Nettings/Offsets Across Organization Affiliations

Effective 1/4/2016, CMS implemented a change to begin netting/offsetting provider money across affiliated providers within the same and also across workloads within a single organization. This CMS change brings consistency to all Part B contractors regarding netting across organization affiliations.

Any related providers conducting business in two different workloads (example: New York and Maine) will have their money applied to any AR with a remaining balance owed to Medicare in all workload affiliations.

• For example: Provider ABC is located in New York and is scheduled to receive a payment of $1,000 on today’s remittance advice.
• Provider XYZ is related to provider ABC but is located in Maine and has ARs with a balance owed of $200.
• Provider ABC’s $1,000 payment will have the $200 applied against provider XYZ’s ARs resulting in a net payment of $800.
• This will be reflected on the remittance advice by the same PLB code as seen today for offsets for the $200.

Reviewed 10/17/2024