TN 13 (05-03)

A. Policy - Medicare Premium Remittances

Remittances may be received in the FO as payment for Health Insurance premiums. There are four kinds of premiums that could be received:

• Regular monthly/quarterly premiums. These premiums are controlled by CMS and should be received with a pre-printed Notice of Medicare Premium Payment Due, CMS-500 (formerly HCFA-500). These payments are sent to:

  Centers for Medicare & Medicaid Services
  Medicare Premium Collection Center
  P.O. Box 790355
  St. Louis, MO 63179-0355

DO NOT SEND REGULAR MONTHLY PREMIUMS TO MATPSC.
These transactions will appear on the FORDL.

• Manually prepared CMS-500 prepared by the PSC for regular monthly or quarterly premiums when the beneficiary cannot be billed electronically by the Direct Bill (DB) system. These premiums should be sent to the Medicare Premium Collection Center and not to the MATPSC. These remittance transactions will appear on the FODRL.

• Retroactive premiums being paid on an installment basis. These premiums are controlled by the PSC and should be received with a Notice of Medicare Premium Payment Due, a CMS-500. There should be very few of these remittances. These payment transactions should be sent to MATPSC (the address shown on the CMS-500 should be changed to the MATPSC address); these transactions will appear on the FORT.

REFERENCE: See HI 00830.060 for an explanation of retroactive premiums.

• Retroactive premiums being paid in a lump sum. These premium remittances are controlled by the servicing PSC. However, they may not have an accompanying CMS-500. These transactions will appear on the FORT.

These two categories of retroactive premiums are the only premium payments that go to the MATPSC.

B. Procedure - Medicare Premium Remittances

Follow the steps below to handle Medicare Premium payments received in the FO.

1. Interviewer

1. If the premium payment is received with a Notice of Medicare Premium Payment Due (CMS-500) or , other than installment payment (this occurs when the DB system cannot produce a bill), or without a bill but with an SSN or a Medicare number and beneficiary name annotated on the check (This occurs when the DB system cannot produce a bill), stamp the remittance “For Deposit Only, CMS.”

   Use Trust Fund Code “N” and Reason Code “H.”

   CAUTION: DO NOT STAMP THESE “For Deposit Only, SSA” -- the lockbox bank will not accept these as CMS deposits.

2. If the premium payment received is a retroactive premium being paid based on an installment agreement, has no SSN, or Medicare number, process as a regular remittance per procedure in GN 02403.006, and send to the MATPSC.

   Use Trust Fund Code “O” and Reason Code “P”.

   Include a CMS-500 or some other documentation that is clearly marked to alert the PSC to the purpose of the remittance. (See example of CMS-500 below.) DMS will generate a payment coupon in addition to the receipt. The receipt should be given to the remitter and payment coupon should be mailed with the remittance and the FORT to MATPSC.

   If a single remittance represents a lump sum retroactive payment and a regular monthly premium, forward the full amount to the lockbox (address above), and let the PSC know what has occurred.

   If a premium payment is received before the HI/SMI award is prepared, make sure the front of all money orders and checks are clearly annotated with the Medicare number, beneficiary's name and in red ink “Prepayment HI/SMI premium.”

   At the end of each workday, forward all “prepayment remittances” to the CMS Medicare Premium Collection Center in the same envelope annotated “Prepayment” in red ink.

3. Enter the payment into the system, and give the automated receipt to remitter. (Use Trust Fund code “N”, and Reason code “H”). In addition to the receipt, DMS will generate a forwarding instruction sheet indicating how the remittance should be handled.

   REFERENCE: See MSOM DMS 003.006 , MSOM DMS 003.007 for how to input acceptable remittances and how to obtain an automated FO receipt.

4. Enter the receipt number and the Medicare number on each check.

5. If payment is cash, follow steps GN 02403.009B.1.b. - GN 02403.009B.3., Processing Cash Remittances Received in the FO.

6. Give the remittance to the remittance clerk.

2. Remittance Clerk

1. Obtain FO Daily Receipt Listing (FODRL) and compare remittance to it.

   REFERENCE: See MSOM DMS 004.009 for how to obtain FO Daily Receipt Listing.

2. Hand carry the FODRL, and premium remittances to the remittance supervisor.

3. Remittance Supervisor

1. Review any mailroom or reception area logs completed that day. Ensure that any premium remittances annotated on a log are included on the FODRL.

2. Record any discrepancies and resolve them with the remittance clerk and/or interviewer.

3. Place all premium remittances in an envelope addressed to:

   Centers for Medicare & Medicaid Services
   Medicare Premium Collection Center
   P.O. Box 790355
   St. Louis, MO 63179-0355

   Seal the envelope and mail it the same day.

   Forward the CMS-500 to CMS with the remittance; do not send any FO control forms, photocopies of the DMS receipts, or Receipt File Query Display.

4. If the client later alleges that he/she was not given credit for the remittance, follow the procedures in HI 01001.375.

C. Exhibit - Form CMS-500

This premium billing notice is mailed automatically to those Medicare beneficiaries who must be billed directly for Medicare premiums. It may be manually prepared by the PSC when the DB system cannot prepare an electronic bill. Premiums received with this bill should be mailed to the CMS Medicare Premium Collection Center at the address shown in GN 02403.030A.

Notice of Medicare Premium Payment Due — English

D. Exhibit - Form CMS-500SP

This premium billing notice is also available in a Spanish version.

Notice of Medicare Premium Payment Due — Spanish