Policy Manual sample

MDT Home Health Care Agency, Inc. MEDICARE CREDIT BALANCE REPORT PURPOSE: To comply with guidelines issued by CMS regarding the quarterly reporting of Medicare Credit Balances on Form CMS-838 (Credit Balance Report). POLICY: · 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. Form CMS-838 is specifically used to monitor the identification and recovery of credit balances owed to 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. · These reports are carefully reviewed against actual agency bills and services provided so that claims are appropriately paid for by Medicare. PROCEDURE: Medicare Credit Balance Reports are submitted to the Fiscal Intermediary within 30 days after the close of each calendar quarter. The report is to include all Medicare credit balances as of the last day of the reporting quarter. The reimbursement staff assigned to Medicare will perform the following procedures on at least a monthly basis: · Identify Medicare credit balances from the remittance schedules, Medicare bill match, and Medicare secondary-payers queries · Verify eligibility status · Identify other liable insurers and the primary payers · Adhere to applicable Medicare reimbursement and claims processing rules regarding the refund of the account · Prepare a refund or adjustment as necessary to remove the credit from the A/R The reimbursement staff prepares the CMS-838 no later than three weeks after the end of the calendar quarter in accordance with the instructions from the Fiscal Intermediary. The reimbursement staff forwards the CMS-838 to the President for review and signature. The completed form is mailed to the Fiscal Intermediary with a copy retained for the agency files. Home Health Agency Overall Plan and Budget F-25