Don’t Take Medicare Credit Balance Management For Granted

By Infinx
December 6, 2016

With a new administration taking office come January, healthcare providers are understandably already a little nervous. Will our new president follow through on campaign promises to dismantle the ACA, or radically alter Medicare? While the future of federal healthcare programs may be up in the air, it’s not unreasonable to assume
the incoming leadership of HHS and CMS will devote renewed effort into cracking down on a persistent existing issue: collection of outstanding credit balances.

Credit balances are overpayments received for Medicare-billed services, most typically attributable to any of the following:

  • Charge correction claims
  • Duplicate billing
  • Medicare payments received for non-covered services
  • Payments exceeding the allowable amount for a covered service
  • Misposted payments or allowances
  • Services billed to Medicare when another payer was responsible for primary

Enforcement is Getting Tougher

For many years, Medicare’s efforts to recoup credit balances were spotty at best. For most healthcare practices – operating under ever-thinning profit margins – devoting the extra accounting required for returning “extra money” to Uncle Sam was hardly a priority. CMS’s most recent attempt at a credit balance crackdown was the agency’s
Final Rule , issued last February, requiring providers to report and remit credit balances within a mandatory 60-day timeframe – or be subject to prosecution for fraud under the False Claims Act.

The Devil You Don’t Know vs. The Devil You Know

Will 2017 bring major changes to federal healthcare programs that turn your practice’s RCM upside-down? Obviously, nobody knows yet. But now is the time to ensure your practice at least remains compliant with existing CMS regulations – either avoiding Medicare credit balances or making sure they’re identified and reported within the 60-day window:

  • Avoid credit balances at the outset by relying upon expert third-party analysts with a healthcare accounting background to make sure all Medicare procedures are correctly classified and error-free.
  • Review every Medicare-billed service and incorporate credit balance reporting into your practice’s RCM auditing and analytics to rapidly identify overpayments.
  • Avoid threats of prosecution or penalties by promptly submitting a fully completed Medicare Credit Balance Report ( Form CMS-838 ) every quarter, accompanied by credit balance repayments, if applicable.

When deploying our advanced healthcare RCM solutions for new customers, we see too often how proper prevention and management of Medicare credit balances have been dangerously overlooked. With major changes to Medicare looming on the horizon, don’t get caught off guard if policy enforcement becomes even more aggressive. To find
out more about effectively tackling credit balances and alleviating other day-to-day RCM hassles, contact us today.

About the Author



Infinx provides innovative and scalable payment lifecycle solutions for healthcare practices. Combining an intelligent, cloud-based platform driven by AI with our trained and certified coding and billing specialists, we help clients realize revenue, enabling them to shift focus from administrative details to billable patient care.

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