Patient overpayment laws

How do I get an overpayment policy? Are overpayments mandatory? If a patient pays more than they are required to, the patient must be notified as soon as the overpayment is discovered.

The practice has a couple of options on how to handle the overpayment , but the provider cannot legally hold on to the money indefinitely. Let’s say a patient came in for an office visit and paid a co-pay.

We all make mistakes, but either deliberately or unintentionally withholding overpayment holds legal consequences. Processing and returning overpayments is not optional. However, recouping an overpayment in this way is often not reasonable. RECOVERY OF OVERPAYMENTS In the event of an overpayment being identified by NWSSP Employment Services (Payroll), the payroll officer will write to the employee as soon as possible after the overpayment has been discovered (refer to Appendix 1). A common phenomenon, overpayments are funds that a physician practice has received that exceed the amounts due and payable under the payer’s policies.

These overpayments may be the fault of either. This applies whether or not the supplier makes provision to return the overpayment. However, if the overpayment is not returned and is used to pay or part-pay a future supply then it becomes consideration for a supply.

So in some cases this may mean that VAT is due on the overpayment. That’s why practices must familiarize themselves with the laws surrounding patient overpayments—and when it’s appropriate to refund them. So, processing and returning overpayments (a.k.a. “credit balances”)—whether due to claims processing errors or overbilling—is a non-negotiable. Overpayments must be returned when they are “identified” 1. What does the law provide?

In the case of an overpayment , (unless there is law that prevents it) Aetna can also refund the patient directly, so that you don’t have to. How to handle patient overpayments : If the patient overpaid using an HSA Visa debit car please credit that amount back to the HSA Visa debit card. This is a big problem,” says Mila Kofman, a research professor at Georgetown University’s Health. You are required by law to refund Medicare and Medicaid overpayments. Also, some managed care contracts specify that you must process refunds for overpayments within a specific time period.

Healthcare providers are also subject to abandoned property laws , which are pertinent in determining patient refunds. On the request of a patient , a physician shall provide, in plain language, a written explanation of the charges for services or supplies previously made on a bill or statement for the patient. For example, if you cannot locate a. If a patient overpays a physician, the physician must refund the amount of the overpayment not later than the 30th day after the date the physician determines that an overpayment has been made.

NJ I had a dental implant done in February of this year - I paid everything in full according to what the patient billing person advised I would owe after what dental insurance would pay. According to the dentist office, the insurance would not pay any portion of the implant itself. Note: There are other relevant statutes, rules, and regs, but those compiled here are the most useful when dealing with overpayment issues.

A Medicare overpayment is a payment that exceeds amounts properly payable under Medicare statutes and regulations. When Medicare identifies an overpayment , the amount becomes a debt Provider owe the Federal government. This therefore enables an employer to correct any overpayment through the payroll process. Things to consider Whilst a deduction may be lawful by virtue section 1 employers should exercise caution in relation to the manner in which the deduction is implemented. Each state has an escheat law that directs how your practice should handle refunds to the payers or patients.

Failure to comply with the timely investigation of overpayments exposes the practice to considerable risk. If your practice does not have an. Attempting to determine the validity of alleged overpayments can divert significant time from direct patient care, resulting in lost practice revenue.

However, it is critical for practices to effectively and efficiently address. Several laws and regulations may govern overpayment demands and offer significant procedural protections to providers. This is even more likely when collecting payments from patients with secondary and tertiary insurances.

Federal law treats overpayments as wages until they are repaid. However, if the employee repays the employer in the same tax year as she receives overpayment , the employer does not.