Refunds

The process of resending excess payments received from the insurance company or the patient is called Refunds.

Cash department identifies excess payments received and does a complete analysis on those accounts. They prepare all backup documents that need to be sent along with the refund check to the patient/insurance explaining the reason for refund. They also need to highlight that in the ‘overpayment form' to the insurance carrier.

Insurance companies also identify excess payments made by them in their audits and request a refund from physician/facility. Usually insurance companies request refunds to be made within 30 days from date of their request. Any delay in refund will result in an offset or the refund amount has to be paid with interest.

Offset

The process of retracting amount for an earlier overpayment is called Offset.

Example: An Insurance company makes an excess payment of $100.00 to a physician for a patient. Subsequently identify that they have made an excess payment and request the physician to refund the excess amount within 30 days. Physician does not refund this amount within 30 days, so the insurance company adjusts $100.00 in their next payment to that physician.