Occasionally, the provider will reimburse too much money for the services provided, resulting in overpayments. Sometimes multiple payments are made by insurance companies, sometimes by patients. In either case, it is important to return the overpayment to the appropriate person or carrier.
If the patient pays more than the patient needs, the patient must be notified immediately after the overpayment is found. If the patient will return, the overpayment can be applied to future visits, but only if the patient agrees. The provider cannot hold the money indefinitely.
An example would be if a patient enters the office and pays for a co-payment. The provider eventually deletes the defects that are considered to be surgery and does not require co-payments to result in overpayments. Once the office realizes that co-payments should not be charged, they can do one of two things.
1. Inform patients to pay more. If the patient will return, the office can advise them to use it as the credit for the next visit. If the patient does not wish to use it for future visits, they must return the overpayment.
2. Send the patient an overpaid check with instructions for explaining the overpayment.
In any case, the provider cannot only keep multiple payments. This is illegal.
If the insurance company pays too much, first determine if it is really an overpayment. Call the overpaid carrier and ask them to explain how they determined their payment and whether they processed the claim correctly. If they confirm that they did pay more, they should reprocess the claim to show the correct payment and send the requesting provider a refund of the overpayment.
Sometimes, they only ask the provider to return more payments by phone. I personally ask them to ask for a refund in writing. When you receive a written request for overpayment, please check the overpaid request and send it to the address indicated in the request. If they do not provide an address, please send it to the claim address, but specify "Attn:Overpayments".
If you receive payment from the insurance company and the entire payment is incorrect or unreasonable, the provider writes "invalid" on the check and returns it to the insurance company, stating the reason why the payment has not expired. For example, if the payment is for a patient not seen by the provider, please write "Invalid" on the check and attach a note stating "The patient is not seen in my office."
If they declare that they handled the claim correctly during the call and did not pay more, then you need to determine if there is a multi-payment. Sometimes patients have two insurance plans. A certain amount is then allowed to be paid and then the claim is processed in a secondary order and a higher amount is allowed than the primary insurer, which results in a credit balance.
This is actually not overpaid. The amount of the main insurance company after the contract adjustment exceeds the amount required for the adjustment of the payment according to the secondary insurance company. Therefore, there is no real overpayment and no refund is required. It is only necessary to adjust the patient's balance to offset the credit.
Sometimes, the patient's secondary insurance company is privately purchased insurance. They do not always follow the same guidelines as other insurance companies. Many times, they ignore the amount of the main payment and pay, as if there is no other insurance involved, resulting in overpayment. In this case, the overpayment is for the patient because they have purchased other insurance plans. Providers can't just keep money. The fee charged by the provider will not exceed his or her service fees.
It is important not to overlook overpayments. First determine if it is a real overpayment. If yes, determine who needs to return the overpayment and then perform the necessary return. Remember, you can only attribute it to future visits if you have a patient license.
Copyright 2010 - Michele Redmond - Solutions Medical Billing Inc.
Orignal From: Hand over overpayments when issuing medical claims
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