Inquiring as to office policies in place concerning refunds to patients. With higher copayments, deductibles etc, we make every effort to accurately collect correct payments based upon insurance verification & fee schedules at the time of service. Inevitably there are overpayments; sometimes a few cents to larger dollar amounts. Deductibles & coinsurances paid at the time of service and reimbursed by insurance are refunded promptly, but how are most practices handling the smaller refunds? Is it acceptable to have a minimum amount required for refund and should this be a written policy?
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Wiki Patient refunds - Inquiring as to office policies
- Thread starter karen1123
- Start date
teresabug
Expert
if a provider knowingly accepts an overpayment from either an insurance carrier or a patient, they are to be notified of the overpayment and provider is to request an insurance "take-back". Patients that have credits should be contacted and informed. Many practices ask the patient if they can leave the patient overpayment as a "credit" on their account to be applied at their next office visit if a copay would be due (not talking about preventive services which are covered at 100%).
cyndeew
Guru
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Yes, you can and you should have a written policy and make it known to patients. You can make it so that you only send a patient a refund check if it's over a specified amount, say like $5 (whatever is prudent for your office), and if it's under, you will apply it to the patient's next appointment. However, if it is clear that a patient won't be returning, say in 12-18 months and that patient hasn't come back, you should refund any amount, including small amounts because credit balances don't belong to the provider, ever. And, every single states has an escheat law (unclaimed property) which requires you to submit to the state, overpayments that have gone unrefunded after a specified time (depends on your state).
Overpayments are supposed to be refunded within 60 days under the Patient Protection and Affordable Care Act of 2010 (PPACA) See http://www.healthcarefinancenews.co...overpayments-60-days-or-risk-false-claims-act
However, if you set your policy at the minimum dollar amount, just be sure to follow your policy to the letter and be able to account for every single credit balance and be sure to take some kind of action after a specified time. This will require you to follow all credit balances within your office.
Also, credit balances should be addressed through your office's OIG Compliance plan. If you don't have a plan, you really should. You can read the guidelines for physician offices at http://oig.hhs.gov/authorities/docs/physician.pdf
Overpayments are supposed to be refunded within 60 days under the Patient Protection and Affordable Care Act of 2010 (PPACA) See http://www.healthcarefinancenews.co...overpayments-60-days-or-risk-false-claims-act
However, if you set your policy at the minimum dollar amount, just be sure to follow your policy to the letter and be able to account for every single credit balance and be sure to take some kind of action after a specified time. This will require you to follow all credit balances within your office.
Also, credit balances should be addressed through your office's OIG Compliance plan. If you don't have a plan, you really should. You can read the guidelines for physician offices at http://oig.hhs.gov/authorities/docs/physician.pdf