Medicare Credit Balance Report

"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."

 Medicare requires agencies to submit this report regardless of whether there is a balance to be refunded. Simione Healthcare Consultants has been submitting these on behalf of clients for a number of years, and have yet to report a credit balance due.  However, it is a necessary requirement that Medicare takes very seriously.  If you fail to submit a Credit Balance (CMS-838) form and/or certification page with all provider numbers identified, Medicare payments will be suspended as stated in 42 CFR 413.20(e) and 405.370.

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

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.

Credit Balance Reports are due on a quarterly basis:

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. 

If you are unable to find what you need or have a question, Simione is prepared to assist you and/or prepare and submit these reports on your behalf for a minimal fee.  If you're interested in this service or need some assistance, please contact Selise Smith by email or call her at 877.424.6527.