Quarterly Credit Balance Reports No Longer Required

As of 12/1/2024, providers are not required to submit the Medicare Credit Balance Report (CMS-838) on a quarterly basis. However, to ensure that monies owed to Medicare are repaid in a timely manner, all providers participating in the Medicare Program are still required to report self-identified overpayments and submit credit balance reports when they occur. The fastest and easiest way to submit a credit balance report is through NGSConnex. Refer to the NGSConnex User Guide for step-by-step submission instructions.

A credit balance is an improper or excess payment made to a provider as the result of patient billing or claims processing errors. 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; or
• A hospital that bills and is paid for outpatient services included in a beneficiary’s inpatient claim.

Credit balances do not include instances where the provider received a demand letter or in cases where proper payments made by Medicare are in excess of a provider’s charges, such as DRG payments made to hospitals under the Medicare prospective payment system.

CMS will be updating the Internet Only Manual (IOM) Publication 100-06, Medicare Financial Management Manual, Chapter 12 in the near future to align with the revised requirement.

Posted 1/10/2025