What is a Credit Balance (838) Report?
Providers use the quarterly CMS-838 report to disclose Medicare credit balances. Medicare credit balance is an amount determined to be refundable to Medicare. Generally, when a provider receives an improper or excess payment for a claim, it is reflected in their accounting records (patient accounts receivable) as a "credit."

The CMS-838 is specifically used to monitor identification and recovery of "credit balances" owed to Medicare. A credit balance is an improper or excess payment made to a provider as the result of patient billing or claims processing errors. 

There are two forms associated with the Credit Balance Report. Links to both forms can be found at the bottom of this page.

1. The Certification Page that must be completed by all providers (CMS 838 form)
2. The Detail Page which is required only if there are credit balances to report

Examples of improper or excess Medicare payments include instances where a provider is:

• Paid twice for the same service either by Medicare or by Medicare and another insurer
• Paid for services planned but not performed or for non-covered services
• Overpaid because of errors made in calculating beneficiary deductible and/or coinsurance amounts or
• A hospital that bills and is paid for outpatient services included in a beneficiary’s inpatient claim

Please note:

• Credit balances do not include improper payments made when a Medicare processing system issue occurs. This overpayment will be recouped when the issue is corrected and the claim(s) are adjusted.
• Once you identify and report a credit balance on a CMS 838 report, do not report the same credit balance on subsequent CMS 838 reports
• Providers with extremely low Medicare utilization do not have to submit a CMS-838. A low utilization provider is defined as a facility that files a low utilization Medicare cost report as specified in PRM-I, section 2414.4.B, or files less than 25 Medicare claims per year.

When is the credit balance report due?
A completed CMS-838 must be submitted within 30 calendar days after the close of each calendar quarter. 

Credit Balance Reports (CMS 838) for the quarters ending are listed below. Be sure to submit the report with all information required:

• Provider Name
• Six digit PTAN
• Correct quarter end date (including the correct year)
• Signature and title of a company administrator or officer dated after the last date of the quarter for which the report is being submitted (March 31, June 30, September 30, or December 31)
• Box marked as to whether the provider is low utilization, detail pages are attached, or no Medicare credit balances to report
• Contact name in case any questions arise
• If you are submitting a detail page with your credit balance report, please use e-services. Faxed copies are difficult to read, particularly if they are handwritten.

Due dates for each calendar quarter are listed below:

• If a complete and acceptable credit balance report is not received by the 15th calendar day after the credit balance report is due, a Suspension Warning Letter will be issued
• If a complete and acceptable credit balance report is not received within 15 calendar days from the date of the Suspension Warning Letter, all payments to the provider will be suspended until a complete and acceptable report is received and processed

How to submit a credit balance report
1. Palmetto GBA’s eServices:

Providers are strongly encouraged to submit their Credit Balance Report via Palmetto GBAs eServices. Providers can electronically submit the Credit Balance Report and PDF attachments online. You may access the form via the Financial Forms sub-tab located under the Financial Tools tab in eServices. Choose the "CMS-838 Credit Balance" option from the Select a Form dropdown menu. Complete the form and attach the actual Credit Balance Report. 

Once the form is successfully submitted, you will receive an inbox message advising you that the form was received by Palmetto GBA. You will get a second message with the Document Control Number (DCN) when the form has begun processing. You can use the DCN to look up form processing status and view your submitted forms. If a form is submitted over the weekend, the DCN may not be assigned until the next business day. Confirmation of receipt does not indicate acceptance of the report. The Credit Balance Report will still need to be reviewed for acceptability after submission.

An officer or the Administrator of the facility must sign and date attached credit balance reports. To complete the submission process through the portal, the name and title of the person authorized to submit the form on behalf of the provider is required (electronic signature), along with a name and contact phone number.

For more information, please review the Financial Tools Section in the eServices User Manual    (PDF, 7.78 MB)