Credit balances are simply a part of everyday life in the delivery of healthcare services. Unresolved credit balance accounts can distort the profitability of a healthcare facility and foster financial…
While credit balances are unavoidable, identified overpayments should be retained for as short a time as possible. Risks associated with unresolved credit balances include: Medicare/Medicaid penalties, class action litigation, misstated revenues, lost payment opportunities and wasted time and resources.
There are several common causes of credit balances: insurer overpayments or duplicate payments, coordination of benefit conflicts, incorrect payment rates in billing systems, insurer refusal to accept provider-identified overpayment, incorrect upfront collections (coinsurance/deductibles), charge corrections, unintentional, erroneous over billing, and uncashed refund checks.
To assist facilities with dealing with credit balances, the Office of Inspector General (OIG) has made general recommendations in its compliance Program Guidance for Third Party Billing Companies:
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