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.
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.
The following provides the reporting periods and associated due dates.
Quarterly Reporting Period | Due By |
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Jan. 1 – March 31 | April 30 |
April 1 – June 30 | July 30 |
July 1 – Sept. 30 | Oct. 30 |
Oct. 1 – Dec. 31 | Jan. 30 |
To ensure timely receipt and processing, send the CMS-838/Certification within 30 days of the quarter end date using one of the options below. If you fail to submit the CMS-838 (certification and/or detail page) timely for all provider numbers and credit balance information identified, program payments will be suspended as stated in 42 CFR 413.20(e) and 405.370. Do not submit duplicate Credit Balance Reports.
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Refer to the myCGS User Manual for details. myCGS provides instant confirmation of receipt. |
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1.803.462.2584 |
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CGS |
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CGS |
Corrections to Credit Balance Reports
If after you submit your Medicare Credit Balance Report you find that you need to remove a beneficiary from the report, submit the Medicare Credit Balance Correction Form with all the appropriate information.
For helpful tips refer to Medicare Financial Management Manual (CMS Pub. 100-06) Ch. 12
Reviewed: 12.01.22