Medicare Compliance & Reimbursement

If you need to return a payment to Medicare, check that you are using the most updated version of the credit balance report.

That’s the word from First Coast Service Options Inc. (FCSO) in a reminder to providers on submitting their quarterly credit balance forms. The Part B MAC urges practitioners to use the most up-to-date CMS-838 and follow the “block-by block instruction” on the report, advises an FCSO notice.

Reminder: When a patient billing or claims processing error generates an improper payment, the amount must be refunded to Medicare — and the CMS-838 is used in the processing of the refund.

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 less 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.

Remember, the quarterly reports are due to the Centers for Medicare & Medicaid Services (CMS) by the following due dates: April 30; July 30; Oct. 30; and Jan. 30. CGS recommends submitting the form within 30 days of the quarter end for “timely receipt and processing.”

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