Corporate

October 9, 2018

Home Health and Hospice Top Medicare Credit Balance Submission Rejects

Credit Balance (CB) reports are often rejected due to missing or invalid information.  Analysis of rejected CB reports submitted for the quarter ending March 31 and June 30, 2018, showed the top reason for rejects was due to CB reports being submitted to CGS incorrectly.  CGS receives CB reports that should be sent to a different Medicare Administrative Contractor (MAC).  This often occurs when a provider has more than one Provider Transaction Access Number (PTAN) and submits claims to more than one MAC.

The next Quarterly Medicare Credit Balance Report is due in our office postmarked by October 30, 2018.  As you prepare your next CB report, please review the top three reasons for rejected CB reports and develop internal processes to prevent these types of rejects.  Preventing these rejects will help you avoid possible payment suspension.    

Reject Reason #1

March 31 Quarter End

June 30 Quarter End

PTAN not our provider

239

163

  • If your facility submits claims to two different MACs, review the Medicare Remittance Advice to determine which MAC originally made payment on the claim being reported on the CB report.

You may also review the claim on the Fiscal Intermediary Standard System (FISS) Direct Data Entry (DDE) screens.  Each FISS DDE screen displays “CGS J15 MAC – HHH REGION” at the top.  Research the FISS DDE screens to verify that the claim being reported on the CB Report is one that CGS processed.  Refer to the FISS Guide: Inquiry Menu Chapter 3PDF for information about checking the status of your claim.


Reject Reason# 2

March 31 Quarter End

June 30 Quarter End

Incorrect Quarter Ending Date

64

34

  • Be sure to include the month, day, and year the reporting quarter in a (e.g., 9/30/18 or September 30 2018.) on the CMS-838 Certification page (see below).

The quarter ending dates are:

  • March 31
  • June 30
  • September 30
  • December 31
4

Reject Reason #3

March 31 Quarter End

June 30 Quarter End

Box Not Checked

44

28

  • One of the following must be checked.


For additional information, refer to the following resources on the CGS Home Health & Hospice website.

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