Practice Management Alert

Question: We have patients who tell us they have copayment for their visits and make the payment. But when we get the explanation of benefits (EOB) from the insurer, there's no indication of a copayment. Do we have to give the patient a refund?

Louisiana Subscriber
 
Answer: If the patient paid the copayment in error, you have to refund it. But, before you give any money back, make sure you are reading the EOB correctly and are certain the patient is not responsible for a copayment. Check the patient's chart for a copy of the insurance card. Most insurers state on their cards whether there is a copayment. If the card has no such indication, call the insurance company and ask.
 
If there is one, and it's not on the card, enter the information in the patient's account on the computer, and ask the insurance company to send you a copy of its copayment policy to keep on file so you have back-up documentation of the collection. If the insurer confirms there is no copayment, make sure the insurer has paid you correctly and did not short you the amount.
 
You can also contact the patient to make sure he has not changed his coverage, because it's possible the insurer made a mistake. When you can confirm the copayment was made in error, refund the patient the money. But it is a waste of time and money to collect copayments in error and then have to refund them. Make sure you have the correct insurance data by asking patients to verify their information at check-in during every visit. Having accurate insurance information cuts down on costly mistakes and saves practice resources.

--  Answers to "You Be the Expert" and "Reader Questions" provided by Catherine A. Brink, CCM, CPC, president of Healthcare Resource Management Inc. in Spring Lake, N.J.; and Tricia Bardon, BBA, president of Medical Perspectives in East Grand Rapids, Mich.