Form Cms-838 - Medicare Credit Balance Reporting Requirements Page 7

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DEPARTMENT OF HEALTH AND HUMAN SERVICES
CENTERS FOR MEDICARE & MEDICAID SERVICES
NOTE: A suspension of Medicare payments may be imposed and your eligibility to participate in the
Medicare program may be affected for failing to submit the CMS-838 or for not maintaining
documentation that adequately supports the credit balance data reported to CMS. Your FI will
review your documentation during audits/reviews performed for cost report settlement purposes.
Provider Based Home Health Agencies (HHAs)
Provider-based HHAs are to submit their CMS-838 to their Regional Home Health Intermediary even though
it may be different from the FI servicing the parent facility.
Exception for Low Utilization Providers
Providers with extremely low Medicare utilization do not have to submit a CMS-838. A low utilization
provider is defined as a facility that files a low utilization Medicare cost report as specified in PRM-I, section
2414.4.B, or files less than 25 Medicare claims per year.
Compliance with MSP Regulations
MSP regulations at 42 CFR 489.20(h) require you to pay Medicare within 60 days from the date you receive
payment from another payer (primary to Medicare) for the same service. Submission of the CMS-838 and
adherence to CMS’ instructions do not interfere with this rule. You must repay credit balances resulting from
MSP payments within the 60-day period.
Report credit balances resulting from MSP payments on the CMS-838 if they have not been repaid by the last
day of the reporting quarter. If you identify and repay an MSP credit balance within a reporting quarter, in
accordance with the 60-day requirement, do not include it on the CMS-838; i.e., once payment is made, a
credit balance would no longer be reflected in your records.
If an MSP credit balance occurs late in a reporting quarter, and the CMS-838 is due prior to expiration of the
60-day requirement, include it in the credit balance report. However, payment of the credit balance does not
have to be made at the time you submit the CMS-838, but within the 60 days allowed.
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number.
The valid OMB control number for this information collection is 0938-0600. The time required to complete this information collection is estimated to average 6 hours
per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you
have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to CMS, 7500 Security Boulevard, Attn: PRA
Reports Clearance Officer, Baltimore, Maryland 21244-1850.
Form CMS-838 (10/03)
Page 5

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