Minimum Requirements for Internal Controls

10.1.2 - Minimum Requirements for Internal Controls (Rev. 99, Issued: 06-30-06; Effective/Implementation Dates: 10-02-06) A. A designated centralized area to receive Medicare credit balance reports. B. FIs shall have all CMS-838 reports and accompanying documents retained in the centralized area. The sole exceptions are the originals of the accompanying check and/or accompanying claim adjustment bill. • A copy of any accompanying check or accompanying claim adjustment bills must be retained with the other original documents. • All other documents must be copied if the information they contain is needed by another area for the resolution of any matter involving provider credit balance reports. • The envelopes shall be retained or copied to substantiate the date of receipt of the CMS-838 report. NOTE: FIs may convert these materials into image files (e.g., PDF files) for electronic storage and archival purposes. C. Faxed credit balance reports that are within 30 calendar days of the close of each calendar quarter should be accepted as timely. • Retain the coversheet to substantiate the date of receipt of the CMS-838 report. NOTE: When the FI accepts faxes, the FI shall ensure that these faxes are received over electronically secure transmission lines, and placed in a limited access work area. D. The FI shall designate a point of contact for receipt and the resolution of credit balance reporting related issues. This individual is to verify that all FI activities related to credit balance reporting are completed timely and accurately in all areas of the FI. E. The FI shall have a listing of all providers required for submitting the CMS-838. FIs shall have written procedures to ensure this listing is reviewed and updated each calendar year quarter. F. Written policies and procedures for monitoring and validating receipt of timely, accurate, and complete CMS-838s from all providers. For example: • Is the name and title of the certifying officer or administrator of the provider on the Certification Page, and are all data fields completed for Medicare credit balances on the Detail Page? Did the Detail Page come with an accompanying check and/or appropriate hard copy or electronic adjustment bills? • Were the monies for the reported credit balances timely recouped to the Medicare Trust Fund? G. FIs shall have appropriate tracking and/or reports for provider credit balances reporting related activities. For example: • Such as related claims adjustments, Suspension Warning Letters and suspensions, verification of low Medicare utilization providers with claims data, demand letters, financial reporting, credit balance summary reports, etc., that have been performed with respect to credit balance reports due or received for a given calendar year quarter. H. The FI shall have internal controls in place to ensure the accurate and timely processing and reporting of credit balances. • The time frame for processing claims adjustments for Medicare credit balances from start to finish is 90 days from the receipt date of acceptable credit balance reports. (Contact your RO if you need additional time.) I. A desk guide or manual with published internal control policies and standard operating procedures for implementing the credit balance reporting process.