Form Cms-838 - Medicare Credit Balance Reporting Requirements Page 6
Download a blank fillable Form Cms-838 - Medicare Credit Balance Reporting Requirements in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form Cms-838 - Medicare Credit Balance Reporting Requirements with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3
4
5
6
7DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
15 – Workers’ Compensation
16 – Other Government Program
41 – Black Lung
42 – Department of Veterans Affairs (VA)
43 – Disability
44 – Conditional Payment
47 – Liability
Column 15 - The name and billing address of the primary insurer identified in column 14.
NOTE: Once a credit balance is reported on the CMS-838, it is not to be reported on a subsequent
period report.
Payment of Amounts Owed Medicare
Providers must pay all amounts owed (column 9 of the report) at the time the credit balance report is submit
ted. Providers must submit payment, by check or adjustment bill.
• Payments by check must also be accompanied by a separate adjustment bill, electronic or hard copy,
for all individual credit balances that pertain to open cost reporting periods. The FI will ensure that
the monies are not collected twice.
• Submission of the detail information on the CMS-838 will not be accepted by the FI as an
adjustment bill.
• Claim adjustments, whether as payment or in connection with a check, must be submitted as
adjustment bills (electronic or hard copy). If the claim adjustment was submitted electronically,
this must be shown on the CMS-838 (see instructions for column 11).
• There is a limited exception for MSP credit balances. Federal regulations at 42 CFR 489.20(h) state
that “if a provider receives payment for the same services from Medicare and another payer that is
primary to Medicare…” the provider must identify MSP related credit balances in the report for the
quarter in which the credit balance was identified, even if repayment is not required until after the date
the report is due. If the provider is not submitting a payment (by check or adjustment bill) for an MSP
credit balance with the CMS-838 because of the 60-day rule, the provider must furnish the date the
credit balance was received. Otherwise, the FI must assume that the payment is due and will issue
a recovery demand letter and accrue interest without taking this 60-day period into consideration.
• If the amount owed Medicare is so large that immediate repayment would cause financial hardship,
you may contact your FI regarding an extended repayment schedule.
Records Supporting CMS-838 Data
Develop and maintain documentation that shows that each patient record with a credit balance (e.g.,
transfer, holding account) was reviewed to determine credit balances attributable to Medicare and the
amount owed, for the preparation of the CMS-838. At a minimum, your procedures should:
• Identify whether the patient is an eligible Medicare beneficiary;
• Identify other liable insurers and the primary payer;
• Adhere to applicable Medicare payment rules; and
• Ensure that the credit balance is due and refundable to Medicare.
Form CMS-838 (10/03)
Page 4
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Medical