Why is there a Refund?

Before you sign your name to a refund check, either to a patient or an insurance company, make sure the situation really calls for a refund.  Even experienced team members incorrectly post insurance payments, write-offs, and credits from time to time.

Payment posting errors are easy to find if you have the explanation of benefits from the insurance company and you compare the amount paid to the amount posted.  When multiple family members are paid from the same check, errors occur.  Also, dual insurance and the coordination of benefit provisions often leave everyone confused.  If an overpayment remains after two insurance companies paid the claim, make sure your team can clearly show you why.

The next common area of confusion involves the posting of write-offs.  When you are a contracted provider, you agree to certain write-offs; however insurance companies make mistakes.  Train your team to look at every write-off with a questioning eye.  The most common mistake I see is the insurance company uses the wrong contracted fee schedule—always lower than yours—and the practice is asked to take an additional discount.

Teams are also fooled by the explanation of benefits from non-contracted providers, and balances are mistakenly written off.  Patients are responsible for the balance unless you decide otherwise.

Credits are the final thing to watch.  Many practices offer credits toward future treatment when patients refer new people to the practice.  Sometimes, however, unused credits are mixed in with overpayments when refunds are issued.

I encourage you to have your team clearly explain why you are writing the refund check.  Before you send the payment, make sure the money really belongs to someone else.

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