Develop a Strategy to Manage Take Backs
By Delly Parham, CPC
“Take backs” have replaced “pay backs,” thanks to the adoption of paperless business practices. This demands a new approach to overpayment issues.
What is a take back, and what does this mean to your practice? A payer automatically deducts dollars for an alleged overpaid claim from a future claim payment. This is a much more difficult challenge for you to overcome because, in this case, the carrier has the money, not you.
Take backs may hinder the efficiency of your practice. However, some carriers list the individual claims and give a reason for the return request; others merely give a dollar figure, with no additional information. Tips that may minimize your frustrations and help to protect your practice, reduce staff time, and keep your records balanced when you are “hit” with take backs are:
- Clarify the take back policies and procedures of each electronic fund transfer (EFT) payer
- Check the notices as they may come by email or by way of electronic remittance advice (ERA).
- Check your billing software to see if it has a function that will transfer previous payment from one patient account to a future patient’s account. If not, adopt a specific policy for the posting and tracking of the take backs to avoid the hassle of explaining to the boss or accountant months later why that ERA batch was out of balance.
- Confirm whether the take back is justified.
If you disagree with the take back, develop a procedure for appealing.
To appeal large amounts:
- Start by making contact at the top. If you start at the top, the carrier’s president (or representative) can authorize lower-level individuals to help you.
- Prepare a letter with the patient’s identifying information on the take back, attaching the ERA and EOB.
- Send the letter by certified mail, keeping copies in a separate file and you may label it take back disputes or whatever you wish.
- Know your ERISA rights: Send a copy of the letter to ERISA, if applicable.
- Retain copies of all correspondence, persons contacted, date and time.
- Contact a healthcare law attorney, if necessary.
To appeal small amounts:
- Contact the carrier representative immediately.
- Send a standard letter (form letter) indicating the reason for the dispute.
- Retain copies for your file.
- To avoid penalties, follow up until resolved.
If the amount is too small, your office may wish to evaluate this process and implement a policy regardless of whether it is cost effective to dispute these take backs, versus writing off these amounts.
Gone are the days when payers reimburse via paper checks and Explanation of Benefits (EOB), and then request money back on previously paid claims by sending paper demand notices or letters.