Issuance of a Notification/Rejection Letter to Providers Regarding Non-Payment

10.4 - Issuance of a Notification/Rejection Letter to Providers Regarding Non-Payment of Medicare Credit Balances or Missing/Inaccurate Information on the CMS-838 Report (Rev. 99, Issued: 06-30-06; Effective/Implementation Dates: 10-02-06) A. The FI shall have a process in place to resolve non-payment of Medicare credit balances or missing/ inaccurate information on received CMS-838 reports. For example: • Review each credit balance entry individually on the CMS-838 report to determine whether it is missing information such as: is it being repaid by check or hardcopy adjustment bill? • Contacting the provider via telephone, to obtain missing information on the CMS-838 report. (Phone calls should be documented). • If the FI is successful at reaching the provider, the provider may fax over the requested information at the FI’s discretion. B. If the FI is unsuccessful in reaching the provider within 30 calendar days from the due date of the CMS- 838 report, the FI should issue a letter on the thirtieth day after the due date of the CMS-838 report. • This letter shall state that the FI will place the provider on 100% withhold up to the total amount owed if the provider does not send a check or adjustment bills for these balances in 15 calendar days from the date of this letter. • After the Notification/Rejection letter has been sent and the provider is placed on 100% withhold up to the total amount owed and a balance remains outstanding 60 days after the due date of the CMS- 838, the FI must issue a demand letter to the provider. Refer to Section 10.6 - FI Issuance of a Credit Balance Demand Letter.