Author Topic: Not showing a patient credit  (Read 4790 times)

Biller67

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Not showing a patient credit
« on: March 21, 2011, 04:36:00 PM »
My question is simple, can a provider make changes to a patient's financial record to "conceal' an overpayment by the patient?  Example: Patient pays $35 copay.  Eob comes back from insurance showing patient responsibility zero and now the $35 shows as a credit to the patient.  Office policy is to reverse the credit to show account balance as zero.  ???

PMRNC

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Re: Not showing a patient credit
« Reply #1 on: March 22, 2011, 06:25:03 AM »
Hmm...   UM NO. lol
That's basically stealing.
Linda Walker
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Anand

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Re: Not showing a patient credit
« Reply #2 on: March 22, 2011, 09:59:29 AM »
Hmm...   UM NO. lol
That's basically stealing.
lol I agree with you Linda:)

PMRNC

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Re: Not showing a patient credit
« Reply #3 on: March 22, 2011, 10:09:22 AM »
I had a client who was unbeknown to me was doing this, Until I sent out statements indicating to the patient they had a credit/refund due. Oh the calls they got! They couldn't argue with any of them and had to refund.  does it get more obvious than that ?  ??? ???
Linda Walker
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rdmoore2003

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Re: Not showing a patient credit
« Reply #4 on: March 22, 2011, 04:53:54 PM »
OMG - Did I read that right?
Regina

Biller67

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Re: Not showing a patient credit
« Reply #5 on: March 22, 2011, 08:15:47 PM »
Let me tell you, I felt pretty moronic for asking because I know it is unethical, but honestly I have searched for hours trying to find something in writing.  All I have found is that a policy has to be put in place to handle credits, not necessarily refund them by law.  I also have to add that the adjustment codes used for this purpose have descriptions that indicate the credit is the patient's.  The policy is that if the patient calls to question, then we will refund the money (the same applies to insurance over payments), so does that somehow "protect" them should they be audited?  We do apply patient credits to any open balances on their accounts, but anything left over is adjusted.

I can understand the insurance over payments since they either apply the overage to another claim or keep a running a/r, or send a letter requesting the over payment refund. 

Sounds crazy I know, but where the heck do I find this so I can print it and present it and say 'YOU CAN'T DO THAT!"??   :o

PMRNC

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Re: Not showing a patient credit
« Reply #6 on: March 23, 2011, 06:38:53 AM »
If you need to show your provider in writing that he cannot keep someone else's money, than it might be a client you don't want to work for. Maybe there is nothing in writing again, because simply keeping something that doesn't belong to you is wrong, illegal, unethical and again.. it's stealing. There's no verbiage to explain that.

Quote
All I have found is that a policy has to be put in place to handle credits, not necessarily refund them by law.  I also have to add that the adjustment codes used for this purpose have descriptions that indicate the credit is the patient's.  The policy is that if the patient calls to question, then we will refund the money (the same applies to insurance over payments), so does that somehow "protect" them should they be audited?  We do apply patient credits to any open balances on their accounts, but anything left over is adjusted.

I'm pretty sure.. handling means..give them their money back.
Linda Walker
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Michele

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Re: Not showing a patient credit
« Reply #7 on: March 23, 2011, 08:32:51 AM »
Biller67,

    Are you employed by the Dr?  Or are you a service?

Michele
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rdmoore2003

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Re: Not showing a patient credit
« Reply #8 on: March 24, 2011, 02:36:39 PM »
Ask your provider this ,  Since you overpaid your malpractice/liability insurance, your agent will be providing lunch for her staff, is that ok?

Last week, I had a doctor make a comment concerning people these days.  IT SO FITS

he said "There is no such thing as common sense anymore"
Regina

PMRNC

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Re: Not showing a patient credit
« Reply #9 on: March 25, 2011, 09:57:48 PM »
Quote
Ask your provider this ,  Since you overpaid your malpractice/liability insurance, your agent will be providing lunch for her staff, is that ok?

I love it.. LOL

If that was my client.. I'd merely copy some definitions from the dictionary :  STEALING: "Taking or keeping something that does not belong to you!" And if that didn't do it, I'd report it, it's completely illegal
Linda Walker
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DMK

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Re: Not showing a patient credit
« Reply #10 on: March 28, 2011, 10:19:58 AM »
The most important thing is "How will the patient's feel if they find out?"  They already think the doctor makes too much money (they might, they most likely don't, that's why they're "stealing") so they'll really be angry when they keep more than they're entitled to!

Money is such a touchy subject in the best of times, and more so these days.  I always try to look out for both sides.  The doctor should get paid what he/she's supposed to get paid (ie: insurance should pay their portion and patient's should pay their portion) but the patient should get all the benefits they're entitled to, and not have to pay a penny more than they have to.  They already pay their insurance premiums!

Honesty always breeds trust, and once that trust is betrayed the patient will go elsewhere!

rdmoore2003

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Re: Not showing a patient credit
« Reply #11 on: March 28, 2011, 03:37:08 PM »
I have found that 45% of the time, when we send refunds to patients, they think it is a bill and they throw it in the trash. 
Regina

DMK

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Re: Not showing a patient credit
« Reply #12 on: March 28, 2011, 03:59:53 PM »
Wow!  They throw it away, even if they think it's a bill?  That kind of breaches the trust of the doctor and the patient too!

dekenn

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Re: Not showing a patient credit
« Reply #13 on: March 29, 2011, 08:37:05 AM »
Sometimes when I send refunds, the patient calls and wants to know what for???
With our practice, we sometimes just bill a procedure, no e&M, consequently, sometimes, the insurance company doesn't always apply the copay, but pays 100% of the allowable.
So then I have the patients calling me, wanting to send back the money, because "they don't want to have a balance", they were there, therefore, they owe the money.... can't win.... ::)

rdmoore2003

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Re: Not showing a patient credit
« Reply #14 on: March 29, 2011, 03:49:24 PM »
I do not believe that its any type of breach.    We do not refund until pt is discharged.  If they have a credit and continue to come in and if they have copay or deductible, we use that credit towards what is owed.   Once they have been discharged and their account shows a credit we send the patient their refund.   If they chose to throw it away, that is their choice.  We have done our part.  Alot of times, refunds will come back to us because pt has moved with no forwarding address or whatever the issue.   we keep the mail once it is returned in case they call or we get new demo information. Our patients always has a superbill to show whats owed and/or credits.  You can only do what you can, it is already difficult enough to get patients to pay their bills.  I surely am not going to "run them down" to give them a refund.   If patient is worried about money going out I assure you that they will also know when a refund is due them. 
Regina