Now that the New Year has rung in, healthcare providers should start marking their accounting calendars for the first quarter Medicare Credit Balance Reports. The first quarter deadline will arrive soon, and other deadlines should already be on the calendar.
What Is the Medicare Credit Balance Report (CMS-838)?
The Medicare credit balance report (form CMS-838) is the government form used to monitor "credit balances" owed to Medicare by providers.
When a provider receives an improper overpayment or excess payment for a claim, it is entered into their patient accounts receivable as a credit. The CMS-838 form shows the total balance due to Medicare each quarter from these overpayments and credits. Medicare credit balances include all monies due to Medicare, no matter how the provider classifies it in their accounting records.
Examples of Medicare credit balances include:
- Double payments — a service paid for twice by Medicare or by Medicare and a second insurer
- Payment for planned services not performed or not covered
- Overpayments due to billing or coding errors
- Billing for outpatient services that were later covered under inpatient payments
A credit balance would not include any excess payment made by Medicare under a prospective payment plan or any Medicare processing errors. These overpayments will be corrected when Medicare adjusts the claims.
The Certification page is signed by the officer or administrator responsible for creating the CMS-838. It verifies that the report is true and accurate to the best of the officer or administrator's knowledge. The Certification also affirms whether the provider is a low-utilization provider and whether a detail page is attached.
The Detail page contains specific information about the overpayments that must be reimbursed to Medicare. The Detail page includes identifying information about the beneficiary, ICN number, admission or treatment dates, and the amounts of overpayment and reimbursement.
How often are facilities required to report credit balances to Medicare?
Credit balances must be repaid within 60 days of receipt of overpayment, no matter when they are received or when the CMS-838 is filed. The CMS-838 must be filed within 30 days of the end of each calendar quarter.
Medicare Credit Balance Report Due Date Schedule
The Credit Balance Report is due within 30 days of the end of the calendar quarter, and it cannot be sent any earlier. For instance, even if your report is complete on March 30, you must wait until April 1 to send the documents, or it will be rejected. The 2023 Medicare Credit Balance Report Due Dates are as follows:
Which providers are exempt from submitting a credit balance report to Medicare?
A provider who files fewer than 25 Medicare claims annually is a low-utilization provider. If a provider files only a few Medicare claims or marks the "Low Utilization" checkbox on the CMS-838 Certification page, the provider may be exempt from submitting a credit balance report.
Low-utilization providers must have a low number of covered Medicare services by beneficiaries and be willing to accept interim Medicare payments as payment in full for services to qualify for the designation.
How do I check the status of my credit balance report?
It is easy enough to confirm the amounts due on your CMS-838 report. Online tracking tools will help you monitor your outstanding balances and track reimbursements made on your account.
Credit balance report status tools
Novitas Solutions allows providers to check their Medicare credit balance by quarter date. Once a provider has an account, they simply log in and enter the quarter's ending date. The system maintains records for one year.
The system will return results for Plans A and B, the date the payment was received, and the total credit balance.
NGS lets you verify the status of your report once it is filed. Enter your Provider Transaction Access Number and Contractor Code, and the system will return the status of your filed/faxed report.
What can happen if a provider is late in submitting a report?
The Medicare Credit Balance Report is due 30 days after the close of each calendar quarter. Failure to provide the report within 30 days may result in the suspension of Medicare payments and interest on the credit balance due. It can affect the provider's eligibility to participate in the Medicare program.
A Suspension Warning Letter will be issued if the report is not received within 15 days after the due date (for instance, by May 15 for the April 30 deadline). The Suspension Warning Letter provides an additional 15 days to comply before further actions are taken.
Why would my report be rejected?
As with any government form, you must carefully follow all submission requirements. The most common reasons for rejection are incomplete or incorrect forms. Other common causes for rejection include:
- Missing or illegible Certification page. Be sure all fields are filled in and the signature is on the Signature line.
- Illegible or incomplete Credit Balance Detail page. Common issues include handwritten numbers, blank fields, and incorrect dates.
- Check payments submitted without the CMS-838 form.
- Combined payments. Each provider number must have its own form and payment, even if they are from the same facility.
- Early Credit Balance Report. The report cannot be sent before the end of the calendar quarter.
- Provider-generated forms. You must use the form provided by CMS. Providers may not copy or duplicate it onto their letterhead or paperwork.
If a provider discovers errors in a report after submission, they should use the Medicare Credit Balance Correction and/or Refund Form. Errors could include incorrect claim numbers, dates of service or payment, or patient Medicare numbers. The correction form should be filed as soon as the mistake is noticed but should not be used in place of the Detail page.
Keeping New Year's Resolutions
If you haven't already prepared to submit your Credit Balance Reports, you still have time to avoid breaking your resolution to stay on track in 2023. Remember, a late report can affect your Medicare payments and your status in the program. March 31 will be here before you know it.