Overpayments: Four Steps Toward Setting Up An Internal Auditing System

By Author: Jaun Paul
Total Articles: 53
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Can insurers minus overpayments from your checks? As a healthcare provider, you're legally obligated to repay overpayments when you or the payer discovers the folly. Owing to the large number of claims a provider submits each month and the complex nature of payer regulations, overpayments are bound to happen. Your office should have a system for repaying overpayments, or at least include a credit balance report with end-of-month reports.


Here are four steps that will help you when setting up an internal auditing system:


Before you refund any money, see to it that the overpayment isn't a payment posting mistake. If it happens to be a legitimate overpayment, determine how it happened and find out ways to avoid it in the times to come.

Contact the insurer to be sure you understand its policies toward credit balances. Payers have different ways to handle refunds. For instance, most Medicare carriers have a refund form for all refunds while private ...
... payers may have their own unique rules.

In case of private payers, write them a letter informing that you have identified an overpayment and you wish to confirm all the contact information you'll need, including where to send the money and to whom you should address it.

In case of internal records, write off the credit balance in the patient's chart. Also keep a dummy ledger for each payer to keep a track of overpayment until you are able to send in the refund when you get the demand letter.


Heeding to these four steps while setting up an internal auditing system will certainly stand you in good stead. So get going!

Provides weekly digest newswire about Internal auditing system for healthcare provider, and offers advanced Learning Opportunities of payer regulations according to 2010 OIG Work Plan.