Message From Your Region 5 Representatives: Vanessa Moldovan and Sherrie Anderson
Don’t Let Excluded Credits Balances Hide Collectible Revenue
By Vanessa Moldovan, CPC, CPPM, CPMA
You may have encountered this situation: Your boss assigns you accounts receivable (A/R) follow up and among the various parameters, such as “over 90 days old” and “commercial payers only,” instructs you to “not work any credit balances.” Out of curiosity, you ask, “Why should I exclude credit balances from my A/R follow up?” Your boss replies, “Our company is focused on bringing more money in, not on sending money out.”
What is the flaw in this scenario? You might think that it’s because you asked, “Why?” That’s not it. The flaw is in the logic that credit balances shouldn’t be reviewed because they indicate money that needs to be returned. Don’t be fooled! Credit balances can hide a mountain of collectible revenue.
Although the rules, regulations, and ethics surrounding “keeping” revenue are time consuming, that’s not the purpose of this message. The purpose is to help the decision-makers in your organization recognize that credit balances need to be given the same amount of time and attention that debit balances do.
Each organization has different levels of education and appreciation among the revenue cycle team and that each practice management system has varying capabilities. The process to reduce or eliminate credit balances may be different for each one, but the causes of the credits are universal. Here are some of the most common causes of credit balances:
- Incorrect adjustments
- The contractual adjustments posted do not match what is on the explanation of benefits (EOB)/electronic remittance advice (ERA).
- The insurance carrier did not apply the correct patient responsibility; it is not uncommon for carriers to not apply appropriate copays.
- Duplicate payment posting
- The patient or insurance carrier was paid twice.
- Multiple carriers were paid, such as Worker’s Compensation and commercial carriers.
- The secondary carrier was processed and paid as the primary carrier.
- There was a charge entry error or corrected claim.
The cause of credit balances, as shown in this list, are not just scenarios where a bunch of checks must be written. Incorrect adjustments are the biggest culprit in hidden collectible revenue. There are so many instances when an adjustment can cover up an unpaid line item. But if it is not addressed in a timely manner, then it will be past the timely filing limit to send a corrected claim or an appeal.
Note: If you are the lucky one assigned to reviewing credit balances, please make it a priority to understand the laws in your state regarding returning funds to carriers and to patients and the guidelines outlined in the carrier contracts.
If you pass this hidden credit balance revenue information on to the A/R cycle decision-makers in your organization, they’ll be happy you’ve helped to recoup payment owed to your practice.
Vanessa L. Moldovan, CPC, CPMA, CPPM, is a revenue cycle manager at Hand to Shoulder Associates. Her focus for more than 17 years has been on education and the physician revenue cycle. Moldovan holds a Bachelor of Arts degree in Healthcare Administration from Ashford University. She has worked as a revenue cycle assessor, a revenue cycle manager, an executive account manager, and a consultant. Moldovan is the NAB’s Region 5 representative. She has been serving as a Des Plaines, Ill., local chapter officer since 2013, and served as president from 2014-2017.
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