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).
- Name and Title – Print you name and your title.
- 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.
TopCMS-838 Detail Page
Begin completing the CMS-838 detail page by providing the information required in the heading area of the detail page(s).
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.
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.
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.
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Refer to the myCGS User Guide, "Chapter 7: Forms Tab" for details. myCGS provides instant confirmation of receipt. |
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1.615.664.5987 |
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CGS |
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CGS |
- 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
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)
and 405.370.
In addition, for complete instructions refer to the online Medicare Credit Balance Report
on the Centers for Medicare & Medicaid Services (CMS) website. Information is also available in the Medicare Financial Management Manual (CMS Pub. 100-06) Chapter 12.
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 Form
with all the appropriate information.
Updated: 08.07.18
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