Records Supporting CMS-838 Data

20.4 - Records Supporting CMS-838 Data (Rev. 99, Issued: 06-30-06; Effective/Implementation Dates: 10-02-06) Develop and maintain documentation that shows that each patient record with a credit balance (e.g., transfer, holding account) was reviewed to determine credit balances attributable to Medicare and the amount owed, for the preparation of the CMS-838. At a minimum, your procedures should: • Identify whether the patient is an eligible Medicare beneficiary; • Identify other liable insurers and the primary payer; • Adhere to applicable Medicare payment rules; and • Ensure that the credit balance is due and refundable to Medicare. NOTE: A suspension of Medicare payments may be imposed and your eligibility to participate in the Medicare program may be affected for failing to submit the CMS- 838 or for not maintaining documentation that adequately supports the credit balance data reported to CMS. Your FI will review your documentation during audits/reviews performed for cost report settlement purposes.