Credit Balance Report (Form CMS-838)
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. Each provider must submit a quarterly Credit Balance Report (Form CMS-838). If your facility has more than one provider number, a separate report should be submitted for each provider number. 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.
Go to the Medicare Credit Balance Report Certification Page to access the credit balance form and instructions. Information is also available in the Medicare Financial Management Manual (CMS Pub. 100-06) Ch. 12.
Providers with low Medicare utilization, as specified in the Provider Reimbursement Manual, CMS Pub. 15-1, Chapter 24, §2414.4 B, or who file less than twenty-five Medicare claims per year, do not have to submit Form CMS 838. Providers that qualify should submit one, signed and dated certification page and a letter indicating that they are a low Medicare utilization provider.
Send your Credit Balance Reports (Form CMS-838) to the address listed on the Home Health & Hospice Contact Information web page along with your payment. The following provides the reporting periods and associated due dates.
|Quarterly Reporting Period||Due By|
|Jan. 1 – March 31||April 30|
|April 1 – June 30||July 30|
|July 1 – Sept. 30||Oct. 30|
|Oct. 1 – Dec. 31||Jan. 30|
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 noncovered services;
- Overpaid because of errors made in calculating beneficiary deductible and/or coinsurance amounts