How Medical Practices Should Handle Patient Credits and Overpayments

April 12, 2014

Patient credits are part of the bigger picture of managing a healthy practice. Manage them right, and everyone walks away happy.

Collecting patient copays, coinsurance, and deductibles is a must for any healthy practice. But what happens when you continue to over-collect from patients? 

Several actions occur:
1. The patient receives an EOB stating his patient responsibility amount is less than what you have collected.  This now makes him wary of your collection practices and creates a negative customer service experience for him.
2. You have created a credit amount on the patient's account, which changes the big picture of your total A/R, leaving you to believe you’re A/R is lower than it truly is.
3. A staff member will now have to spend administrative time reviewing the account and writing the patient a refund check.

This also happens when a patient reaches her out of pocket maximum, and is covered at 100 percent.

The best way to prevent these problems from occurring at your practice is by taking a proactive approach. Most software will automatically “post” payments to a patient's account when electronic EOBs are applied.  It only takes another few moments to check that patient's account for any credit that the patient might have. 

Consider the following example: Mr. Smith has a $1,500 deductible with a 20 percent coinsurance. After seeing you and having an X-ray and/or MRI, he meets his deductible. He does not tell you about the X-ray and/or MRI that enabled him to meet his deductible, so your front office continues to collect up front at each appointment. The plan typically pays within 14 days to 30 days, so when the visit is processed by the insurance plan, it applies a 20 percent coinsurance instead of towards the deductible creating a credit on the account.

You can manage this two ways: You can leave the credit on the account and ask the patient if he would like to use that credit for future visits (if he has some on the books), or you can write him a refund check. 

Either way, contacting the patient is the best route.  Be upfront and let him know that you were not aware his deductible was being applied from other physician, radiology, or lab appointments. 

Giving the patient the option to leave the credit on the account gives him the feeling that he is in control of the situation and he will not think you are trying to keep his money and be paid by the insurance, too. 

The words “insurance fraud” may come up in conversation.  Don't panic, simply state again that you were not aware of the other visits, and ask how the patient would like this credit to be processed.  It takes all of the negative energy out of the conversation and keeps you in the patient's good graces.

Patient credits are part of the bigger picture of managing a healthy practice.  Be sure that you are truly managing them to the best of your ability, and everyone walks away happy