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Thread: Patients with Credit

  1. #1
    Join Date
    Apr 2007

    Default Patients with Credit

    AAPC: Back to School
    I have been told that any patient who has a credit needs to receive a
    statement from the billing office stating that they have a credit. I was told
    it is the law. Anyone familiar with this law? Our statements are not set
    up to go out if there is a credit only.
    Any help would be greatly appreciated.

  2. #2
    Join Date
    Apr 2007
    North Carolina


    I don't know of any law that requires you to send a statement with a credit balance; this could be state driven. It would be easier to just refund the patient in a reasonable time frame. I can tell you that Medicare typically requires you to refund the patient within 30 days. Other carriers may specify this same process within their contracts with the provider.

    Excerpt from Medicares IOM Manual...

    The physicians services refund requirement provision, found in §1842(l) of the Act as amended by the Omnibus Budget Reconciliation Act (OBRA) of 1986, requires timely refunds for certain services. When a reduction in payment, not a full denial, occurs, the physician must refund to the beneficiary any amounts collected which exceed the Medicare payment for the less extensive item or service. These refund requirements apply to both participating and non-participating physicians.

    Physicians must make prompt refunds unless they could not have been expected to know that Medicare would not provide coverage or they notified the beneficiary in advance by issuing the ABN. Refunds are considered prompt when made within 30 days of notice of denial from Medicare or within 15 days after a determination on an appeal if an appeal is made.

  3. #3
    Join Date
    Apr 2007

    Default patient credit

    Thanks Rebecca,

    We are a billing service for this podiatrist....and they called and told us that
    we have to send out a statement to each patient who has a credit with them...
    they stressed that it was the law....we asked them which law it was and they
    could not give us an answer....we really don't want the extra postage....plus our
    system isn't set up to send credit statements.....I told them, they shouldn't take
    copays from patients who don't have copays....that is where most of the credits
    are coming from.

    Thanks again

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