Wiki Patient Refunds

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Brenda88

Brenda88

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Fargo, ND
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Does anyone know where I can find information on the laws regarding patient refunds? Our practice is located in North Dakota. Specifically we are wondering if there is a certain threshold, underneath which we are not required to refund if not requested by the patient. (i.e. not required to refund if it's less than $5). I've tried searching but have not been able to find anything for North Dakota and am not sure who to ask/where to go.

Thank you!
 
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They had asked me to look into it, but I'm having no luck. :( I've found some information for other states like Texas and California, but have been unable to confirm North Dakota. Although, everything else I'm seeing says we have to refund any amount no matter how small. We were just thinking if it was under a certain amount ($5? $1?) at some point is it ok to retain as a credit on the patient's account? We would, of course, return any amount if requested, but as far as automatic processing goes...?
 
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our clinic had a policy where if the amount of the refund was less than $5 (though it might have been $10), that the money would be applied as credit towards the next visit.
I am not sure if a documented policy is required to be able to do this.
 
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Brenda88 said:
They had asked me to look into it, but I'm having no luck. :( I've found some information for other states like Texas and California, but have been unable to confirm North Dakota. Although, everything else I'm seeing says we have to refund any amount no matter how small. We were just thinking if it was under a certain amount ($5? $1?) at some point is it ok to retain as a credit on the patient's account? We would, of course, return any amount if requested, but as far as automatic processing goes...?
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What is the rule in California. I am going back to 2018 forward to follow up on credits that have not been resolved. Some are patient credits. There are many that Blue Shield, BC, Cigna, etc paid primary, but when we balance billed Partnership they also paid as primary. I also have many where patient has 2 secondaries that paid, leaving a credit. I have tried to research this and have been processing refunds to Partnership, etc, but I don't want to send money back that I don't have to. Partnership has not requested any of this money back. I am just going by the payments/credits.
 
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greendm said:
What is the rule in California. I am going back to 2018 forward to follow up on credits that have not been resolved. Some are patient credits. There are many that Blue Shield, BC, Cigna, etc paid primary, but when we balance billed Partnership they also paid as primary. I also have many where patient has 2 secondaries that paid, leaving a credit. I have tried to research this and have been processing refunds to Partnership, etc, but I don't want to send money back that I don't have to. Partnership has not requested any of this money back. I am just going by the payments/credits.
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Oh my, I am in Lakeport!!
According to CAMFT Attorneys (link below), in CA we are not required to return insurance over payments unless requested to do so. Also, there is a statute that says "reimbursement for over payment...shall not be made...unless written request...is sent".
With that said, if I get a duplicate payment or incorrect payment from Medicare, that is obvious, I return it. With Partnership HP, they probably would not know what to do with it if you sent it back without a request for return. Many times, I find that the system over adjusted leaving a credit, so check that as well.
The best way to know for sure is to contact the payer. Sure enough, as soon as you send money back unsolicited, the other payer comes at you with a demand for return of over payment. You could keep the credit reflected in the account with a note of why it's there so that when the demand arrives, you have all the details, but hold the credit until a demand for return is received. Just something to consider...
 
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podcoder70 said:
Oh my, I am in Lakeport!!
According to CAMFT Attorneys (link below), in CA we are not required to return insurance over payments unless requested to do so. Also, there is a statute that says "reimbursement for over payment...shall not be made...unless written request...is sent".
With that said, if I get a duplicate payment or incorrect payment from Medicare, that is obvious, I return it. With Partnership HP, they probably would not know what to do with it if you sent it back without a request for return. Many times, I find that the system over adjusted leaving a credit, so check that as well.
The best way to know for sure is to contact the payer. Sure enough, as soon as you send money back unsolicited, the other payer comes at you with a demand for return of over payment. You could keep the credit reflected in the account with a note of why it's there so that when the demand arrives, you have all the details, but hold the credit until a demand for return is received. Just something to consider...
Click to expand...
We are so close! I am just finishing out the accounts here and will no longer be working here after 05/31. I am currently looking for work. We have downsized, which is the reason for my layoff. I have excellent references from my employers, who are Emergency Room physicians. I did call Partnership a while back. They told me that I needed to refund the full amount of their payment with another copy of primary EOB and they will reprocess. This won't result in much, since most of the private insurances pay more than they allow. I have already sent a bunch of refunds to them but am still cleaning up and have many more. I will look at the law you have referenced, I just don't want to be fraudulent. There were not our fault, but have been sitting on the books for 3 years & forward. Thank you for your help. My name is Dawna.
 
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greendm said:
We are so close! I am just finishing out the accounts here and will no longer be working here after 05/31. I am currently looking for work. We have downsized, which is the reason for my layoff. I have excellent references from my employers, who are Emergency Room physicians. I did call Partnership a while back. They told me that I needed to refund the full amount of their payment with another copy of primary EOB and they will reprocess. This won't result in much, since most of the private insurances pay more than they allow. I have already sent a bunch of refunds to them but am still cleaning up and have many more. I will look at the law you have referenced, I just don't want to be fraudulent. There were not our fault, but have been sitting on the books for 3 years & forward. Thank you for your help. My name is Dawna.
Click to expand...
Hey Dawna, reach out to your PHC rep if you haven't already.
Tonia
 
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