As the name implies, the credit balance occurs when collecting extra money compared to the charges for the service rendered by the Supplier. This may be due to many reasons and should be corrected, while the final steps of processing medical claims are completed. Credit balance may be due to overpayment of the patient in the form of co-insurance or deduction; or it may be due to excessive payments by insurance payers. Let's analyze some scenarios and why it’s important to quickly contact:
Patient Balance:
Patients could pay the amount in advance, based on the assumption that Payers will cover them. As soon as medical claims processing is completed and the Payer pays in full, the Patient's payment will exceed. The decision to invoice the physician can also trigger the patient and provide an opportunity to correct this excess against future visits or sending a check. But in any case, the patient's consent must be obtained and is required.
Payer's creditor balance:
Many times the credit balance occurs due to excessive payments by payers. Even a patient's credit balance usually occurs because the payer has paid more than expected. When processing medical claims it is very important to process payments from payers by priority. This will not only design the right cash flow as a result of the doctor’s billing solution, but also prevent an overvalued AR. Some scenarios of balance payments:
1) Both primary and secondary payers are paid as primary
2) The payer pays more than the allowed amount by mistake
3) Cross errors, especially between Medicare and Medicaid
4) Private Purchased Plans - always pay as Primary, although there may be a different Primary
Rules:
In all these cases, there are very strict rules and time frames in which excess money must be returned to either the payer or the patient, depending on the circumstances. In case of Payer errors, the Payer must be notified of the error within 30-120 days depending on the Payer. Impossibility to notify during the term could be considered as a “Fraud” of the Payer and the state with severe sanctions. If Payers refuse to refund (as is the case with private purchase plans), then this money belongs to the Patient and the Patient must be notified. Medical application providers and physician billing solution providers should consider these requirements and process credit balances daily / weekly to avoid any problems for the Supplier and the Practice.
Payback and bias:
Some payers will adjust payments for current and future claims for credit balances due to other payers that are Payable. When payers adjust payments for current and future claims for overpayments made in the past in their own Plans, they are called biases.
The best option for processing credit balances is to outsource medical billing to a professional medical claims handling company.
Log in to http://www.mgsionline.com/medical-claims-billing.html to learn more about billing and medical claims handling.
