Payments > Insurance Payments

Insurance audits

<< < (5/5)

Pay_My_Claims:
Yes, now lets play another game......how about google the answer :-)

midwifebiller:
That's the answer I was digging for--Linda would NOT set a precedence by just handing a refund over to the provider. Not that you'd ever be in this predicament, but (theoretically speaking, of course) how would you handle it if one of your employees made a billing error that resulted in a refund request from the insurance carrier?

~Kelli

PMRNC:

--- Quote ---how would you handle it if one of your employees made a billing error that resulted in a refund request from the insurance carrier?
--- End quote ---

Glad you asked, first thing is I would consult my compliance plan. I'd take all the necessary steps to fix the error on our end but I would not just automatically assume financial responsibility. I've had a few situations where carriers wanted to be reimbursed and yes providers are not happy about it but that's the way it goes, each one has to be investigated and a determination has to be made on the action to either correct a mistake on our part or the providers part. I do know this.. if it was a client I billed on a % of collections, that money does get adjusted off. for example if a carrier wants $5000 back and we researched and found it was correct and the money had to be returned, the following invoice would reflect that because we are not going to keep money we received on money that has to go back, so if we got $400 from that $5000 (8%), their next invoice would reflect that $400 as a credit once we know the funds were returned. I require the provider to give me a copy of the check showing it was returned so that I can document it and of course adjust their invoice.

Again.. two lessons from this.. #1 Have proper insurance to do this work.. mistakes DO happen! I'm not a lawyer and I can't say for sure but it's quite possible if this provider took the billing company to court over this they could win.. OR even if it was an error the billing company could lose their business just trying to defend their mistake!
and #2 HAVE  A COMPLIANCE PLAN TO BACK YOU UP!! 

Pay_My_Claims:
Kudos Linda.

midwifebiller:
Thank you!  Audits and refund requests are indeed a part of the insurance cycle and it's nice to hear how veteran billing services handle these situations.

~Kelli

Navigation

[0] Message Index

[*] Previous page