Cardiology Coding Alert

Question: How can we be sure we’re refunding the correct amount when a claims processing error generates an improper payment?

Maine Subscriber

Answer: When you’re returning a payment to Medicare, the key is to make sure you have the updated version of the credit balance report (CMS-838). Use the most up-to-date CMS-838 and follow the line-by-line instruction on the report.

Additionally, “if your facility has more than one provider number, a separate report should be submitted for each provider number,” notes CGS Medicare in online guidance. “If you fail to submit a credit balance (CMS-838) form and/ or certification page with all provider numbers identified, Medicare payments will be suspended as stated in 42 CFR 413.20(e) and 405.370,” the MAC warns.

If you file fewer than 25 Medicare claims per year or are considered to have low Medicare utilization, you don’t need to submit the CMS-838. “Providers that qualify should submit one, signed and dated certification page and a letter indicating that they are a low Medicare utilization provider,” CGS says.

Review the updated form at www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/CMS838.pdf.