Medicare Provider Instructions for Credit Balance Reporting
Accountant Miami: All providers of health care services participating in the Medicare program are required to submit a Medicare Credit Balance Report (form HCFA-838). A completed HCFA-838 is to be submitted on a quarterly basis.
Accountant Miami states that Section 1866 (a) (1) (C) of the Social Security Act requires hospitals and other health care providers participating in the Medicare program to make adequate provisions to refund any monies incorrectly paid. In accordance with sections 1815 (a) and 1833 (e) of the Act, the Secretary is authorized to request information from providers, which is necessary to properly administer the Medicare program. In accordance with these provisions, form HCFA-838 must be completed by all hospitals and other health care facilities participating in the Medicare program to help assure that monies owed to the Medicare program are repaid in a timely manner and Accountant Miami can prepare the forms.
The Form HCFA-838 is specifically used to monitor the identification and recovery of “credit balances” due the Medicare program. A credit balance is defined as an improper or excess payment made to a provider as the result of patient billing or claims processing errors. Accountant Miamior illustrates an example, if a provider is paid twice for the same service (e.g., by Medicare and another insurer), then a refund must be made to the secondary payer.
For the purpose of completing the HCFA-838 form, a Medicare credit balance is an amount determined to be refundable to the Medicare program. Generally, when a provider receives an improper or excess payment for a claim it is reflected in their accounting records (patient account receivable) as a “credit” as recorded by Accountant Miami. However, Medicare credit balances include money due the program regardless of its classification in a provider’s accounting records. For example, if a provider maintains credit balance accounts for a stipulated period, e.g., 90 days, and then transfers the accounts or writes them off to a holding account, this does not relieve the provider of its liability to the program. The provider is responsible for identifying and repaying all of the monies due to Medicare.
To assist in the determination of whether a refund is due the Medicare program, another insurer, the patient or beneficiary, refer to the following manual sections which pertain to the eligibility and Medicare Secondary Payer (MSP) admissions procedures:
Sections 300 and 301 of the Medicare Hospital Manual;
Sections 400 and 401 of the Medicare Skilled Nursing Facility Manual:
Sections 300, 302 and 341 of the Medicare Home Health Agency Manual;
Sections 250 and 300 of the Medicare Renal Dialysis Facility Manual;
Sections 245-251, 300 and 302 of the Medicare Outpatient Physical Therapy and Comprehensive Outpatient Rehabilitation Facility Manual
Submitting the Form HCFA-838
Submit a Medicare Credit Balance Report to your intermediary (FI) within 30 days after the close of each calendar quarter. The report is to include all Medicare credit balances reflected in your accounting records (including transfer, holding or other general accounts used to accumulate credit balance funds) as of the last day of the reporting quarter.
Completing the Form HCFA-838
The Form HCFA-838 consists of a certification page and a detail page. The certification page is to be signed and dated by an Officer or the Administrator of your facility. If no Medicare credit balances are reflected in your records for the reporting quarter, the certification page must still be signed and submitted attesting to this fact.
The detail page requires specific information on each credit balance, on a claim-by-claim basis. The detail page provides space to address 17 claims, but it may be reproduced as many times as necessary to accommodate all of the credit balances being reported.
Complete the Form HCFA-838 as follows:
The full name of the facility;
The facility’s provider number; if there are multiple provider numbers for dedicated units within the facility (e.g., Psychiatric, Physical Medicine and Rehabilitation), complete a separate Medicare Credit Balance Report for each provider number;
The Month, Day and Year of the reporting quarter, e.g., 10/01/01;
An “A” if the report page(s) reflects Part A credit balances;
The number of the current detail page and the total number of pages forwarded, excluding the certification page (e.g., Page 1 of 3); and
The name and telephone number of the individual who may be contacted regarding any questions that may arise with respect to the credit balance data.
Complete the data fields for each Medicare credit balance by providing the following information (when a credit balance is the result of a duplicate Medicare primary payment, report the data pertaining to the most recently paid claim):
Column 1 The last name and first name of the person with
Medicare. (e.g., Doe, J.)
Column 2 The Medicare Health Insurance Claim number of the person with Medicare.
Column 3 The 10-digit Internal Control Number (ICN) assigned by Medicare when the claim is processed.
Column 4 The 3 digit number delineating the type of bill, e.g., 111 – inpatient, 131 – outpatient, 831 – same day surgery, etc. Refer to Part III; section 3871 of the Medicare Intermediary Manual, or the Uniform Billing instructions of your manual (Hospital, SNF, HHA, etc.).
Column 5/6 The Month, Day and Year the beneficiary was admitted and discharged, if an inpatient claim, or “From” and “Through” dates (date service(s) were rendered) if an outpatient service. Indicate the Admission (From) and Discharge (Through) date using numerals (e.g., 01/01/01).
Column 7 The Month, Day and Year (e.g., 01/01/01) the claim was paid. If a credit balance is caused by a duplicate Medicare payment, the paid date and ICN number must correspond to the most recent payment.
Column 8 An “O” if the claim is for an open Medicare cost reporting period or a “C” if the claim pertains to a closed cost reporting period. (An open cost report is one for which a NPR has not yet been issued. A cost report is not to be considered open if it was reopened for a specific issue such as graduate medical education or malpractice insurance).
Column 9 The amount of the Medicare credit balance that was determined from your patient/accounting records.
Column 10 The amount of the Medicare credit balance identified in column 9 being repaid with the submission of the report. (As discussed below, Medicare credit balances should be repaid at the time the Form HCFA-838 is submitted to your FI).
Column 11 A “C” when a check is being submitted with the Form HCFA-838 to repay the credit balance amount shown in column 9, or an “A” if an adjustment request is being submitted.
Column 12 The amount of the credit balance that remains outstanding (column 9 minus column 10). Show a zero if full payment is made.
Column 13 The reason for the Medicare credit balance by entering a “1″ if it is the result of duplicate Medicare payments, a “2″ for a primary payment by another insurer, or a “3″ for “other reasons”. If a “3″ is indicated, a UB92 claim form must be submitted with the credit balance report indicating in red the changes that must be made.
Column 14 The Value Code to which the primary payment (column 14) relates, using the appropriate two digit code as follows:
12 working aged
13 end stage renal disease
14 auto no-fault/liability
15 workers’ compensation
16 other government program
41 black lung
42 veteran adminstration
43 disability
This column is completed only if the credit balance was caused by a payment when Medicare was not the primary payer.
Column 15 The name and address of the primary insurer identified in column 14.
Note: Once a credit balance is reported on the form HCFA-838, it is not to be reported on a Subsequent period report.
Payment of Amounts Owed Medicare
All amounts owed Medicare as shown in column 9 of the credit balance report should be paid at the time the Form HCFA-838 is submitted. Payment may be made by check or by the submission of the adjustment request. Adjustment requests may be submitted in hard copy or electronic format.
If a check is used to pay credit balances, adjustment requests must also be submitted for the individual credit balances that pertain to open cost reporting periods. Your FI will assure that monies are not collected twice.
If the amount owed Medicare is so large that immediate repayment would cause financial hardship, contact your FI regarding an extended repayment schedule.
Interest will be assessed on Medicare credit balances not timely repaid, in accordance with 42 CFR 405.376.
Records Supporting Form HCFA-838 Data Submissions
Providers must develop and maintain documentation which shows that each patient record with a credit balance(transfer, holding account, etc.) was reviewed to determine credit balances attributable to Medicare and the amount owed, for the preparation of the Form HCFA-838. At a minimum, your procedures should:
identify whether or not the patient is an eligible Medicare beneficiary
identify other liable insurers and the primary payer
adhere to applicable Medicare reimbursement rules
Penalties may be imposed for failure to submit the Form HCFA-838, or for not maintaining documentation that adequately supports the credit balance data reported to the Medicare program. Intermediaries will review a provider’s documentation during their audits/reviews performed for cost report settlement purposes.
Provider Based Home Health Agencies
Provider based home health agencies are to submit their Form HCFA-838 to their Regional Home Health Intermediary, even though it may be different from the intermediary servicing the parent facility.
Exception for Low Utilization Providers
Providers with extremely low Medicare utilization do not have to submit the Form HCFA-838. Low utilization is defined as a provider that files a low utilization Medicare cost report as specified in PRM-1, section 2414.B or files less than 25 Medicare claims per year.
Compliance with MSP Regulations
MSP regulations 42 CFR 489.20 require providers to reimburse Medicare within 60 days from the date they receive payment from another payer (primary to Medicare) for the same service. Submission of the Form HCFA-838 and adherence to its instructions do not interfere with this rule; credit balances resulting from MSP payments must be repaid within the 60 day period.
Credit balances resulting from MSP payments must be reported on the Form HCFA-838 if they have not been repaid by the last day of the reporting quarter. When an MSP credit balance is identified and repaid within a reporting quarter, in accordance with the 60 day requirement, it would not be included in the credit balance report, i.e., once payment is made a credit balance would no longer be reflected in your records.
The claim universe shall consist of Medicare inpatient, outpatient, and sub-unit claims (such as surgery or ESRD) for which a primary or secondary Medicare payment was made. The Intermediary will select the onsite claim sample using the following criteria:
If an MSP credit balance occurs late in a reporting quarter, and the Form HCFA-838 is due prior to the expiration of the 60 day requirement, it would be included in the credit balance report. However, payment of the credit balance does not have to be made at the time the Form HCFA-838 is submitted, but within the 60 days allowed.
If a provider fails to submit a credit balance report, the first course of action will be a 20% reduction in program payments, unless extraordinary circumstances prohibited them from doing so. Continued non-compliance could result in the full suspension of program payments, in accordance with 42 CFR 413.20 (e) and 405.370.
Check out our or new Videos: English or Spanish
CPA firms, Accountants in Miami | Accounting Services in Miami | Accountants Miami | Certified Public Accountant in Miami | CPA in Miami | CPA Miami | Miami Accountant | Miami Accounting Firms | Miami CPA Firm | Miami CPA | Miami Accounting | Accountant 33157 | Accountant 33176 | Accountant 33186 | Accountant 33183 | Accountant Miami
Brandi
Gosh, I wish I would have had that information ealreir!
Lexine
Your article was eexcllent and erudite.
Anonymous
It’s a nice blog you have over here! It’s very usefull information for me and I just want to thank you for that! If you post more threads as this one, I’ll follow your blog active!
viagra
Awesome blog over here! Thanks for sharing this very usefull information. I will visit your blog again into a couple off days to check if you have some new articles.
Elric
And I was just wdonering about that too!
sex
Keep up this good work, you have a nice blog over here with much good information! When you post some new stuff, I’ll visit your blog again and I’ll follow it.
gokkasten
Awesome blog, it’s just like a game for me! It’s so infomative and usefull, thanks a lot! If you post more of this great stuff, I’ll visit your blog again!
Almena
This artilce went ahead and made my day.
viagra kopen
Awesome blog over here! Thanks for sharing this very usefull information. I will visit your blog again into a couple off days to check if you have some new articles.
Real Estate Lewes Delaware
With a vibrant and distinct history, British sovereigns became sought-after by numismatists and collectors.
exotic car rental
Hi-Ya! our family loves your beautiful site thank you and please carry on
Landscaping Wilmington
There are many posts on the market near this, I’m sure taking there reference could experience chose to make this spot or article really informative. I’m not expression this information is unhealthy. Simply I must pronounce that the info provided here was unique, merely to restore more near to complete, supporting for some other former information will get been actually good. The points you will get touched listed below are really important, thus I’ll spot many of the information here to build this actually suitable for entirely the newbie’s here. Thanks for this information. Actually helpful!
Bethany Beach House Rentals
I was examining some of your posts on this website and I think this web site is really instructive! Keep posting.
Wilmington De Real Estate Listings
Spot on with this write-up, I truly suppose this website wants far more consideration. I’ll in all likelihood be once more to find out rather more, thanks for that information.
foreclosures
I was so lucky. I found the best website for my Immediately following much research, I really found the best Birthday party Upper Darby
Landscaping Hockessin
Comfortabl y, the article is really the best on this noteworthy topic. I fit in with your conclusions and will thirstily look forward to your next updates. Just saying thanks will not just be sufficient, for the fantasti c lucidity in your writing. I will directly grab your rss feed to stay privy of any updates. Authentic work and much success in your business enterprize!
real estate lewes
I was reading through some of your blog posts on this internet site and I believe this internet site is very instructive! Keep posting . Best Regards.
bethany beach rentals
I am back. Hi there nice people, if you are interested in sweet excellent quality i meet a excellent place for you… moovi.co.cc, just came back from it and I like it very…
55 PLUS COMMUNITIES IN DELAWARE
The train that goes all the way through is the El Cantabrico taking the fave trains, you need to go from point to point.
foreclosures
This is a very unique idea, its violent, sexy, crazy awesome great story, but this is a mostly visual film from what i can tell. Honestly reminds me of scott pilgrim somehow, dont know why, but it does. I am gonna see for it at fillmsi.co.cc. Also, this trailer has a kickass song in it!
Newark houses for sale
Outstanding post, I think website owners should acquire a lot from this blog its real user pleasant. So much good information on here .
Mohammad Tam
Appreciate it for all your efforts that you have put in this. Very interesting information. “Don’t ever take a fence down until you know the reason why it was put up.” by Gilbert Keith Chesterton.
myp2p forum nhl
Great! Thanks for post
Tia
We’re a gaggle of volunteers and starting a new scheme in our community. Your site offered us with useful info to work on. You have performed an impressive task and our whole group will likely be grateful to you.
landrover west chester
Too add to what NC and Carlos are posting, Why is it that elected Republicans cannot figure out that those of us who vote for them, are the WORKING folk in America. For the most part, we aren’t looking for the easiest way to get a free ride. We have a sense of pride at the end of a day, knowing that it is a job well done. We know that if we save our employers a dime, it could translate into a million. We work hard for our paychecks, and we expect that same attitude from our elected “leadership”. How hard is this to figure out??? Lorica
Johnie Pavlica
At this time it sounds like WordPress is the top blogging platform available right now. from what I’ve read Is that what you’re using on your blog?
Mabelle Thomaston
Nice post. I was checking continuously this blog and I am impressed! Extremely helpful info particularly the last part
I care for such info a lot. I was looking for this particular information for a long time. Thank you and good luck.
Iomoio music downloads
We are a group of volunteers and starting a new initiative in our neighborhood. Your site provided us with valuable information to help us get started|.You have done a great job!
real estate Lewes de
Thank you for this blog. That’s all I can say. You most definitely have made this blog into something that’s eye opening and important. You clearly know so much about the subject, youve covered so many bases. Great stuff from this part of the internet. Again, thank you for this blog.”
Commercial real estate Delaware
I was wondering if you ever thought of changing the page layout of your website? Its very well written; I love what youve got to say. But maybe you could a little more in the way of content so people could connect with it better. Youve got an awful lot of text for only having 1 or two images. Maybe you could space it out better?
neutrogena acne makeup
Bom dia amigos, verdadeiramente mandar um SMS grátis está cada vez mais custoso devido falta de opções das operadoras móveis. Há ainda os websites que prometem entregar minha menssagem mas nem sempre chegam ao usuário final. Alguns como o Mundo oi e o Oi Torpedo funcionam mas e para as outras operadoras? E os que prometem que enviam e nada chega. Para onde está indo as meus torpedos? E para a Tim, Vivo? Alguma Idéia? Ou significa ter de desembolsar?. É só um desabafo, realmente está difÃcil achar serviços para enviar SMS barato.
Active adult communities delaware
Thanks for all your efforts that you have put in this. Very interesting information. “What one knows is, in youth, of little moment they know enough who know how to learn.” by Henry Adams.
retaining wall
I like the helpful information you provide in your articles.
I’ll bookmark your blog and check again here frequently. I’m quite sure I’ll learn many new stuff right here! Good luck for the next!
Best Regards Justin
lawn service
My brother suggested I might like this web site.
He was totally right. This post truly made my day.
You can not imagine just how much time I had spent for this info! Thanks!
Best Regards Justin
bet365 offer code
I’ve read several excellent stuff here. Definitely value bookmarking for revisiting. I wonder how a lot effort you set to create this sort of magnificent informative site.
ladbrokes singapore
Its superb as your other content : D, regards for posting . “I catnap now and then, but I think while I nap, so it’s not a waste of time.” by Martha Stewart.
bluesq Promotion code
I believe this is among the most important information for me. And i am glad studying your article. However wanna statement on few common issues, The site style is great, the articles is in reality great
. Just right job, cheers.
coral bonus code
Its fantastic as your other posts : D, appreciate it for posting .
Car Accident Lawyer Philadelphia
Have you ever considered adding more videos for your blog page posts to maintain the readers more entertained? I imply I just examine through the entire post of yours and it was quite good but since I’m more of a visual learner,I identified that to be more helpful effectively let me know how it turns out! I really like what you guys are always up also. These clever perform and reporting! Maintain up the wonderful works guys I’ve added you guys to my blogroll. This can be a excellent report thanks for sharing this informative information.. I will pay a visit to your blog site regularly for some latest post.
Car Accident Lawyer Philadelphia
Hi my friend! I want to say that this article LAMBORGHINI LP640 SHOW ON ROAD | extreme sports cars|bmw concept cars|fast cars wallpapers|car videos is awesome, nice written and come with almost all important infos. I would like to peer extra posts like this. Thx … Flash Websites
Gdansk Autobus
Very interesting information!Perfect just what I was searching for!
Car Forums
Perfectly pent articles, Really enjoyed looking through.
Accident Attorney Philadelphia
I simply couldn’t depart your web site before suggesting that I extremely enjoyed the usual info a person provide for your visitors? Is going to be again ceaselessly in order to investigate cross-check new posts.
centrebet promotional code
Perfectly pent subject matter, thanks for information. “Necessity is the mother of taking chances.” by Mark Twain.
Ladbrokes Singapore
I think that is one of the so much important info for me. And i am happy studying your article. However wanna statement on few common things, The site taste is great, the articles is really nice
. Excellent job, cheers.
Bet365 Singapore
Very nice pattern and wonderful articles , very little else we need : D.
kataskeyh istoselidon
I liked as much as you’ll obtain carried out proper here. The caricature is tasteful, your authored subject matter stylish. nonetheless, you command get bought an impatience over that you want be handing over the following. sick for sure come more formerly again as exactly the same nearly a lot steadily inside case you shield this hike.
Retirement Communities in Delaware
This kind of web site document directory provides a lot of excellent material. I’d a good time exploring every one of the random posts and observing what other people are engaging in. Please always keep writing, I am excited to your following posting.
global internet marketing
Great article. Keep it up.
rolls royce
Thanks for sharing superb informations. Your web-site is very cool. I’m impressed by the details that you’ve on this blog. It reveals how nicely you perceive this subject. Bookmarked this web page, will come back for extra articles. You, my friend, ROCK! I found just the information I already searched everywhere and just couldn’t come across. What an ideal web site.