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REFUNDS PROCESSING

Who wouldn’t want to have a credit balance on their books? However, a Credit Balance for the Healthcare provider can pose serious risks and become a liability if not managed well. Why so? We deal with Credit Balances expeditiously when it comes to deciphering, processing and posting refunds or making account corrections, which is the key to protect revenue cycle integrity. A Credit Balance is not “extra cash” or an asset for the healthcare provider. It means that you actually lit the fuse and it can go off anytime damaging your reputation and corroding goodwill if not managed through an effective A/R process.

It is the fiduciary responsibility of the provider to manage this risk. Almost 55% of credit balances are due to incorrect postings as per data available in the industry. Misuse of debit codes, wrong adjustments and credits that are processed erroneously are quite challenging to clear. QWay establishes a strong working relationship with clients in order to process their credit balances in a timely fashion and reduce the backlog.

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    The team at QWay is comprised of professionals who have strong analytical skills with experience in hospital accounting standards and norms. Our cohesive working model with clients, and internal processes enables in resolving a higher number of credit balances as an ‘account correction’ instead of a refund. A successful Credit Balance process lies in its effectiveness to prevent it.

    What we do at QWay to reduce and resolve Credit Balances?

    • Complete analysis of the account along with the EOB.
    • Inspect patient liability and other issues on adjustment.
    • Check to see if a double payment was made and if so refund.
    • Check if there are two Insurance carriers and both are acting as primary.
    • Work towards increasing the number of CPAT (Certified Patient Account Technician) credit balance analysts.
    Credit-Balances

    PATIENT DEMOGRAPHICS ENTRY SERVICES FROM QWAY WILL CAPTURE

    PATIENT DETAILS

    Patient name and ID#, Gender, Marital Status, Email, Date of Birth, Social Security Number, Contact numbers work and home and Address work and home.

    GUARANTOR / ACCOUNT DETAILS

    Guarantor Name, Date of Birth, Work and Home Phone and Address details.

    INSURANCE DETAILS

    Insurance Identification Number, Name and address of the Insurance company, Group name/ group number, Details of the policy and policy effective date and termination, policy number, Name of the insured, Date of Birth and the relationship of the insured to the patient.

    FREQUENTLY ASKED QUESTIONS

    • 1. What’s a Credit Balance in Medical Billing?

      Credit balances are the payments and adjustments that exceed the posted charges. They are not the additional cash or a positive asset for a healthcare provider. Instead, they need to be addressed through an effective accounts receivable (A/R) solution initiative.

    • 2. What is Refund processing in medical billing?

      It is the process of returning back the excess or additional money paid by the insurance or patient on request. If the payment is received in excess than the specified amount, insurance or patient can request for a refund.

    • 3. What is over payment in medical billing?

      Overpayment issues occur when patients or insurance companies pay healthcare providers more than they're supposed to. When healthcare service providers don't return overpayment, it’s equal to keeping their revenue and reputation on the line.

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    HEALTHCARE BILLING
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    RBMA Corporate Partner

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