Understanding the CMS-838 Credit Balance Report
The CMS-838 Credit Balance Report is a crucial tool for Medicare providers, used to disclose and manage excess or improper payments. This quarterly report helps ensure that any overpayments made to providers are identified and refunded to Medicare.
What Is a Credit Balance?
A Medicare credit balance refers to amounts determined to be refundable to Medicare, typically resulting from billing or processing errors. When a provider receives an excess payment, it shows up as a “credit” in their accounting records.
Why Is the CMS-838 Report Important?
The CMS-838 report is specifically designed to monitor and recover these credit balances. Common situations leading to credit balances include:
– Duplicate payments for the same service by Medicare or another insurer.
– Payment for services that were planned but not performed, or for non-covered services.
– Overpayment due to errors in calculating beneficiary deductible or coinsurance amounts.
– Hospitals billing for outpatient services that are included in a beneficiary’s inpatient claim.
Reporting Forms
There are two key forms associated with the CMS-838 Credit Balance Report:
1. Certification Page: Required for all providers, this form confirms that the report has been completed.
2. Detail Page: Needed only if there are credit balances to report.
You can find links to these forms at the bottom of this page.
Key Points to Remember
– Exclusions: Credit balances do not include overpayments due to Medicare processing system issues. These will be corrected and recouped automatically.
– Reporting Frequency: Once a credit balance is reported, it should not be included in future reports.
– Low Utilization Providers: Facilities with minimal Medicare activity (less than 25 claims per year) do not need to submit a CMS-838.
Submission Deadlines
Submit your CMS-838 report within 30 calendar days after the end of each calendar quarter. Here are the due dates for each quarter:
– 1st Quarter (March 31): On or Before April 30
– 2nd Quarter (June 30): On or Before July 30
– 3rd Quarter (September 30): On or Before October 30
– 4th Quarter (December 31): On or Before January 30
Consequences of Late or Incomplete Reports
If your report is not submitted by the due date, or is deemed unacceptable, you will receive a Suspension Warning Letter. Failure to resolve the issues within 15 days of this notice will result in payment suspension until an acceptable report is received.
How to Submit the Report
1. Palmetto GBA’s eServices: The preferred method. Submit your report and attachments online via the Financial Forms section. You will receive confirmation and a Document Control Number (DCN) upon successful submission. This method ensures efficient processing and tracking.
2. By Fax: Send the completed Certification Page, Detail Page, and UB04s to 803-419-3277. Note that this method does not confirm receipt of your submission.
3. By Mail:
– Regular & Certified Mail:
Palmetto GBA, LLC
Attn: Credit Balance Reporting
PO Box 100109
Columbia, SC 29202
– Overnight Courier:
Palmetto GBA, LLC
Credit Balance Reporting
2300 Springdale Dr
Building One
Camden, SC 29020
For detailed instructions, review the Financial Tools Section in the eServices User Manual.
By staying on top of your CMS-838 reports, you ensure compliance and avoid disruptions in Medicare payments.
