Credit Balance Report
A Medicare credit balance is an amount determined to be refundable to the Medicare program for an improper or excess payment made to a provider because of patient billing or claims processing errors. Each provider must submit a quarterly Credit Balance Report, (Form CSM-838). 
Refer
to the Medicare
Financial Management Manual (CMS Pub. 100-06) Ch. 12 for
instructions.
Providers with low Medicare utilization, as specified in Provider Reimbursement Manual, CMS Pub. 15-I, §2414.B, or files less than twenty-five Medicare claims per year, do not have to submit Form CMS-838. Providers that qualify should submit one, signed and dated certification page and a letter indicating that they are a low Medicare utilization provider.
Send your Credit Balance Reports to the “Credit Balance Reporting” address listed under Provider Audit and Reimbursement / Financial section of the Write Us page. Please submit the CMS Credit Balance 838 form along with your payment. The following provides the reporting periods and associated due dates:
| Quarterly Reporting Period | Due By |
|---|---|
| Jan. 1 - March 31 | April 30 |
| April 1 - June 30 | July 30 |
| July 1 - Sept. 30 | Oct. 30 |
| Oct. 1 - Dec. 31 | Jan. 30 |
Examples of Medicare credit balances 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 noncovered services;
- overpaid because of errors made in calculating beneficiary deductible and/or coinsurance amounts;
- a hospital that bills and is paid for outpatient services included in a beneficiary's inpatient claim.
If you fail to submit a Form CMS-838 and/or certification page with all provider numbers identified, program payments will be suspended as stated in 42 CFR 413.20(e) and 405.370.
Page last updated: September 15, 2008
