correctly per insurance contract; and
• no management approval is initiated for accounts with higher dol-
lar amounts because no policy and procedure is in place to provide
direction for the staff.
Require monthly reporting of adjustments/write-offs that require
approval to include reporting for those not requiring approval: specific
patient name, dollar amount, payer and supporting documentation.
Also, require monthly reporting regarding the status of accounts, pend-
ing payments and progress made.
Not returning overpayments. Require monthly reporting of credit
balances. Some facilities or billing companies keep overpayments
until the carrier requests them, but this practice will draw scrutiny of
the Office of Inspector
General. Returning
overpayments is
mandatory. Establish a
policy for refunds
based on carrier con-
tract requirements for
timelines of refunds.
Some federal payers
expect refunds within
60 days, while others
range from 15 to 45
days. Monthly moni-
toring of credit bal-
ances and refunds will
show a more accurate
7
A U G U S T 2 0 1 7 • O U T PA T I E N TS U R G E R Y. N E T • 2 7
Call: 888.416.2409
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