Medical Billing Forum

General Category => New! => Topic started by: mruiz12 on March 04, 2009, 01:47:35 PM

Title: Patient and Insurance credit balances
Post by: mruiz12 on March 04, 2009, 01:47:35 PM
I am working on old aging account from 2004 that have alot of credit balance due to the patient of the insruance company. Can i write these off? I also have accouts from 2005 to current.Please advise :)
Title: Re: Patient and Insurance credit balances
Post by: PMRNC on March 04, 2009, 03:03:03 PM
No, you should make the attempt to refund the patient and/or insurance company.

Linda Walker
PMRNC
www.billerswebsite.com
Title: Re: Patient and Insurance credit balances
Post by: Pay_My_Claims on March 04, 2009, 08:24:16 PM
it looks like you meant to say patient OR the insurance company. What I would look at first is the charge, the posted amount and the write off. If its an insurance credit, that can only happen if someone adjusted too much off, or the insurance company double paid and you need to refund the money especially if its medicare/medicaid/tricare

if its a patient credit, (providers HATE to give refunds), you should determine why the patient also has a credit. In my experience this usually happens when the incorrect copay is received. Before you refund the patient check to see who has been there. If a patient hasn't been seen since 2004 you should definitely try to reach them to refund the money. You just can't make it "disappear" For those that are true credits and are being seen often, you can still contact them, but its just as easy to not take the next visit copay (which should have happened anyway) so that the credit can be applied to that visit. Most of our clients preferred to keep the credit since they generally came for thier check ups and follow up visit.
Title: Re: Patient and Insurance credit balances
Post by: mruiz12 on March 05, 2009, 11:24:22 AM
I have another question what if the patient is deceased or does not respond to my letter sent to the address we have on file and the number is disconnted. Can I then write off. What protocol do i take. I would also like to thank all of you who responded.
Title: Re: Patient and Insurance credit balances
Post by: Pay_My_Claims on March 05, 2009, 05:31:29 PM
I have had that happen, where we have tried to contact a client regarding a refund. I have adjusted the credit and posted a comment in the clients account and in the chart that was flagged closed. If the client ever comes back, you can always refund the monies. I can just tell you that most providers don't do refunds and it takes forever to get yours. It took me 3 years to get the refund owed me from a dentist, and every provider I ever worked for would always leave them as credits.
Title: Re: Patient and Insurance credit balances
Post by: Michele on March 06, 2009, 09:46:56 PM
As long as you make a reasonable attempt, which in the case you described you did, that is all that is required.

Pay_My_Claims suggestion is good, note the file and move on.

Michele
Title: Re: Patient and Insurance credit balances
Post by: PMRNC on March 08, 2009, 08:53:09 AM
What I used to do for the patients we could not find or have had mail returned whether due to death or moving, is setup a separate database per provider. This is because sometimes in the cases of deceased patients it can take many years for an estate to be settled in some cases, and later the executor of the estate could come back and request monies, this way the credit's are not in the A/R and instead in a nice neat database where it could easily be retrieved and refunded later.I also do this with patients turned over to collections.
Title: Re: Patient and Insurance credit balances
Post by: Bob13 on March 12, 2009, 12:08:28 PM
If this is a patient credit you can not hold it forever no matter how hard you have tried to contact the patient.  Please check your state's Escheat Laws on Unclaimed Property.  After the period of time allowed by the state you MUST turn over that amount to the state under the Unclaimed Property Law.
Title: Re: Patient and Insurance credit balances
Post by: Michele on March 12, 2009, 06:31:42 PM
Thanks for clarifying that. 

When I originally answered I thought they were asking about writing off an amount owed, not a credit.  So when I said "as long as you made a reasonable attempt" I was referring to the attempt at billing the patient, not returning a refund.

Hope I didn't confuse anyone!  :(

Michele
Title: Re: Patient and Insurance credit balances
Post by: Pay_My_Claims on March 13, 2009, 08:00:27 AM
If this is a patient credit you can not hold it forever no matter how hard you have tried to contact the patient.  Please check your state's Escheat Laws on Unclaimed Property.  After the period of time allowed by the state you MUST turn over that amount to the state under the Unclaimed Property Law.

There is really nothing "WE" can do, since we are not the providers. As I stated every provider that I have worked for HATED to give back refunds. I had to threaten to sue a dentist who kept a balance of 36.00 of mines for 3 years. They expect you to forget and they keep it. As the Biller, you can only notify the provider. It is the PROVIDERS responsibility to refund or actually turn it over.
Title: Re: Patient and Insurance credit balances
Post by: Michele on March 13, 2009, 11:45:06 AM
Good point!
Title: Re: Patient and Insurance credit balances
Post by: Pay_My_Claims on March 13, 2009, 12:35:45 PM
Thanks,
I agree with the posters comment on the legal issues, but we simply have no control over it. I had one provider that wouldn't allow me to tell the client they had a credit, but I told them I was legally obligated otherwise that would be double billing. She frowned and let me do my job.
Title: Re: Patient and Insurance credit balances
Post by: PMRNC on March 15, 2009, 08:53:49 PM
I agree with you on the issues with the credits to the patient.. however..
The laws regarding "fraud/abuse" are very clear.  If YOU know your provider owes a refund to an insurance carrier, you are then "aware" and just as libel if you do nothing. That is why it's incredibly important to have a compliance plan in the office or if you are a third party billing company. Your compliance plan is what you would refer to in order to follow procedure.  It's no different if a doctor insists on up-coding and the biller KNOWS it's up-coding, they are just as legally libel.  The same would even be equally true if it were an office manager employed by a physician. Their employment does not release them of the legal ramifications of the job functions/law. While we can't FORCE the provider to write the check, proper procedures to notify the patient and/or the insurance company to the credit is the right and legal thing to do, then they in turn will make the request/demand for payment return, if they don't, you are off the hook.
of course...DOCUMENT and CYA!
Title: Re: Patient and Insurance credit balances
Post by: Pay_My_Claims on March 15, 2009, 09:18:06 PM
I agree with you on the issues with the credits to the patient.. however..
The laws regarding "fraud/abuse" are very clear.  If YOU know your provider owes a refund to an insurance carrier, you are then "aware" and just as libel if you do nothing. That is why it's incredibly important to have a compliance plan in the office or if you are a third party billing company. Your compliance plan is what you would refer to in order to follow procedure.  It's no different if a doctor insists on up-coding and the biller KNOWS it's up-coding, they are just as legally libel.  The same would even be equally true if it were an office manager employed by a physician. Their employment does not release them of the legal ramifications of the job functions/law. While we can't FORCE the provider to write the check, proper procedures to notify the patient and/or the insurance company to the credit is the right and legal thing to do, then they in turn will make the request/demand for payment return, if they don't, you are off the hook.
of course...DOCUMENT and CYA!

You may want to go back and re-read all the replies. Nobody stated to NOT tell the provider, however it was stated that we have no control over the refunds. We did state that once you determine that it is a true credit either for the patient or the insurance company then you notify the provider, however you can not make them give the refund!!!  So I am missing something in this reply
Title: Re: Patient and Insurance credit balances
Post by: PMRNC on March 16, 2009, 06:30:07 AM
I wasn't necessarily picking on anyone at all, yes you tell the provider, but if the provider owes the insurance company or the patient and you know about it your are legally responsible also to notify the carrier and/or the patient.
I was just clearing up the legal "responsibility" process.