Corporate

Credit Balance Credit Balance Report (Form CMS-838)

A Medicare credit balance is an amount determined to be refundable to the Medicare program for an improper or excess payment made to a provider because of patient billing or claims processing errors. Each provider must submit a quarterly Credit Balance Report (Form CMS-838)External PDF. If your facility has more than one provider number, a separate report should be submitted for each provider number. 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.

Providers with low Medicare utilization, as specified in the Provider Reimbursement Manual, CMS Pub. 15-1External Website, Chapter 24, §2414.4 B, or who file less than twenty-five Medicare claims per year, do not have to submit Form 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.

The following provides the reporting periods and associated due dates.

Quarterly Reporting Period Due By

Jan. 1 – March 31

April 30

April 1 – June 30

July 30

July 1 – Sept. 30

Oct. 30

Oct. 1 – Dec. 31

Jan. 30

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. 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 WebsiteDo 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
2 Vantage Way
Nashville, TN 37228

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.

For helpful tips refer to Tips on Completing a Credit Balance Report (Form CMS-838) and Medicare Financial Management Manual (CMS Pub. 100-06) Ch. 12External PDF

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