Wiki Overpayments/refunds

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MDPAYNE

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Idaho Falls, ID
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If a patient has a primary and a secondary insurance both carriers pay on the claim creating an overpayment phone calls have been made to both carriers on a number of occasions and overpayment letters have been sent out a number of times to both carriers and no response. Who would get the refund ? Or is this something that would go to unclaimed properties?
 
Our office policy is to try 3 times to ask for a refund request. If we receive no response and it has been 1 year since their payment, we note the account as an unwanted refund. If I know for a fact it is the secondary's credit ,if I have their address, I do a voluntary refund. I like to keep my credits as slim as possible. If both insurance companies are paying as primary, you need to get the patient to call both insurance carriers and update their information. This happens a good bit and after the patient calls to correct the insurance carriers almost immediately request their portion of the overpayment back.
 
So is the unwanted refund written back on to restore the patient account back to zero or do you leave the credit balance on and know that the account does not need to be worked anymore after the year?
 
Medicare Audit ...

Hello

I would suggest that you may want to leave the extra money as a credit to that patient's account ... and use the credit as more services are rendered.

What you would not want is - to be caught with the "unwanted refunds" in a Medicare audit ... especially if that is not what they are looking for.

Also .. if you want ... you can check the OMFS to see what the correct amount should have been - and then find out who overpaid their portion ... and return the extra money to that payor.
 
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