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October 9, 2018

Part A Top Medicare Credit Balance Submission Rejects

Credit Balance (CB) reports are often rejected due to missing or invalid information.  Analysis of rejected CB reports submitted for the quarter ending March 31 and June 30, 2018, showed the top reason for rejects was the reporting of an incorrect quarter end date.

The next Quarterly Medicare Credit Balance Report is due in our office postmarked by October 30, 2018. As you prepare your next CB report, please review the top three reasons for rejected CB reports and develop internal processes to prevent these types of rejects.  Preventing these rejects will help you avoid possible payment suspension.

Reject Reason# 1

March 31 Quarter End

June 30 Quarter End

Incorrect Quarter Ending Date

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  • Be sure to include the month, day, and year the reporting quarter in a (e.g., 9/30/18 or September 30 2018.) on the CMS-838 Certification page (see below).

The quarter ending dates are:

  • March 31
  • June 30
  • September 30
  • December 31

Reject Reason #2

March 31 Quarter End

June 30 Quarter End

PTAN not our provider

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  • If your facility submits claims to two different MACs, review the Medicare Remittance Advice to determine which MAC originally made payment on the claim being reported on the CB report.

You may also review the claim on the Fiscal Intermediary Standard System (FISS) Direct Data Entry (DDE) screens.  Each FISS DDE screen displays “CGS J15 MAC – Part A REGION” at the top.  Research the FISS DDE screens to verify that the claim being reported on the CB Report is one that CGS processed.  Refer to the Part A FISS Guide: Inquiry Menu Chapter 3PDF for information about checking the status of your claim.

 

Reject Reason #3

March 31 Quarter End

June 30 Quarter End

Certification date missing or incorrect

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  • On the Medicare Credit Balance Report Certification Page, a date must be included in the “Date” field (shown below).  This date must be the quarter end date, or after.


For additional information, refer to the following resources on the CGS Part A website.

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