Overpayments

Submit a Quarterly Credit Balance Report

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Submit a Quarterly Credit Balance Report

Credit balance reporting is used to certify whether you have any outstanding monies owed to the Medicare Program. Part A providers submit credit balance reports to Medicare on a quarterly basis.

Generally when a provider receives an improper or excess payment for a claim, it is reflected in the provider’s accounting records as a “credit.” The provider is responsible for identifying and repaying all monies from these credits to the Medicare Program.

Although, you have several options available to submit your Credit Balance Report, the preferred method is through our secure internet portal, NGSConnex. NGSConnex allows you to:

  • complete the Certification Page and the CMS-838 spreadsheet in one transaction. You won’t need to fax or mail anything,
  • either manually enter the CMS-838 details or upload your completed CMS-838 Excel file saved as a CSV file extension,
  • benefit from the validation edits to ensure all required fields on the Certification Page are complete and
  • receive immediate confirmation that your report has been submitted.

If you are not yet a registered NGSConnex user for the provider, follow the NGSConnex User Guide instructions to register now so you are ready to use NGSConnex when the next quarterly report is due.

If you are already a registered NGSConnex user, follow the NGSConnex User Guide instructions to complete the Certification page and submit the accompanying documentation, either the Credit Balance Report details or specify that there are no credit balances to report for the quarter.

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How to Submit a Quarterly Credit Balance Report

What Should I Do When…

I don’t have a credit balance.

  • You must still complete a certification page and check the bottom box on that page certifying that no monies are owed to Medicare for this quarter.

I do have a credit balance as of the last day of the reporting quarter.

  • Complete a certification page with the middle box checked. All 10 fields of the certification page must be completed to avoid rejection.
  • Complete the 838 detail page. All 15 columns of the 838 detail page must be completed for each credit balance identified.
    • NGSConnex submitters manually enter or upload the CMS-838 details.
    • FISS/DDE users can submit the 838 detail page directly over the FISS/DDE provider online system. (Certification page must still be faxed separately and include your email address on your fax cover sheet.)
    • CDs or diskettes shouldn’t be submitted with a CMS-838 detail page.

Please note: Only those credits for which the amount due to Medicare has not been recouped through the claim adjustment process as of the last day of the quarter should be reported on the 838 detail page.

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Credit Balance Submission Timeline

Quarter 1: Reports can be submitted starting 1/1 for the quarter ending 12/31. Providers have 30 days to submit their reports timely.

Quarter 2: Reports can be submitted starting 4/1 for the quarter ending 3/31. Providers have 30 days to submit their reports timely.

Quarter 3: Reports can be submitted starting 7/1 for the quarter ending 6/30. Providers have 30 days to submit their reports timely.

Quarter 4: Reports can be submitted starting 10/1 for the quarter ending 9/30. Providers have 30 days to submit their reports timely.

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Failure to Submit/Late Filings

Providers who have failed to submit a credit balance report within the 30-day period following the end of a reporting quarter will receive a warning letter to advise that Medicare has not received a report and if the report is not submitted within 15 days of the date of the warning letter, a payment hold will be initiated until a valid report is received.

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Additional Tips for a Successful Credit Balance Report Submission

  1. Utilize NGSConnex to submit your reports.
  2. Submit your credit balance reports as soon after the end of the quarter as possible, especially if you are faxing your reports. Due to the high volume of submissions, providers may receive a busy signal when faxing their reports during peak submission periods.
  3. Review your certification page to avoid the most common reasons for rejection:
    1. Quarter end date is incomplete-refer to timeline for quarter end dates
    2. Title of signor is missing
    3. Date report submitted to NGS is PRIOR to the date the certification page was signed
    4. Box on lower left corner of certification page is not checked
  4. Avoid hand writing information on the 838 detail page. Submitting claim information using an Excel spreadsheet is acceptable as long as the format is identical to the CMS-838 detail page.
  5. When faxing 838 detail page(s), select a font size no less than 8 point and include your email address on your fax cover sheet.
  6. Credits being reported on the 838 Detail page due to Medicare paying incorrectly as the primary insurance should include the complete mailing address of the other insurance carrier along with the company name.

Only those credits that a provider would submit on a CMS UB-04 form are to be included on the CMS-838 Detail page. DME and claim information submitted on CMS-1500 forms are not reported on a CMS-838 Detail page.

Revised 6/4/2021