What About Patient Credits?


Most providers are aware that any overpayment by Medicare and Medicaid is to be promptly refunded to the government, but what about when patients overpay? There are many ways a patient credit might be created-maybe there was confusion over the correct co-pay or co-insurance amount or the estimation of the cost of procedures was too high and too much deductible was collected. Did you know there are rules governing how providers handle patient overpayments?

For governmental insurers, the provider is required by law and provider agreements to refund beneficiaries when it is found that the amount paid by beneficiaries for copayments, deductibles and statutorily excluded services exceeds that required on remittance advices. Are you doing this?

Can’t find the patient to refund the balance? Be aware that each state has some version of an Unclaimed Property Law which applies to providers. Have you checked your state’s rule? The Mississippi law requires businesses and other organizations to report to the State Treasurer certain funds and securities that have remained unclaimed for 5 years. This includes “any intangible personal property…including any income or increment thereon and deducting any charges that may have accrued, that is held in the ordinary course of the holder’s business and has remained unclaimed by the owner ….intangible personal property includes- Credit balances, customer overpayments,… refunds.” Penalties for non-compliance include fines, percentage interest on monies not remitted and possible jail time.

Now is a good time to review those patient credits.

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