Here are five recommendations concerning how to address overpayments and refunds in your ASC.
1. When an overpayment is received, immediately begin the refund process and issue a check to the appropriate payer.
2. If billing is outsourced, when overpayment is received, the billing company should immediately process a refund request to ASC management for approval and repayment.
3. For federal and third-party payers, do not exceed 60 days for issuing repayment.
4. For patients, try not to exceed 30 days for repayment.
5. To maintain compliance with federal* and state regulations and avoid possible penalties, it is advisable that you audit your credit balances at least monthly and refund overpayments promptly.
Note: This tip was included in the June issue of the Serbin Medical Billing Newsletter. You won't miss future tips and other great news and announcements by signing up for the free newsletter here by filling out the form to the right!
*Excerpt from the "Medicare Program; Reporting and Returning of Overpayments" final rule: The final rule requires providers and suppliers receiving funds under the Medicare program to report and return overpayments by the later of the date that is 60 days after the date on which the overpayment was identified. The requirements in this rule are meant to ensure compliance with applicable statutes, promote the furnishing of high quality care, and to protect the Medicare Trust Funds against fraud and improper payments. Overpayments retained beyond the applicable 60-day period can result in the imposition of treble damages and monetary penalties under the FCA if there is a knowing and improper failure to return the overpayment. (Federal Register, Vol. 81 Friday, No. 29 February 12, 2016, Part III)