LICENSES AND NOTICES

License for Use of "Physicians' Current Procedural Terminology", (CPT) Fourth Edition

End User/Point and Click Agreement: CPT codes, descriptions and other data only are copyright 2009 American Medical Association (AMA). All Rights Reserved (or such other date of publication of CPT). CPT is a trademark of the AMA.

You, your employees and agents are authorized to use CPT only as contained in the following authorized materials including but not limited to CGS fee schedules, general communications, Medicare Bulletin, and related materials internally within your organization within the United States for the sole use by yourself, employees, and agents. Use is limited to use in Medicare, Medicaid, or other programs administered by the Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement.

Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized here in must be obtained through the AMA, CPT Intellectual Property Services, 515 N. State Street, Chicago, IL 60610. Applications are available at the AMA websiteExternal Website.

This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2)(June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a)(June 1995) and DFARS 227.7202-3(a)June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department Federal procurements.

AMA Disclaimer of Warranties and Liabilities.

CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. AMA warrants that due to the nature of CPT, it does not manipulate or process dates, therefore there is no Year 2000 issue with CPT. AMA disclaims responsibility for any errors in CPT that may arise as a result of CPT being used in conjunction with any software and/or hardware system that is not Year 2000 compliant. No fee schedules, basic unit, relative values or related listings are included in CPT. The AMA does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this file/product is with CGS or the CMS and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This Agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this Agreement.

CMS Disclaimer

The scope of this license is determined by the AMA, the copyright holder. Any questions pertaining to the license or use of the CPT must be addressed to the AMA. End Users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CPT. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL CONTAINED ON THIS PAGE. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.

This license will terminate upon notice to you if you violate the terms of this license. The AMA is a third party beneficiary to this license.

POINT AND CLICK LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT")

End User License Agreement

These materials contain Current Dental Terminology, Fourth Edition (CDT), copyright © 2002, 2004 American Dental Association (ADA). All rights reserved. CDT is a trademark of the ADA.

THE LICENSE GRANTED HEREIN IS EXPRESSLY CONDITIONED UPON YOUR ACCEPTANCE OF ALL TERMS AND CONDITIONS CONTAINED IN THIS AGREEMENT. BY CLICKING BELOW ON THE BUTTON LABELED "I ACCEPT", YOU HEREBY ACKNOWLEDGE THAT YOU HAVE READ, UNDERSTOOD AND AGREED TO ALL TERMS AND CONDITIONS SET FORTH IN THIS AGREEMENT.

IF YOU DO NOT AGREE WITH ALL TERMS AND CONDITIONS SET FORTH HEREIN, CLICK BELOW ON THE BUTTON LABELED "I DO NOT ACCEPT" AND EXIT FROM THIS COMPUTER SCREEN.

IF YOU ARE ACTING ON BEHALF OF AN ORGANIZATION, YOU REPRESENT THAT YOU ARE AUTHORIZED TO ACT ON BEHALF OF SUCH ORGANIZATION AND THAT YOUR ACCEPTANCE OF THE TERMS OF THIS AGREEMENT CREATES A LEGALLY ENFORCEABLE OBLIGATION OF THE ORGANIZATION. AS USED HEREIN, "YOU" AND "YOUR" REFER TO YOU AND ANY ORGANIZATION ON BEHALF OF WHICH YOU ARE ACTING.

  1. Subject to the terms and conditions contained in this Agreement, you, your employees, and agents are authorized to use CDT-4 only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. Use of CDT-4 is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). You agree to take all necessary steps to ensure that your employees and agents abide by the terms of this agreement. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT-4. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials.
  2. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CDT-4 for resale and/or license, transferring copies of CDT-4 to any party not bound by this agreement, creating any modified or derivative work of CDT-4, or making any commercial use of CDT-4. License to use CDT-4 for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611. Applications are available at the American Dental Association websiteExternal Website.
  3. Applicable Federal Acquisition Regulation Clauses (FARS)\Department of Defense Federal Acquisition Regulation Supplement (DFARS) Restrictions Apply to Government use. Please click here to see all U.S. Government Rights Provisions.
  4. ADA DISCLAIMER OF WARRANTIES AND LIABILITIES. CDT-4 is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. No fee schedules, basic unit, relative values or related listings are included in CDT-4. The ADA does not directly or indirectly practice medicine or dispense dental services. The sole responsibility for the software, including any CDT-4 and other content contained therein, is with (insert name of applicable entity) or the CMS; and no endorsement by the ADA is intended or implied. The ADA expressly disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. This Agreement will terminate upon notice to you if you violate the terms of this Agreement. The ADA is a third-party beneficiary to this Agreement.
  5. CMS DISCLAIMER. The scope of this license is determined by the ADA, the copyright holder. Any questions pertaining to the license or use of the CDT-4 should be addressed to the ADA. End users do not act for or on behalf of the CMS. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CDT-4. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL COVERED BY THIS LICENSE. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material.

The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. If the foregoing terms and conditions are acceptable to you, please indicate your agreement by clicking below on the button labeled "I ACCEPT". If you do not agree to the terms and conditions, you may not access or use the software. Instead, you must click below on the button labeled "I DO NOT ACCEPT" and exit from this computer screen.


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Tips on Completing a Credit Balance Report (Form CMS-838)

Credit balance reports with missing or invalid information are rejected and are not considered received for the quarter. A corrected report must be received by the due date for the quarterly reporting period. Please review the following tips to avoid a rejected Credit Balance Report.

Note: A separate Medicare Credit Balance Report (CMS-838) should be submitted for each Medicare provider number.

CMS-838 Certification Page

If you have no credit balances as of the last day of the reporting quarter a signed and dated certification page must still be submitted.

  • Provider 6-Digit Number – Be sure to complete a separate Medicare Credit Balance Report for each provider number (also known as a PTAN). Do not submit one Medicare Credit Balance Report with multiple providers listed.
  • Quarter Reporting Period – Include the end date of the reporting quarter in a month, day, year format (e.g., 9/30/12 or September 30, 2012).

    form example
  • Name and Title – Print you name and your title.
    form example
  • Check One – Check the appropriate box.
  • Contact Information (at the bottom of the certification page) – Please print the name and telephone number of the individual who may be contacted regarding any questions that may arise with respect to the credit balance report.

    form example

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CMS-838 Detail Page

Begin completing the CMS-838 detail page by providing the information required in the heading area of the detail page(s).

form example

Report all Medicare credit balances shown in your records regardless of when they occurred. Complete all the data fields for each Medicare credit balance. When the credit balance is the result of a duplicate Medicare primary payment, report the data pertaining to the most recently paid claims. Frequently missed fields include:

  • (4) Type of Bill – provide the 3-digit type of bill of the claim
  • (11) Method of Payment – Choose one of the following:

    C – When you submit a check with the CMS-838 to repay the credit balance amount shown in column 9 (Include the UB-04)

    A – If a claim adjustment is being submitted in hard copy with the CMS-838 (Include the UB-04)

    Z – If payment is being made by a combination of a check and a hard copy adjustment bill with the CMS-838

    X – If an adjustment bill has already been submitted electronically or by hard copy

  • (13) Reason for Medicare Credit Balance – When entering a "3" for "other reasons", provide an explanation on the detail page. CGS suggests that you include the explanation in column (15) Primary Payer (Name & Billing Address), to assist the CGS staff.

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UB-04 Form/Adjustment

When submitting a claim adjustment for an individual credit balance, complete the field locators (FL) required on an adjustment UB-04 claim. This includes the:

  • Type of Bill (FL 4), with the third digit of a "7";
  • Condition Code (FL 18-28) (when using a D9, enter an explanation of the adjustment in the Remarks field (FL 80); and
  • Document Control Number (FL 64) of the claim being adjusted.

For additional information, refer to the "Adjustments/Cancels" Web page.

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Mailing Address/Fax

 

To ensure timely receipt and processing, send the CMS-838/Certification within 30 days of the quarter end date using one of the options below. Do not submit duplicate Credit Balance Reports.

  • myCGS, secure Web Portal (preferred method):

Refer to the myCGS User Guide, "Chapter 7: Forms Tab"PDF for details. myCGS provides instant confirmation of receipt.

  • Reports may be faxed to (do not send duplicate faxes):

1.615.664.5987
MCBR Receipts
Attn: Credit Balance Reporting

  • Regular and Certified Mail:

CGS
Attn: HHH Credit Balance Reporting
P.O. Box 20014
Nashville, TN 37202

  • Fed Ex/UPS/Overnight Courier:

CGS
J15 Credit Balance Reporting
26 Century Blvd STE ST610
Nashville, TN 37214-3685

  • Please note that if you have or will be submitting an adjustment, please send the UB-04 along with the CMS-838 form.
  • If you are issuing a refund check for a credit balance:

    Send the CMS-838 and a copy of the refund check using one of the options listed above.

    Send the refund check with a copy of the CMS-838 or documentation that indicates the check is for a credit balance, the quarter end date, and provider number associated with the check to the following address:

    CGS - J15 Home Health and Hospice
    P.O. Box 957124
    St. Louis, MO 63195-7124

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Timely Submission

The Medicare Credit Balance Report (CMS-838) (mailed or faxed) that are received within 30 days of the close of each calendar quarter are considered to be timely. However, if you fail to submit the CMS-838 (certification and/or detail page) timely for all provider numbers and credit balance information identified, program payments will be suspended as stated in 42 CFR 413.20(e)External Website and 405.370External Website.

In addition, for complete instructions refer to the online Medicare Credit Balance ReportExternal PDFon the Centers for Medicare & Medicaid Services (CMS) website. Information is also available in the Medicare Financial Management Manual (CMS Pub. 100-06) Chapter 12External PDF.

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Corrections to Credit Balance Reports

If after you submit your Medicare Credit Balance Report you find that you need to remove a beneficiary from the report, submit the Medicare Credit Balance Correction FormPDF with all the appropriate information.

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Updated: 08.07.18

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