Credit Balance Report



Save, fill-In The Blanks, Print, Done!

Click on image to zoom / Click button below to see more images
Adobe Acrobat (.pdf)

  • This Document Has Been Certified by a Professional
  • 100% customizable
  • This is a digital download (792.65 kB)
  • Language: English
  • We recommend downloading this file onto your computer.


  
ABT template rating: 8

Malware- and virusfree. Scanned by: Norton safe website

How to draft a Credit Balance Report? An easy way to start completing your document is to download this Credit Balance Report template now!

Every day brings new projects, emails, documents, and task lists, and often it is not that different from the work you have done before. Many of our day-to-day tasks are similar to something we have done before. Don't reinvent the wheel every time you start to work on something new!

Instead, we provide this standardized Credit Balance Report template with text and formatting as a starting point to help professionalize the way you are working. Our private, business and legal document templates are regularly screened by professionals. If time or quality is of the essence, this ready-made template can help you to save time and to focus on the topics that really matter!

Using this document template guarantees you will save time, cost and efforts! It comes in Microsoft Office format, is ready to be tailored to your personal needs. Completing your document has never been easier!

Download this Credit Balance Report template now for your own benefit!

(No Detail Page(s) attached.) Contact Person Telephone Number Form CMS-838 (10/03) INSTRUCTIONS FOR COMPLETING THIS PAGE ARE IN MEDICARE CREDIT BALANCE REPORT PROVIDER INSTRUCTIONS, FORM CMS-838 HIC Number Beneficiary Name Form CMS-838 (10/03) (2) (1) Type of Bill (6) Admission Discharge Date Date (MM/DD/YY) (MM/DD/YY) (8) Paid Date Cost Report (MM/DD/YY) (Open/Closed) (7) (9) Amount of Medicare Credit Balance (10) Amount of Medicare Credit Balance Repaid (11) Method of Payment (12) Amount of Medicare Credit Balance Outstanding (13) (14) Reason for Medicare Value Credit Balance Code INSTRUCTIONS FOR COMPLETING THIS PAGE ARE IN MEDICARE CREDIT BALANCE REPORT - PROVIDER INSTRUCTIONS, FORM CMS-838 ICN Number (3) (5) Primary Payer (Name Billing Address) (15) Phone Number ()- Quarter Ending: (4) Contact Person: Provider Number: Medicare Part: (Indicate “A” or “B”) Pageof Detail Page Medicare Credit Balance Report 2 Form Approved OMB No.. If there are multiple provider numbers for dedicated units within the facility (e.g., psychiatric, physical medicine and rehabilitation), complete a separate Medicare Credit Balance Report for each provider number • The month, day and year of the reporting quarter e.g., 12/31/02 • An “A” if the report page(s) reflects Medicare Part A credit balances, or a “B” if it reflects Part B credit balances • The number of the current detail page and the total number of pages forwarded, excluding the certification page (e.g., Page 1 of 3) and • The name and telephone number of the individual who may be contacted regarding any questions that may arise with respect to the credit balance data.. For code description, see each provider manual has the appropriate cite for that manual .) 12 – Working Aged 13 – End Stage Rena




DISCLAIMER
Nothing on this site shall be considered legal advice and no attorney-client relationship is established.


Leave a Reply. If you have any questions or remarks, feel free to post them below.


default user img

A man should never neglect his family for business. | Walt Disney