Refunds & Prepayments-Refunds & Prepayments

Refunds & Prepayments - Job Aid

Pdf Summary

The Refunds & Prepayments Job Aid outlines best practices for managing financial hygiene in healthcare settings through effective prepayments, time-of-service (TOS) collections, and refunds. Key strategies include verifying insurance coverage and collecting patient payments at the time of service by utilizing batch tools and payer portals to confirm benefits, deductibles, copays, and referrals. Staff should document these benefits in the practice management system, notify patients of outstanding balances well in advance, and collect copays during check-in and deductibles or coinsurance at check-out, leveraging tools such as Phreesia for streamlined payment collection.<br /><br />For surgeries, workflows should be established to track upcoming procedures and collect necessary payments—including deductibles, copays, and coinsurance—at least seven days prior, coordinating with hospitals to prevent duplicate charges. Managing overpayments requires proactive checks for duplicate payments and account credits, confirming their validity before issuing refunds or applying credits to future services or related accounts.<br /><br />Insurance overpayments must be carefully reconciled through review of explanation of benefits (EOBs), claim adjustment reason codes (CARC), and payment postings to detect errors or duplicates. Compliance with state prompt pay laws, such as Florida's 12-month recoupment limit, is critical. Additionally, adherence to unclaimed property laws mandates awareness of dormancy thresholds, timely filing of annual reports, and sending due diligence letters for balances over $50 before escalation.<br /><br />Automation is encouraged for reporting, refunds, and payment plans. Writing off small balances, where permitted, can reduce administrative burden. Strengthening collection efforts involves structured follow-ups and regular audits of refund and credit processes, combined with staff training to ensure legal compliance. This comprehensive approach improves financial management efficiency and mitigates risks in medical billing and collections.

Keywords

financial hygiene

prepayments

time-of-service collections

refunds management

insurance verification

patient payments

practice management system

overpayments reconciliation

compliance laws

automation in billing