17 November 2011, by tpotisk
Insurance payments to chiropractors for honestly and ethically rendered services should not have to be refunded.
In rare instances of clerical error, misunderstood contract rules, or blatant improprieties, refunds should be made promptly. Officers should have billing and collection procedures and policies in place just as they should for marketing, and patient education. A well run organization will be crucial for a chiropractic office to survive any changes from health care reform legislation.
Here are a few details that will help a chiropractic office maintain collections congruent with services rendered and sustain a chiropractors salary and income.
“More and more, insurance companies are doing post payment audits or hiring outside firms to conduct payment reviews and requesting money back from your office.
Refunds should never be automatically sent out based on a request from an insurance company. Each request needs to be individually reviewed and processed and the patient’s account should be audited to determine if a refund is actually due and to whom.
Sometimes, a refund is due. Examples may be when an insurance company has double paid dates of service, or when two insurance companies both pay on the same date of service. These are legitimate refunds – ie: you have been paid more than you billed or were due for services rendered. These should be refunded.
Often however, a refund is NOT due and should be disputed. Examples might be when an insurance company or third party does a “post payment review” and determines that the care was not medically necessary, or when insurance pays but later determines that work comp or PI were primary, or when an insurance company decides that the patient did not have a particular benefit or coverage for what they already paid.
Essentially, when you have delivered quality services to a patient that were medically necessary and in the best interest of the patient, and the insurance company pays for those services, you have NOT been overpaid and no refund is due. Even if the insurance company later decides they overpaid or paid in error. These refund requests should always be disputed.
Legally, you are not obligated to repay the insurance company when you have been paid in good faith for services rendered and they paid in error. These should always be disputed.
This will not stop some insurance companies from ‘recouping’ the payment, but you should still attempt to dispute the refund request first. Our experience is that by disputing the refund you will avoid 85% of all refund requests. It is well worth the time and effort to do so.
The exception to the above involves government programs such as Medicare and Medicaid. We generally advise refunding these right away and THEN disputing the request. Remember that you must use the approved Medicare refund form and mailing address (check on line with your local Medicare carrier for the latest form and address).”
– an excerpt from an article by Dave Michel from Petty, Michel and Associates (PM&A). Get the complete article: Handling Insurance Company Refund Requests of Chiropractic Patients
Dr Tom Potisk
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