Wiki Refunding Patient Overpayments

[jthweatt]

Is anyone willing to share their office policy on refunding patients? I am aware of the time limit for Medicare/ Medicaid, but want to know how quickly you refund patient overpayments. Do you have a minimum overpayment before you issue a refund? Do you require the patient pick up the check? Or do you mail it?

Thanks.

 

[penguins11]

Our office manager does patient overpayment refunds 2x a month on Fridays and we mail the payment back to the patient. We do not have a minimum. If the patient is coming back in then we generally call the patient and tell them that a refund will be waiting for them at the front desk or ask them if they would like to apply the overpayment to a copay if you know one is going to be due.

 

[Tracey Thompson]

Medicare / Medicaid

Can you elaborate on the time limits for Medicare / Medicaid?

Thanks!

 

[ckkohler]

I am not aware of any time frame requirement by Medicare or Medicaid - but, in our office .. we have implemented the practice that any overpayments greater than $100 automatically get a refund (unless there is a specific reason they have such a large credit); by this, I mean - we have some patients that have $5,000 annual deductibles so to offset that - they pay $100 per month ... of course if ever a patient calls about an overpayment of any amount then we automatically process; for overpayments less than $100 ... I review their appointment history to see if they will be coming back - we are a pain management specialty clinic .. so, some return on a regular basis and sme return as needed ... hope this helps!

 

[dclark7]

According to the Affordable Care Act, providers have 60 days after they become aware of an overpayment to refund the money. If the overpayment is not refunded within that time period it can be considered a false claim. This is copied from the ACA:

SEC. 6402. ENHANCED MEDICARE AND MEDICAID PROGRAM INTEGRITY
PROVISIONS.​

(d​

) REPORTING AND RETURNING OF OVERPAYMENTS.—​

(1) IN GENERAL.—If a person has received an overpayment,
the person shall—
(A) report and return the overpayment to the Secretary,
the State, an intermediary, a carrier, or a contractor,
as appropriate, at the correct address; and
(B) notify the Secretary, State, intermediary, carrier,
or contractor to whom the overpayment was returned in
writing of the reason for the overpayment.
(2) DEADLINE FOR REPORTING AND RETURNING OVERPAYMENTS.—
An overpayment must be reported and returned under
paragraph (1) by the later of—
(A) the date which is 60 days after the date on which
the overpayment was identified; or
(B) the date any corresponding cost report is due,​

if applicable.

 

[dflieger]

Is anyone willing to share their office policy on refunding patients? I am aware of the time limit for Medicare/ Medicaid, but want to know how quickly you refund patient overpayments. Do you have a minimum overpayment before you issue a refund? Do you require the patient pick up the check? Or do you mail it?

Thanks.

First off Roll Tide! Our office policy to do refunds a minimum of once per month. Unless of course they can be applied elsewhere.