We have several patients who seen providers in our practice that were not credentialed, and claims did not get billed to the insurance. Copays were collected at time of service. Do these copays need to be refunded to the patients since insurance was not billed at all or can we keep these?
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Wiki Patient Copays
- Thread starter nklunk86
- Start date
TThivierge
True Blue
Hi
From my understanding copays collected are for the office. Keep them. However if wait too long and let contract expire with timely billing on claims....you cannot bill those patients later for balance; those should be adjusted off. Just my two cents from when I was a reimbursement billing manager years ago
Lady T
From my understanding copays collected are for the office. Keep them. However if wait too long and let contract expire with timely billing on claims....you cannot bill those patients later for balance; those should be adjusted off. Just my two cents from when I was a reimbursement billing manager years ago
Lady T
Contractually, copays are part of the allowed amount.
If there's no allowed amount, there's no copay. They should be returned.
TThivierge
True Blue
Hello Again,
These patient paid the assigned copayment required for visit in which they did get treatment. If copay is sent back the treatment given for the day was for free. Makes no sense to me, but things do change.
Lady T
These patient paid the assigned copayment required for visit in which they did get treatment. If copay is sent back the treatment given for the day was for free. Makes no sense to me, but things do change.
Lady T
Could you not see the patient as a self pay if the provider is not credentialed yet? Could have collected with a good faith estimate?
lfontanez
Contributor
If you did not bill the insurance for the claim, then taking the co-pay would not be correct since that is the amount set by the insurance carrier/plan for the service, in which you did not bill. You should be taking an amount for a self-pay rate.
julieordway
Networker
If you were not yet contracted you can keep the copays since you did not have a formal agreement with the insurance plan. I would not charge the self pay fee unless you informed the patients prior to seeing them with a good faith estimate that you would be charging them.