Credit Balance Reporting (CMS 838)

The quarterly Credit Balance Reports (CMS 838) are due within 30 days of the end of each calendar quarter. The Credit Balance report is used to disclose Medicare credit balance amounts due from the provider to Medicare as of the last day of each quarter. 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.’ Credit balances should only be reported at the end of the quarter if the provider has not repaid the amount to Medicare through a voluntary refund, have not received a remittance advice indicating that the adjustment associated with the credit has been adjudicated, or have not received a demand letter for the credit balance amount.

The CMS guidelines governing these processes can be found on the CMS website under:

Palmetto GBA is committed to helping providers understand the Credit Balance process. For more information and the options available to you, please select the link below for additional information regarding the Credit Balance process. 

Topic
Brief Description
A complete and acceptable Medicare Credit Balance Report (838) is due within 30 calendar days from the end of each calendar quarter.
Are you still using paper to submit your quarterly Credit Balance Report via fax or email? Take advantage of the benefits of submitting your report electronically.
Helpful tips for submitting claim adjustments or cancelations associated with the credit balance report
Complete and accurate Credit Balance Reports are required. If a Credit Balance Report is rejected a complete and accurate report will need to be resubmitted.
After submission of an acceptable credit balance report, providers may determine that a correction needs to be made to information provided on the detail page submitted with the credit balance report, may determine that funds collected on a credit balance should be refunded, or want to provide additional information to correct claim history after a credit balance demand letter has been issued.
For more information on the credit balance process, please see our Credit Balance Webcast.
This interactive module provides assistance with completing the Medicare Credit Balance Report (CMS 838).

 


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