Wiki over payments by insurance company

[mhammy67]

Hi All,
I am new to billing, but I am a CPC. We have had some turn over at our ASC and I am now dabbling in billing. In reviewing he AR we are finding a lot of over payments by our local Excellus that go back years. I recall the biller, who has recently left, explain that she told the payer to take it back and they just dont do a take back. This payer also audits us quarterly and have plenty of time to take the money back. These particular incidences have not been on the audits.

Does any one know what happens now? These are sitting as unapplied monies on patient accounts and we want to clean it up. Should we just accept the money at this point and zero out the patients accounts or continue to contact the payer and remind them they have to retract the money.

Thanks in advance.
Marianne

 

[Melissasuewashburn]

Marianne,

I too am working on accounts at the practice I work at in order to clean up credits on patient's accounts. We were using a billing service and they just didn't take the care needed to make sure things were correct.

Many of the "over payments" on patient's accounts have actually turned out to not be credits in further research as many of them have actually been taken back by the insurance company - the take backs were just never accurately applied to the accounts.

The first thing I would do would be to research each account to make sure the credit is actually due. Once you have the information on exactly which remittance the overpayment stems from and have verified that the insurance company did in fact over pay I would contact each insurance company and find out if they will process the take back or if you need to do so. BCBS has a form that you fill out for the over payments that can be mailed in and so do a few other insurance companies.

I definitely would NOT keep the over payments as that can lead to legal issues.

 

[Leenahz]

I agree with Melissa about not keeping the overpayments.

Also, if I recall correctly, under the ACA laws, I believe once a credit is found on an account you have to return it within sixty days. I'd definitely look into and contact these payers ASAP.

Lena

 

[KN]

Always refund Medicare voluntarily, but not all over-payments should randomly be returned to an insurer without fully assessing that specific account and the over-payment, and why it occurred. An insurer cannot take back monies if a refund is being contested/appealed. Know your payer contracts and how refunds/take backs are to be handled. Ask the insurer who made the over-payment for an audit of that specific patient account. Once an insurer defines you as a provider/facility that does not ask questions about over-payments (errors by an insurer) you will get designated as a provider/facility that they can take advantage of. Always question the whys and hows of their errors (over-payments). Keep the monies in the patients unapplied and always include it on your A/R and you should not have any problems.