Credit balance in medical bills

As the name suggests, credit balances occur when the excess funds are charged compared to the cost of the provider's services. This may be due to a number of reasons that must be resolved in the final steps of processing the medical claim. The credit balance may be due to excessive payments to patients in the form of co-insurance or deductibles; or may be due to overpayments by insurance payers. Let's analyze some scenarios and why it's important to deal with them in a timely manner:

Patient credit balance:

The patient may have paid a certain amount in advance based on the assumptions covered by his payer. Once the medical claim is processed and the payer pays in full, the patient's payment will be excessive. The doctor billing solution can also call the patient and provide the option to adjust this excess or send a check for future visits. In either case, however, the patient's consent must be obtained and is mandatory.

Payer credit balance:

In many cases, the credit balance occurs due to the overpayment of the payer. Even the patient's credit balance is usually due to the higher than expected payment by the payer. In the processing of medical claims, it is important to prioritize the payment of the payer. This not only predicts the correct cash flow through the doctor's billing solution, but also increases the inflated AR. Some scenarios for the payer's credit balance:

1] Both primary and secondary payers are primary payers
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  2] The payer pays the error exceeding the allowable amount
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  3] Cross errors, especially between medical insurance and Medicaid
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  4] Plan for private purchases - always as a primary payment, although there may be another major plan

Rule:

In all of these cases, there are very strict guidelines and time frames, and depending on the circumstances, excess money must be returned to the payer or patient. If the payer is wrong, the payer must receive an error notification within 30-120 days, depending on the payer. Failure to notify within this time frame may be considered "fraud" and "fraud". Severe punishment by the payer and the state. If the payer rejects the refund [such as a private purchase plan], the money belongs to the patient and the patient must be notified. Providers of medical claims processing and physician billing solutions must keep these requirements in mind and process credit balances daily/weekly to avoid any hassle of provider and practice.

Compensation and offset:

Some payers adjust the payments for current and future claims based on the credit balances of other payers. These are called offsets when the payer adjusts payments based on current and future claims for past payments in their own plans.

The best option for handling credit balances is to outsource medical bills to professional medical claims processing companies.

Learn more about medical claim settlement and processing at http://www.mgsionline.com/medical-claims-billing.html.

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