Practice Management Alert

In most cases, the overpayments that you’ll have to deal with will come from one single payer or Medicare. But if you find yourself scratching your head about what seems to be an overpayment that the payer says is a valid payment, consider:

Checking for Multiple Plans

If the payer assures you it processed the claim correctly, check to see if the patient has a second insurance plan, advise billing experts Alice Scott and Michele Redmond of Solutions Medical Billing Inc. There may be a confusion if the secondary insurance allows a higher amount than the primary, in which case it’s not truly an overpayment and no money needs to be returned. Simply adjust the patient’s balance to offset the credit.

To further complicate things, write Scott and Redmond in a blog post for CareCloud, privately-purchased secondary insurance plans “do not always follow the same guidelines as other insurance carriers. Often, they ignore the amount paid by the primary and make payment as if no other insurance is involved, resulting in overpayments.” If this is the case and it’s a true overpayment, the patient should be repaid, because he or she purchased that other plan.

How to Let the Patient Know About an Overpayment

If you need to refund an overpayment to patients, you’ll typically be greeted with joy. However, being clear and concise as to why they’re receiving a check will help instill confidence in your practice.

The reasons for refunds to patients for overpayments are typically related to incorrect insurance information. Below are yet more reasons to always verify patients’ eligibility and coverage changes, according to health educator Laura Palmer of Pinnacol Assurance:

• Incorrect copay
• Supplemental insurance that the patient forgot to mention
• Incorrect billing
• Insurance coverage changes.

Once you discover the overpayment, you should contact patients immediately to discuss the reason for returning the funds and to inform them of repayment options. In the event that you can’t reach them, it’s not just free money. State laws vary on unclaimed property, but you cannot simply keep the money. “It’s not up to the practice to decide whether they want to write a check for outstanding patient credit balances,” Palmer told MGMA Connection Plus.