BA11 Payment Adjustment

Question 1

OU Pay line (BOUD/OP) is created when there’s a LDO and contains what?

Answer 1

DPO (OP). DPRD (+2 months for due process). DPOT (Sic code). DWA (withholding amount)

Question 2

SCH Pay shows payment for CMA and PMA in what form?

Answer 2

PMA thru (COM minus 1) CMA (MBC minus SMI) for COM

Question 3

SPC Pay can show payment information for?

Answer 3

IPs, UPs, Deferral, and Advance File.

Question 4

Difference between incorrect payment and legally defined overpayment.

Answer 4

IP has no due process, no SIC code, and recovered immediately.

Question 5

What is OCO 1 and OCO 3?

Answer 5

OCO 1 releases UP when beneficiary is suspended or terminated. OCO 3 releases UP when there is an OP and we don’t use UP to reduce OP.

Question 6

What is RFD X?

Answer 6

Prevents system from doing PVP since it’s considered correctly paid.

Question 7

What is special entry AA?

Answer 7

Releases payment as PMA and needs to be prorated by year. Use DOE if 1 month payment. Use January if more than 1 month payment.

Question 8

How to calculate deferred payment amount (DSP SPA) and DPD?

Answer 8

Use SPA and DPD cal. The Spa is the amount to be paid on the DPD when future payment will restart.

Question 9

How to calculate OP?

Answer 9

Use SPC cal. Input COM, DPD, SPA, and MBC from SPC Pay line.

Question 10

Partial Recovery line is capped when?

Answer 10

2049. If past 2049, special procedures are needed.

Question 11

Where to check for remittance on PHUS PVP?

Answer 11

PHUS event 019. And CMS for Medicare remittance.

Question 12

Recomp changes what on PIA?

Answer 12

IME is different.

Question 13

When does OCO apply?

Answer 13

The suspension or termination must be effective before COM, COM, or COM+1.