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What's New: Commercial Surety

CMS Issues Claims Guidance for DME Bonds

Wednesday, July 23, 2014  

Of note, Centers for Medicare & Medicaid Services has released a guidance document for the handling of DME bond claims.  

  • Before a claim letter is sent to the surety, the claims contractor must send a pre-notice (an “Intent to Refer” letter);
  • A claim letter shall not be sent in cases where the aggregated balance of the debt is less than $25, the contractor believes the debt will be collected through recoupment, or the supplier has a recent offset. 

Documentation still may be an issue.  The contractor now is required to provide the date of service.  However the contractor has “significant discretion” in determining what other documentation to provide. 

Also of note—the guidance provides commentary regarding the scope of the surety’s liability.  That is, the surety is liable for claims arising from overpayment determinations made on or after the surety bond effective date.  However, the services causing such overpayment must have been performed on or after March 2, 2009. 

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