2911.9 Problem Situations
Situations which may arise which will require contact with the fiscal Agent Buy-in Analyst are:
A request to adjust the effective date on a buy-in record.
A complaint that an individual is on buy-in and is being billed directly for Medicare Part B premiums, or the premiums are being withheld from the Social Security check.
A complaint that a claim for Part B benefits was denied due to lack of Part B coverage, and the individual should have Part B coverage as entitlement to buy-in. If it is determined that the beneficiary was deleted from buy-in error because of incorrect KEES information, the record should be corrected.
A complaint that an individual received a Medicare Part B termination notice and should be covered by buy-in.
An allegation that the individual is no longer on buy-in, but the premiums are not yet being deducted from his or her Social Security check or has been placed in direct billing status. The fiscal agent will attempt to resolve a problem case within three updates (approximately 90 days). However, due to the length of time involved in obtaining documentation and the fact that not all corrective actions can be taken in the same update, it may require four updates (approximately 120 days) to make all of the corrections.
Retroactive buy-in accretions shall be limited to either the Title XIX eligibility effective date or 6 months prior to the month that the request is received, whichever is less. Exceptions shall be limited to the following circumstances: The Medicare entitlement decision is retroactive to an earlier date (such as a decision rendered based on an SSA appeal). Attempts to timely accrete an individual to buy-in have been unsuccessful. The agency has failed to reflect Medicare coverage reported to them in a timely manner, and has also failed to approve assistance timely (other than protected filing date applications due to SSA appeals or applications delayed by the disability determination process).