Health care providers’ payment handling departments handle offset payments and refunds regularly as part of their everyday routine. This aspect deserves due focus. The medical billing department must adopt the practices considered to be the best in dealing with offset and refund cases. To dig deep, let us define offsets and refunds:
- Offset Payments : Insurance companies make offset payment adjustments when they make excess payments or when they do not make correct payments. It occurs when an insurance company pays a claim more than the specified amount or pays incorrectly. In this scenario, it asks for a refund or adjusts/offsets the payment against the payment of another claim. These kinds of payments are Offset payments.
- Refund Payment: Refund is the process by which the insurance company or a patient takes back the excess or additional payments made by them. When payments exceed specific amounts as per the insurance plan, insurance companies or patients can request a refund..
Refund payments give birth to credit balance in medical practices account. It happens due to:
- Excess amount from the patient that is not covered by insurance
- In the event of a patient with two insurance carriers. Perhaps both got treated as primary. It might lead to a double payment error.
Why You Need To Adopt Best Practices In Dealing With Offset & Refund Cases:
When the medical provider does not return the money after accepting an offset or refund, it becomes a serious problem. Whether you are withholding overpayment intentionally or unintentionally, it is against law.
Returning overpayments and processing them is a mandatory task. Regulations regarding this are as per federal law. Offsets and refunds can lead to legal issues for health care providers, insurers, and patients. Practices can look into options to deal with overpayment. But they cannot keep the excess payment for an indefinite time.
Mishandling Offset payment and refund cases can lead to giving an unrealistic picture of the financial state of the healthcare providers. Since insurance takes a long duration to process, sitting on overpayment and refunds can lead to inefficiency in revenue cycle management.
Different Scenarios for Offset & Refund Cases:
Generally, if a health care provider receives a wrong payment from a patient or payer, it must go through the detail. It should keep a record of the over-the-phone conversations. The reason for the overpayment or refund should be available in writing.
In cases where the patient’s overpayment will be refunded
The first step is to contact the patient and inform him/her reason for the overpayment. Get the information if the patient will be returning to take further treatment. If not, send the check or send the money to the sourced credit card account urgently. It should have enclosed note detailing the reason for the overpayment refund.
Cases Where The Insurance Company Overpays
Make contact with the insurance company. Medical practices must return overpayments regardless of whether the insurer noticed it. Always keep a written copy of your communication with them.
In the event of a refund request, make sure the insurer explains the reason for payment. It is important to validate the reason.
Process the refund only when you receive the refund request. It is important to avoid duplicate payments. Keeping an eye on recoupment is important. In the event of an overpayment, approach the insurer and request the repayment in writing. This is considered to be the best method while dealing with offset & refund Cases.
The best practices while dealing with refunds in medical billing:
A refund request should be thoroughly examined by the team once they receive it. To do this, it is necessary to study and analyze the patient account thoroughly. It is important to confirm the liabilities involved. After reviewing the papers, the team should proceed with a refund if everything looks good. However, the investigation part is vital to avoid unnecessary refunds.
Refunds can occur due to multiple reasons in medical billing. It might occur due to overpayments, billing mistakes, medical coding errors, or many other reasons. Through utilizing some best practices, medical bringing can become more efficient.
Adopt Electronic Transfers
Refunds and patient satisfaction interrelate. Any medical practice wouldn’t create a situation where it finds itself on the pile of refunds. Legal consequences are another headache. Generally, it takes weeks for patients to receive eligible refunds. And, medical practices tend to given the refund in the form of a check. It is one of the unpopular methods that is not likable from a patient’s point of view.
By pushing refunds electronically, you can make patients happy. They are likely to come back to take further treatment in the future. Removing hindrance is something one needs to aim at.
Use Control Measure And Adopt Technology
Refunds need careful handling. They need processing only after a deep examination of the refund request. Medical practice needs to document every step and communication of the process. Generally, it is advisable to hand over this task to only a few members of your team. These members need to have credentials and experience in handling refunds.
Furthermore, over-refunding needs stopping by setting up controls. When a patient receives an over-refund, it means he or she receives a refund more than what they overpaid in the first place.
As with medical billing, modern technology has helped, refunds are no exception. There are multiple software and tools available that make the whole process of refund effective.
How Virtual Oplossing HealthCare Is Best Choice In Dealing With Offset & Refund Cases:
Virtual Oplossing Health care is the leading medical billing outsourcing company with vast experience in handling US clients. VO Healthcare have experts who can improve your RCM process and bring effectiveness in offset/ overpayment handling and refunds. We take pride in our work can produce transparent results in a short period for our clients.
We can enhance your ability to focus on quality medical care by handling your medical billing. Contact our professionals today to find out more!