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Medicare Credit Balance Report

What is it?


There are situations where an amount is determined to be refundable to the Medicare program for various reasons. These reasons can include an improper payment made to a provider due to claims processing errors. Improper payments due to errors and patient billing are also included. In addition, excess payments made to a provider due to either of these types of errors can also be included. Medicare credit balances can happen for numerous reasons.


One reason is if a service is paid for twice, by Medicare, or Medicare and another insurance provider. Paid services that are planned but never actually happened, or for services that are not covered but were paid for, can also be included in a Medicare credit balance report. Additionally, errors made in calculating a beneficiary deductible or coinsurance amount can also result in an overpayment and will appear on a Medicare credit balance report.


Why Do You Have To Do It?


Agencies are required to submit this report to Medicare regardless of whether a balance needs to be refunded. A person might not have a credit balance due, but it is still a serious requirement that has penalties and consequences if the proper paperwork is not submitted. If you fail to identify all provider numbers or fail to submit the proper paperwork, it is possible your Medicare payments will get suspended.


Where Are The Forms Located?


You will need to contact the CMS to get the Medicare credit balance report. If no credit balances need to be reported, the certification page is the only page that you will need to complete. Once this certification page is completed, you will submit a copy to your MAC. If you do have a credit balance to report, make sure also to fill out the Detail Page and submit that to your MAC as well.


When Is It Due?


These reports are due quarterly, with due dates on April 30, July 30, October 30, and January 30. Each of these due dates corresponds to a quarterly reporting period. For the quarterly reporting period of January 1 to March 31, the due date is April 30 for the forms. For the quarterly reporting period of April 1 to June 30, the due date is July 30. There is a quarterly reporting period from July 1 to September 30, and the Medicare Credit Balance Report for that period is due on October 30. The last quarterly reporting period of the year is between October 1 and December 31. The due date for this is January 30.


Remember that missing these due dates can have consequences and result in your Medicare payments being suspended. It is up to you to pay attention to these overpayments and submit them with your Medicare credit balance report. Many people find that by keeping track of their medical expenses in one place, as well as keeping all of the documentation in that place as well, is extremely helpful for efficiently submitting a Credit Balance Report.


Who Do You Send It To?


Make sure to send your properly filled out Credit Balance Reports to your MAC. This can be done by fax unless a payment is due. If payment is needed, agencies are recommended to send it by certified mail or courier.