Wiki Refunds / Overpayments

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vnorman

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:confused: I am trying to clean up my physicians A/R and am running across a lot of accounts that show an insurance over payment, however some are from 3 years or more. As there has been no request from the payer and no activity by us in that amount of time, what do I do with the overpayment? In many cases its due to a secondary insurance paying beyond what the primary insurance left as a balance. We have even called on some of them and we are told by the payer they have already closed their books on this claim. Please help??? :(

Valarie
:)
 
If they said they "closed their books", then not sure what else you can do other than document the patient's account to show you've tried.
I've seen payers ask for refund on very old claims & while I can't recall the exact insurance company or how old it was...I do recall thinking why don't payers have a timely limit when providers have one we have to abide by :confused:
I'd suggest combing through the accounts in AR to verify it's really an overpayment & then calling on each of them that appear valid.....even though it won't be enjoyable. :)
 
I heard that insurance companies can ask for their money back for five years back. It would be worth looking into. I dont do billing, so I never looked into it.
 
What i do is determine what they should have paid and them refund them the difference. I send proof of why they overpaid and if the send the payment back then at least I tried, so they can't ask for interest.
 
asterling said:
I heard that insurance companies can ask for their money back for five years back. It would be worth looking into. I dont do billing, so I never looked into it.
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Verify from your state. Some state require insurance companies to ask for refund from providers within a one year time frame only.
 
Florida

Our state has a limit for insurance companies to ask for refunds. They have 2.5 years. After that I am not sure what to do with it, we have some that are more than 4 years old.
 
check with your state insurance commissioner. they will have a policy in place for commercial insurance. there is no time limit for government agencies and self-funded policies
 
I suggest working any Medicare and Medicaid overpayments first. The False Claim Act states that CMS overpayments must be reported and returned within 60 days of identification; any overpayment retained 60 days after identification is considered a violation of the FCA.
 
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