Dealing With Overpayments When Billing medical Claims

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Sometimes a provider is reimbursed too much money for the services provided which results in an overpayment. Sometimes the overpayment is made by the insurance carrier and sometimes it is made by the patient. In whether case, it is prominent that the overpayment be returned to the appropriate person or carrier.

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If a inpatient pays more than they are required to the inpatient must be notified as soon as the overpayment is discovered. The overpayment can be applied to a future visit if the inpatient will be returning but only if the inpatient agrees to that. The provider can not just indefinitely hold onto the money.

An example would be if a inpatient came in for an office visit and paid a co-pay. The provider ends up removing a mole which is determined surgery and doesn't need a co-pay resulting in an overpayment. Once the office realizes the co-pay should not have been collected they can do one of two things.

1. Notify the inpatient of the overpayment. If the inpatient will be returning the office can recommend that they apply it as a prestige toward the next visit. If the inpatient doesn't want to apply it toward a future visit, the overpayment must be returned.

2. Send the inpatient a check for the overpaid whole with a note explaining the overpayment.

In any case a provider cannot just keep the overpayment. That is illegal.

If an insurance carrier makes an over cost it is prominent to first decree if it is truly an over payment. Call the carrier that made the overpayment and ask them to justify how they determined their cost whole and if they processed the claim correctly. If they confirm that they did make an overpayment they should reprocess the claim to show literal, cost and send a invite for the provider to return the overpayment.

Sometimes they will just ask the provider over the phone to return the overpayment. Personally I all the time ask them to invite the money back with a written explanation. When you receive the written invite for the overpayment attach a check for the overpayment to the invite and send it to the address indicated on the request. If they don't furnish an address send it to the claims address but indicate "Attn: Overpayments".

If you receive a cost from an insurance carrier and the entire cost is wrong or not rightfully due to the provider write "void" on the check and return it to the insurance carrier with an explanation of why the cost was not due. For example if the cost is for a inpatient that was not seen by the provider, write "void" on the check and attach a note saying "This inpatient was not seen in our office."

If they state during the call that they processed the claim correctly and that there was no overpayment then you need to decree if there truly was an overpayment. Sometimes a inpatient has two insurance plans. The original allows a inevitable whole and then makes cost Then the secondary processes the claim and allows a higher whole than the original insurance carrier which results in a prestige balance.

This is not truly an overpayment. The whole contractually adjusted off from the original insurance carrier was more than needed to be adjusted off based on the secondary insurance carrier's payment. Therefore there is not a true overpayment and no money needs to be returned. The patient's balance just needs to be adjusted to offset the credit.

Sometimes a patient's secondary insurance carrier is a confidentially purchased insurance. They do not all the time consequent the same guidelines as other insurance carriers. Many times they ignore the whole paid by the original and make cost as if no other insurance is complicated resulting in an overpayment. In this case the overpayment whole belongs to the inpatient since they purchased the other insurance plan. The provider cannot just keep the money. The provider cannot get more than he or she billed out for their services.

It is prominent that overpayments are not ignored. First decree if it is a true overpayment. If it is, decree who the overpayment needs to be returned to and then do what is needful to return it. Remember only prestige it to a future visit with the patient's permission

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