Today, we are reminding everyone to submit a completed Medicare Credit Balance Report, Form CMS-838, to your fiscal intermediary (FI) by January 30. This report is due to your FI within 30 days after the close of each calendar quarter. If you do not submit this report, the Centers for Medicare & Medicaid Services (CMS) may suspend your Medicare payments, and it may affect your eligibility to participate in the Medicare program. In addition, always maintain documentation that shows 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.

You may download the CMS-838 form with instructions at http://www.cms.gov/cmsforms/downloads/CMS838.pdf

CMS uses form CMS-838 to monitor identification and recuperation of "credit balances" - "improper or excess payment made to a provider as the result of patient billing or claims processing errors" - owed to Medicare.

The remainder of this post references the CMS guidelines for the Medicare Credit Balance Report. If you have any questions, please leave a comment below the post.

Your minimum 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.

Credit balances would not include proper payments made by Medicare in excess of a provider's charges such as diagnosis-related group (DRG) payments made to hospitals under the Medicare prospective payment system.

Examples of Medicare credit balances include instances where a provider is:

• Paid twice for the same service, either by Medicare or by Medicare and another insurer;
• Paid for services planned but not performed or for non-covered services;
• Overpaid because of errors made in calculating beneficiary deductible and/or coinsurance amounts; or
• A hospital that bills and is paid for outpatient services included in a beneficiary's inpatient claim.

Generally, when a provider receives an improper or excess payment for a claim, it is reflected in their accounting records (patient accounts receivable) as a "credit." However, Medicare credit balances include monies due the program regardless of its classification in a provider's accounting records. For example, if a provider maintains credit balance accounts for a stipulated period; e.g., 90 days, and then transfers the accounts or writes them off to a holding account, this does not relieve the provider of its liability to the program. In these instances, the provider must identify and repay all monies due the Medicare program.

Only Medicare credit balances are reported on the CMS-838.

To help determine whether a refund is due to Medicare, another insurer, the patient, or beneficiary, refer to the sections of the manual [each provider manual will have the appropriate cite for that manual] that pertain to eligibility and Medicare Secondary Payer (MSP) admissions procedures.

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Pamela Pruitt has over 20 years experience as an accountant, with a majority in public accounting specializing in health care industry such as physicians, anesthesiologists, dentists, hospitals/clinics, etc. Ms. Pruitt is the Chief Accountant at All Nursing Home Health Services, Inc. in Houston, TX, as well as a Certified QuickBooks Pro Advisor, Certified Public Bookkeeper and Certified Bookkeeper. After hours, she blogs on Jobing.com and runs a business providing services to small businesses such as bookkeeping, accounting, and software setup, among other services. To reach Ms. Pruitt, call (281)636-9929 or send an email to pruitt_pam@yahoo.com.