Instructions for Medicare Credit Balance Reporting Activities Provider Types Affected Background Providers use the quarterly CMS-838 report to disclose Medicare credit balances. They determine the number and amount of these balances for refunds due to the Medicare program. Generally, when a provider receives an improper or excess payment for a claim, it is reflected in their accounting records (patient accounts receivable) as a “credit.” However, Medicare credit balances include money due to the program regardless of its classification in a provider’s accounting records. For example, if a provider maintains credit balance accounts for a stipulated period, such as 90 days, and then transfers the accounts or writes them off to a holding account, this does not relieve the provider of its liability to the program. In these instances, the provider is responsible for identifying and repaying all of the monies from these credit-balance accounts to the Medicare program. Key Points for Providers Submit Completed CMS-838 Within 30 Days of Each Quarter The current version of the Medicare Credit Balance Report (CMS Form 838 Certification Page and Detail Page) and instructions for its completion are available at http://www.cms.hhs.gov/CMSForms/CMSForms/list.asp#TopOfPage Report all Medicare Credit Balances Providers need an officer or the administrator of their facility to sign and date the certification page. If no Medicare credit balances are shown in your records for the reporting quarter, the officer or administrator should sign the form and submit it to attest to this fact. Detail Page Part A Versus Part B Credit Balances Other Instructions Providers must show the full name of the facility and provider number. If there are multiple provider numbers for dedicated units within the facility (e.g., psychiatric, physical medicine, and rehabilitation), complete a separate Medicare Credit Balance Report for each provider number, including the month, day, and year of the reporting quarter, e.g., 12/31/02. Providers should write the number of the current detail page and the total number of pages forwarded, excluding the certification page (e.g., Page 1 of 3); and the name and telephone number of the individual who may be contacted regarding any questions that may arise with respect to the credit balance data. Providers should complete the data fields for each Medicare credit balance by providing the following information (when a credit balance is the result of a duplicate Medicare primary payment, report the data pertaining to the most recently paid claim). Providers complete columns 1-15. Once a credit balance is reported on the CMS-838, it is not to be reported on a subsequent period report. Providers must pay all amounts owed Medicare as shown in column 9 of the credit balance report at the time you submit the CMS-838. Make payment by check or by submission of adjustment bills. Submit adjustment bills in hard copy or electronic format. Providers should include a separate adjustment bill, electronic or hard copy, if payments are made by a check for all individual credit balances. The FI will ensure that the monies are not collected twice. Providers should not submit credit balance information on the CMS-838 detail page as a substitute for adjustment bills. This will not be accepted by the FI as a substitute for adjustment bills. Providers should send in claim adjustments, whether as payment or in connection with a check, by submitting them as adjustment bills (electronic or hard copy). If the claim adjustment was submitted electronically, this should be shown on the CMS-838 (see instruction for column 11). MSP Rules If you are not submitting a payment (by check or adjustment bill) for an MSP credit balance with the CMS-838 because of the 60-day rule, you must furnish the date the credit balance was received. Otherwise, the FI will assume that the payment is due and will issue a recovery demand letter and accrue interest without taking this 60-day period into consideration. Extended Repayment Schedule Documentation Procedures
FIs will impose a suspension of Medicare payments and your eligibility to participate in the Medicare program may be affected for failing to submit the CMS-838 or for not maintaining documentation that adequately supports the credit balance data reported to CMS. Your FI will review your documentation during audits/reviews performed for cost report settlement purposes. Submission of CMS-838 Providers with extremely low Medicare utilization are not required to submit a CMS-838. A low utilization provider is defined as a facility that files a low utilization Medicare cost report as specified in the Provider Reimbursement Manual (PRM- 1), Section 2414.4.B, or files less than 25 Medicare claims per year. The PRM-1 manual is available at http://www.cms.hhs.gov/Manuals/PBM/list.asp#TopOfPage Repayment of Credit Balances Resulting from MSP Payments Providers must report credit balances resulting from MSP payments on the CMS-838 if they have not been repaid by the last day of the reporting quarter. If you identify and repay an MSP credit balance within a reporting quarter, in accordance with the 60-day requirement, do not include it in the CMS-838, i.e., once payment is made, a credit balance would no longer be reflected in your records. Providers are required to report a MSP credit balance, if an MSP credit balance occurs late in a reporting quarter, and the CMS-838 is due prior to expiration of the 60-day requirement, include it in the credit balance report. However, payment of the credit balance does not have to be made at the time you submit the CMS-838, but within the 60 days allowed. Implementation The current version of the Medicare Credit Balance Report (Certification Page and Detail Page) and instructions for its completion are available at http://www.cms.hhs.gov/CMSForms/CMSForms/list.asp#TopOfPage If you have questions, please contact your Medicare carrier, FI, RHHI, or DMERC at their toll-free number, which may be found at http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.pdf Disclaimer MLN Matters Number: MM5084 Attention Providers! |
on the CMS Web site. 
on the CMS Web site. The Medicare Financial Management Manual, Chapter 12 - Instructions for Medicare Credit Balance Report Activities, is attached to CR5084.
