrangement has ended.
There are instances where CMS will automatically remove an individual when CMS records
indicate that the individual died, does not meet all the requirements for Medicare,
withdrew or was terminated from Medicare. CMS may also automatically remove an individual
when CMS records indicate that a formal group payer or State Medicaid agency is paying
the individual’s Part B premium.
The surcharge payer must pay premium surcharges for individuals through the month
it notifies CMS that it is dropping an individual from its premium surcharge payment
rolls, through the month of termination of Part B coverage, or through the month of
death, whichever occurs first.