Medicare Financial Management Manual (Pub. 100-06), Ch. 1 § 140.1
Completing the Schedule of Non-COB Credits (Schedule C) -
140.1 - Completing the Schedule of Non-COB Credits (Schedule C) -
(Rev. 1, 08-30-02)
A1-1217.1, B1-4217.1
A. General
The contractor shall use this schedule to identify specific Non-COB Credits included in
the Non-COB Credit line of the Activity Screen as defined in §90.9 G. A separate
Schedule C is completed for each activity requiring the specific identification of Non-
COB Credits.
B. Uses
The contractor shall complete this schedule only with the concurrence of CMS. It may
not be required of all contractors. If required, the schedule may be used for the BR, SBR,
IER and/or FACP.
C. Explanation of Entries on the Schedule C
1. Code - A three-digit code identifying each credit item. The contractor shall use 999 to
identify all remaining credits not requiring specific identification.
2. Description - A brief description of the discrete credit item. Types of credits to be
reported are described in §90.9 G. Those items requiring identification will depend on the
nature of the contractor's contract, materiality and other considerations.
3. Total Credits - The contractor shall report the total credit for each item. The total for
all Non-COB Credits, including those reported under 999 if applicable, must agree with
the total reported on the Non-COB Credits line of the Activity Screen.