Do you know about - Dealing With Overpayments When Billing healing Claims
Phone Claim! Again, for I know. Ready to share new things that are useful. You and your friends.Sometimes a provider is reimbursed too much money for the services provided which results in an overpayment. Sometimes the overpayment is made by the insurance carrier and sometimes it is made by the patient. In whether case, it is leading that the overpayment be returned to the suitable man or carrier.
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If a outpatient pays more than they are required to the outpatient must be notified as soon as the overpayment is discovered. The overpayment can be applied to a time to come visit if the outpatient will be returning but only if the outpatient agrees to that. The provider can not just indefinitely hold onto the money.
An example would be if a outpatient came in for an office visit and paid a co-pay. The provider ends up removing a mole which is determined surgery and doesn't wish a co-pay resulting in an overpayment. Once the office realizes the co-pay should not have been collected they can do one of two things.
1. Notify the outpatient of the overpayment. If the outpatient will be returning the office can suggest that they apply it as a prestige toward the next visit. If the outpatient doesn't want to apply it toward a time to come visit, the overpayment must be returned.
2. Send the outpatient a check for the overpaid amount with a note explaining the overpayment.
In any case a provider cannot just keep the overpayment. That is illegal.
If an insurance carrier makes an over payment it is leading to first conclude if it is truly an over payment. Call the carrier that made the overpayment and ask them to clarify how they determined their payment amount and if they processed the claim correctly. If they confirm that they did make an overpayment they should reprocess the claim to show correct payment and send a ask for the provider to return the overpayment.
Sometimes they will just ask the provider over the phone to return the overpayment. Personally I all the time ask them to ask the money back with a written explanation. When you receive the written ask for the overpayment attach a check for the overpayment to the ask and send it to the address indicated on the request. If they don't supply an address send it to the claims address but indicate "Attn: Overpayments".
If you receive a payment from an insurance carrier and the whole payment is wrong or not rightfully due to the provider write "void" on the check and return it to the insurance carrier with an explanation of why the payment was not due. For example if the payment is for a outpatient that was not seen by the provider, write "void" on the check and attach a note saying "This outpatient was not seen in our office."
If they state while the call that they processed the claim correctly and that there was no overpayment then you need to conclude if there truly was an overpayment. Sometimes a outpatient has two insurance plans. The original allows a obvious amount and then makes payment Then the secondary processes the claim and allows a higher amount than the original insurance carrier which results in a prestige balance.
This is not literally an overpayment. The amount contractually adjusted off from the original insurance carrier was more than needed to be adjusted off based on the secondary insurance carrier's payment. Therefore there is not a true overpayment and no money needs to be returned. The patient's equilibrium just needs to be adjusted to offset the credit.
Sometimes a patient's secondary insurance carrier is a secretly purchased insurance. They do not all the time consequent the same guidelines as other insurance carriers. Many times they ignore the amount paid by the original and make payment as if no other insurance is involved resulting in an overpayment. In this case the overpayment amount belongs to the outpatient since they purchased the other insurance plan. The provider cannot just keep the money. The provider cannot derive more than he or she billed out for their services.
It is leading that overpayments are not ignored. First conclude if it is a true overpayment. If it is, conclude who the overpayment needs to be returned to and then do what is significant to return it. Remember only prestige it to a time to come visit with the patient's permission
Copyright 2010 - Michele Redmond - Solutions medical Billing Inc
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