Total Members Voted: 1
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.
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!