Author Topic: Payment application  (Read 1303 times)

Andy

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Payment application
« on: January 17, 2019, 09:11:17 AM »
Hi, I was wondering if anyone knows how legal this is. Insurance A (for example BCBS) has a credit balance on a patient's account due to either an overpayment or underbooked charges. Is it legal to post a payment reversal removing that credit, and to post offsetting payment to a different payer and different patient account (for example an unpaid Medicare charge). Net zero transaction.

Obviously this is inaccurate recording of payments to patient accounts because there is no paper trail. However, is there a specific statute that would classify this as fraud or make it illegal? Would this classify as insurance fraud and/or violation of Accounting practices?
Also, it's a skilled nursing facility nursing home provider.

Thank you for your input, I appreciate it

« Last Edit: January 17, 2019, 10:05:56 AM by Andy »

Michele

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Re: Payment application
« Reply #1 on: January 18, 2019, 12:32:39 PM »
I cannot advise you legally on this, however if there was an overpayment the provider should be returning the money to whoever the overpayment was made by.  IF there is a credit that is due to the patient that should be either given to the patient, or credited to another balance. 

I can't tell by your post if the overpayment is on one patient, or if it's just a posting error.  If it's a posting error it should be corrected if possible.  It's really hard to tell you what needs to be done without more information. 

I keep re-reading the post to try to understand what has happened.  I guess bottom line, it sounds like an error was made in the posting.  Even if there is no paper trail you really should try to correct that error.  It sounds like many records could be inaccurate as a result of the error.  You really can't just post a reversal and apply it to other accounts without knowing what was done wrong.
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PMRNC

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Re: Payment application
« Reply #2 on: January 29, 2019, 11:21:13 AM »
I'd have to agree with Michele on how to handle this but also add that it may not be "illegal" to do this accounting wise, but it could be legal issue in regards to whom the refund belongs to. That is where the legality would fall into play.
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