Wiki Overpayments/Refunds

[rbynmnk]

Can I please get some input regarding overpayments? Our office is not contracted with almost all insurance carriers. If our office receives an overpayment from an insurance carrier we are not contracted with (and that is not a government sponsored plan), are we required to issue the refund? Or is it up to the insurance carrier to request the overpayment or recoup the overpayment?

 

[dmaec]

well, not my area of expertise - but seems to me, if you're overpaid and know it, and keep it - you're stealing. (not you personally, but your facility). I would assume that when and if it catches up with the facility for NOT reimbursing over payments,..there'll be more than just a slap on the wrist.

(sort of reminds me of parents who don't pay child support just because there isn't an order to do so). Why do they (or your facility) need someone else to tell them to do what they know is right and required?....

 

[Radcoder1313]

I don't know what insurance companies you're dealing with, but from my experience, there are some companies that are going to pay their allowable no matter what your charge is and will not accept a refund. I would contact the companies to see if they want refunds and go from there. Make sure to document your accounts with the individual's name (and reference number if available) that you speak with.

 

[jdrueppel]

I'm confused - if you're NOT participating and therefore not bound to a fee schedule how do you know the insurance is overpaying? Unless, are they paying MORE than your billed amount?? If that is the case then you have an obligation to inform the payer of the overpayment.

Not that I think you should raise your charges but have you done a review of your charge amounts to make sure your charges are not based on a low fee schedule (i.e. Medicare)?

Julie, CPC