Wiki Patient refunds - We have a change in administration

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l1ttle_0ne

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We have a change in administration happening at our clinic. We have always refunded the patient any money owed no matter the amount. The new adminstration wants to come up with a dollar amount to not refund. So for example anything under $10.00 you don't refund. Unless the patient asks for it. This doesn't really seem right to me.... I think the patients should get the refund no matter how small the amount. What is the policy at your practice??
 
We have a similar policy, but do not know enough to elaborate. Interesting to see others doing this, since I thought it was odd when I first heard of it.
 
Should be refunded

Any credit balance, no matter who was responsible for the overpayment, is a compliance red flag. And if these are consitently being written off instead of refunds being provided to the party who overpaid, be it the patient, government or commercial payer, that is asking for trouble.
 
MnTwins29 said:
Any credit balance, no matter who was responsible for the overpayment, is a compliance red flag. And if these are consitently being written off instead of refunds being provided to the party who overpaid, be it the patient, government or commercial payer, that is asking for trouble.
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Thank you!! That's the way I feel. We'll see if I can convince adminstration of the same thing.
 
Another point to consider is that if you have a lot of patients with a $10 copay and you are consistently writing off $10 balances, it gives the appearance that you are forgiving copays.

Also, no matter how small it is, you MUST make a good faith effort to refund the patient or carrier. Additionally, every single state has an unclaimed property law, which requires your office to submit those unpaid refunds to the state.

If this were your money, you'd want it back and the clinic is NOT entitled to it no matter how they try to justify it.

Disgruntled employees could easily turn the practice in and once investigators start digging, no telling what they will find/create.

And, last, but certainly not least, you are required to repay Government overpayments back within 60 days of identification, no matter how small they are.

Good luck - hopefully they will listen to reason.
 
Same thing done at my practice

Our billing supervisor has instructed all billers not to refund anything under $100.00 unless the patient request the refund. I dont think this is fair and have wondered myself if its legal. :eek:
 
I cannot believe that in this day and time, an office supervisor would implement a policy such as this. It's not just unfair, it is fraudulent. Policies like this violate all payer contracts as well as Government participation rules. In fact, your practice is required to repay overpaid and improperly paid claims under FERA (improper retention) and within 60 days under PPACA, not to mention your state escheat law.

You have grave reason to be concerned.
 
refunds

Our office will only refund if the patient, etc request it in writing and then we have to tell them it will be up to 30 days after we receive the request before a check goes out. How do we (the biller) protect ourselves when this is a company policy (that I have not found in writing) same as above, new manager?
 
kpamplin said:
Our office will only refund if the patient, etc request it in writing and then we have to tell them it will be up to 30 days after we receive the request before a check goes out. How do we (the biller) protect ourselves when this is a company policy (that I have not found in writing) same as above, new manager?
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That is a sticky situation. Which has to be totally illegal. I would e-mail my manager asking if I understood the policy correctly. Hopefully they reply saying that it's correct. So at least you have something showing that this is what your manager wanted you to do.
 
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