How to Deal with Recoupments in Medical Billing?

There are a variety of complex terms in medical billing and recoupment is one of them. It refers to the recovery of overpaid claims by the insurance company. This might be due to discrepancies in billing, or a payment made by error. This is deduced during audits when providers review and reveal any discrepancies in the previous bills.

The Insurance Payer will either deduct the amount from your future payments or straight up ask for a refund from the provider. Recoupment is used to cover the losses incurred due to collisions between two stakeholders.

Receiving a recoupment request is frightening and upsetting as it feels like losing money. Even though it was due to additional payment, this is money going out of your pocket.

This procedure can be triggered through lawsuits or a mutual settlement. Healthcare practices may also request reimbursements for specific treatments and services when they are not satisfied with the diagnosis provided. There could also be some disagreements about in-patient and out-patient treatment or the use of imaging services or lab tests.

If you want to understand recoupment in medical billing, you must first understand overpayment.

What is Overpayment?

Overpayment in medical billing happens when a healthcare provider expects to be paid more than he should actually be paid. It is a big concern for patients who could make early payment. They might not need the payout but end up compensating for that.

Patient overpayment laws work in this regard to ensure that the person has a better and safer chance of receiving the full payment. The healthcare departments need to follow instructions set by the law.

Overpayment in Medical Billing

In the context of medical billing, overpayment is a point to consider which is manageable with an efficient medical billing process. The patient needs to manage the payment amount well in advance to clear the payments and receive uninterrupted services from the health center.

They can look at the policy which notifies them of maintaining an opinion about the extra payment which would be returned back to the patient if the overall cost is less than the cost assumed.

Reasons for Overpayment

There can be various reasons for overpayment but most of the time healthcare facilities can seek advice from a serious connection point to clear the documentation for the sake of patient’s security and stability.

Some explanations are as follows:

Billing Errors

The insurance plan might assist patients in achieving proper operational perspective. Billing issues may be critical if the required medical billing service is inefficient.

Odd Policies

Poor guidelines and policies are a major reason for overpayment. Such policies and practices are categorized as destructive guidelines.

Dealing with Insurance Provider Overpayment

When you are rectifying an overpayment made by the insurance provider, it could lead to legal consequences which are complex and difficult. Sometimes the insurance provider’s internal auditing system might detect a mistakenly overpaid claim which may result in an authoritative recoupment request.

In such cases it is very important to determine the authenticity of overpayment as fast as possible. Preferably one must speak with the healthcare provider directly and get clarification on determined estimate and claim handling.

If the insurance company can strongly demonstrate overpayment, they will file an authorized recoupment request. Healthcare providers must refund the amount as soon as possible to minimize the legal repercussions.

If the insurance provider feels that the overpayment was the outcome of a fraud, this would lead the practice to big troubles. Whenever you receive a documented recoupment request you must check it thoroughly and if true, reimburse the insurance company promptly. This is how recoupment in medical billing works.

Ways to Prevent Overpayment

If you come across overpayments in your medical practice, you must take assertive actions and protect your practice from the consequences in the long run. Let’s take a look at some ways to prevent overpayment.

Updated Software

Outdated software or unintentional coding errors that may go undetected by the system can cause overpayment for your practice. Integrate the best medical billing software into your practice to keep it safe from overpayment as it will only add to the hassle for you. An efficient software will notify you if there is any sort of overpayment.

Staff Training

Always make sure that the administrative staff who manage your medical bills are up to date with the latest guidelines in the field. This involves technical guidance along with regular training and knowledge sharing.

Outsource Billing to Professionals

Outsource your medical billing to a professional medical billing company like Unify Healthcare Services who are well-versed with all the latest guidelines and provisions of the field. Trained medical billers and coders can catch errors before submitting the claim which decreases the chances of overpayment significantly.

What Is Medical Billing Refund?

A medical billing refund is the method of requesting a refund from the healthcare organization for the surplus amount sent to them by mistake. Often the track record of healthcare practitioner is hampered, and they may be sued if the correct amount is not returned to the insurance company.

There are some steps healthcare providers can take to avoid recoupment in medical billing and save themselves from the inconvenience of paying back to the insurance provider.

Refund to Patients

This happens when the patient’s insurance plan co-payment amount has been modified. This can also happen if the patient's requirements like supplies and medical devices were covered under the previous plan but not in their latest health insurance.

The patient will be given credit which can be provided to the patient as future support.

Refund to Insurers

When an insurance payment is overpaid the payer can appeal for a refund using a proper channel and the healthcare provider will refund it back.

Save Your Practice from Recoupment

Recoupment in medical billing is any practice's nightmare. It is a huge burden on the finances which results in great disturbance for the healthcare practice. This is a hassle which makes practice’s lose money and effort on things that are not in favor of the organization.

Determining the error and rectifying is a tiring process that may frustrate your employees. The best option to deal with recoupments is to file accurate claims in the first go.

Now keeping in mind, the complexities of medical billing, this seems to be an impossible task.

Not anymore!

Partner with an efficient medical billing company such as Unify Healthcare Services that can take care of your billing, so you don't have to worry about it anymore.

Unify Healthcare Services is a well acknowledged name in the field of medical billing and has numerous satisfied clients. We take the burden of administrative tasks from your shoulders so that you can focus solely on providing the best patient care.

Unify Healthcare Services has trained and professional employees who are well-versed with all the coding and billing guidelines. These employees ensure that all your claims are error free and accurate for maximum and fast reimbursements.

We also keep track of claims, so we can proactively determine their status. If under any circumstances there is any discrepancy in a claim, we will rectify it and submit it again within a provided time frame.

Unify Healthcare Services envisions making billing easy for every healthcare practice so you can focus solely on providing the best patient care.