Simione™ Healthcare Consultants

Back

Medicare Credit Balance Report


What is it?

A Medicare credit balance is an amount determined to be refundable to the Medicare program for an improper or excess payment made to a provider because of patient billing or claims processing errors. Examples of Medicare credit balances include instances where a provider is:

  • Paid twice for the same service either by Medicare or by Medicare and another insurer;

  • Paid for services planned but not performed, or for non-covered services;

  • Overpaid because of errors made in calculating beneficiary deductible and/or coinsurance amounts.

Why do you have to do it?

Medicare requires agencies to submit this report regardless of whether or not there is a balance to be refunded.  You may not have a credit balance due, but it is a necessary requirement that Medicare takes very seriously.  If you fail to submit a Credit Balance (CMS-838) Certification Page and/or identify all provider numbers, your Medicare payments will be suspended as stated in 42 CFR 413.20(e) and 405.370.

Where are the forms located?

Use the following link https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/downloads/cms838.pdf to obtain the Medicare Credit Balance Report.  If there are no credit balances to report, you’ll only need to complete the Certification page and submit a copy to your MAC.  Subsequent pages include instructions and a Detail Page that you will need to complete if you DO have a credit balance to report.  

When is it due?

Credit Balance Reports are due on a quarterly basis:

Quarterly Reporting Period

Due By

January 1 – March 31

April 30

April 1 – June 30

July 30

July 1 – September 30

October 30

October 1 – December 31

January 30

Who do you send it to?

Credit Balance Reports may be submitted to your MAC by fax unless a payment is due and needs to accompany the submission, in which case agencies should send it by Certified Mail or Courier. You can search your MAC website for this information if needed.

MAC

Fax To:

Fax number

Website

NGS

NGS

315.442.4287

http://www.ngsservices.com

Palmetto GBA

MCBR Receipts

803.419.3277

http://www.palmettogba.com

CGS

J15-HHH Credit Balance

615.664.5987

http://cgsmedicare.com

 

For information and assistance, contact Susan Chickoskyat [email protected] or call 800-949-0388.