Wiki Secondary pymts causing credit balance

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bbates@mgo.md

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When a secondary carrier's payment causes a credit balance on the patient's account, who does the credit go to the secondary carrier or patient? If my memory is correct, I think it is the patient but I need a resource for documentation of this rule for management. Thanks
 
the payer contract should stipulate that you can't bill or accept payment from patients for services covered and paid by plan benefits. All payers have a no balance billing clause, I'd think this would be covered in there someplace.
 
I'm not attempting to balance bill or accept a payment from the patient, I am trying to determine who gets the credit ? patient which was created from the secondary carrier's payment.
 
You need to check the secondary eob to make sure cob info is listed. If secondary pays more for the service then the primary did you will get more $$. The patient does not get a refund. Check your fee schedule for the service with each carrier. Make sure each carrier knows about the other, that may be why you received too much. It may be just an adjustment. Hope that helps. :)
 
When I've seen this it's usually because the primary & secondary don't know about each other & both think they are the primary.
I wouldn't refund anyone until you verify who the correct primary payer is. Call both plans, call the patient...something to get the info corrected.
If the correct primary payer is who you have listed as the secondary payer & you've already refunded them.....then you'll be fighting for $$ back.
A refund to one of the plans is likely due...but of course like the previous post, someone might have posted too much of an adjustment. Review both EOBs in comparison to how it was posted in the acct to be sure!
 
Bbates, CPC

HBULLOCK said:
You need to check the secondary eob to make sure cob info is listed. If secondary pays more for the service then the primary did you will get more $$. The patient does not get a refund. Check your fee schedule for the service with each carrier. Make sure each carrier knows about the other, that may be why you received too much. It may be just an adjustment. Hope that helps. :)
Click to expand...
Thanks Prim and secd carriers are listed as correct. I will investigate further to make sure both are aware of each other.
 
hopepg said:
When I've seen this it's usually because the primary & secondary don't know about each other & both think they are the primary.
I wouldn't refund anyone until you verify who the correct primary payer is. Call both plans, call the patient...something to get the info corrected.
If the correct primary payer is who you have listed as the secondary payer & you've already refunded them.....then you'll be fighting for $$ back.
A refund to one of the plans is likely due...but of course like the previous post, someone might have posted too much of an adjustment. Review both EOBs in comparison to how it was posted in the acct to be sure!
Click to expand...
Thanks
 
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