Program Components:
Background
The most common reason for the overstating Gross Retiree Costs error is including costs that are not covered by Medicare Part D, therefore making them ineligible for RDS subsidy during interim payments. At Reconciliation, a Plan Sponsor identifies those drugs that were not supposed to be claimed for subsidy, which consequently reduces the Gross Retiree Cost reported during interim payments and leads to an overpayment.
Resources Related to This Issue
- Refer to Prepare Cost Data in the RDS User Guide for guidelines and step-by-step instructions for preparing costs.
- Refer to Submit Interim Costs in the RDS User Guide for guidelines and step-by-step instructions for submitting interim costs.
- For guidance on what constitutes a Part D drug, refer to Chapter 6 of the Medicare Part D Manual, specifically Appendix C – Medicare Part B versus Part D Coverage Issues.
- For information to assist with excluding ineligible costs from payment requests, refer to CMS guidance Extract Certain Medicare Part B Costs from RDS Payment Requests.
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