Module 1, Topic 1
In Progress

Day 8: Credit Balance Reports and Cost Reports

Petria September 3, 2020

Credit Balance Reports and Cost Reports

Credit Balance Reporting (CMS 838)

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.

  • The Certification Page that must be completed by all providers (CMS 838 form)
  • 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

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 . Faxed cothe MAC portal. Copies are difficult to read, particularly if they are handwritten.

 

 

Due dates for each calendar quarter are listed below:

 

What happens if my credit balance report is not submitted on time, or was deemed not acceptable upon review?

  • 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

Providers are strongly encouraged to submit their Credit Balance Report the MAC portals. Providers can electronically submit the Credit Balance Report and PDF attachments online. 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. 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 agency 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.

2. By fax:
Providers may submit the completed 838 Certification Page, Detail Page and UB04s by fax. It should be noted that this method will not provide confirmation that the submission was received.

3. By mail:
Providers may mail the completed 838 Certification Page, Detail Page and UB04s via:

  • Regular & Certified Mail, or
  • Overnight Courier

Even if no Medicare credit balances are shown in your records for the reporting quarter, you must still have the form signed and submitted to your FI in attestation of this fact.

NOTE: A suspension of Medicare payments may be imposed and your eligibility to participate in the Medicare program may be affected for failing to submit the CMS-838 or for not maintaining documentation that adequately supports the credit balance data reported to CMS.

If the amount owed Medicare is so large that immediate repayment would cause financial hardship, you may contact your FI regarding an extended repayment schedule.

 

 

 

Cost Report. General Information ​​

Medicare-certified institutional providers are required to submit an annual cost report to a Medicare Administrative Contractor (MAC). The cost report contains provider information such as:

  • facility characteristics,
  • utilization data,
  • cost and charges by cost center (in total and for Medicare),
  • Medicare settlement data, and financial statement data.

 

 

 

 

Cost Report Filing Information

Please note the following updates and tips for filing Medicare cost reports. These updates and tips encourage filing early, submitting files in an electronic format and minimizing the amount of paper submitted.

Also note that when a cost report is filed late, the provider will be placed on payment hold. The payment hold will be released after the cost report has been received, reviewed, and accepted. In peak periods (such as the month of June), it may take 30 days to accept the report. Please file timely (or early) to prevent being placed on payment hold!

Tips for filing cost reports:
File electronically. Benefits of filing electronically are that an electronic signature is accepted, no postage is required, PHI is secure and confirmation of receipt is received immediately.

 

 

 

File early.

Benefits of filing a cost report early are: 1) Providers will have time to correct issues in the event the report is rejected, and 2) Providers will not have their payments suspended because the cost report was filed before the due date.

  • Obtain PS&R reports.
    Providers are responsible for obtaining access to the PS&R System and ordering PS&R reports for use in preparing the cost report. Access to the PS&R System is obtained through the Enterprise Identity Management (EIDM) system.  These contain screen shots and step-by-step instructions.

    • PS&R — Obtain Access through EIDM
    • PS&R — Order Summary Report
    • Sending files (e.g., PI, EC), schedules, reports and analysis
  • If the cost report is to be mailed, files should be sent on a disk and should be in their native format
  • Bad debt lists should be sent in an Excel file format
  • If sending cost reports for multiple providers, please submit a separate disk for each cost report
  • Limit the number of paper documents submitted
    • Only send the signed, signature page(s) (with encryption code) as a printed document
    • Do not send extra copies of the cost report or other documents
    • Do not send reports in notebooks or binder
    • Exception for cost reports filed as Low Utilization or No Utilization. These types of reports can all be sent via hardcopy.
  • Verify cost report information.
    Ensure the provider number and fiscal year are listed correctly.
  • Sign reports using blue ink.
    Original signatures (not stamped) are required. Blue ink assists in confirming a signature is original.

 

 

 

PS&R – Obtain Access through EIDM

The Centers for Medicare & Medicaid Services (CMS) established the Enterprise Identity Management (EIDM) website as a means for providers to obtain access to several CMS applications. The Provider Statistical & Reimbursement (PS&R) is one such application.

Each provider must enroll two people in EIDM. One will have the role of PS&R Security Official. This person will be requested to submit information about the provider, will set up the access for the provider and then approve other users. The second person will have the role of PS&R User. The PS&R User can order PS&R reports.

Each person will:

  • Create an EIDM account
    For assistance in obtaining access to EIDM go to https://eus.custhelp.com/  , refer to the EIDM User Guide or call the EIDM Help Desk at 866-484-8049.
  • Request access to the PS&R
    The following is information on creating EIDM accounts and requesting PS&R access. If there are questions or issues, the help desk for EIDM can be reached at 866-484-8049 (press 2). As well, the EIDM User Guide, provides more information and can be obtained from the cms.gov website (enter ‘EIDM User Guide’ in the search box).

Create EIDM Account

1) To access the CMS Portal

  • Go to https://portal.cms.gov, and select New User Registration (refer to red arrow below) Read the Terms and Conditions. Select checkbox, I agree to terms and conditions, and choose the Next button.
  • Complete the required fields under the Your Information screens and choose the Next button. (Enter your name, date of birth and Social Security Number exactly as it is on file with the Social Security Administration.)  Choose the Next button.