Refunds & Prepayments-Refunds and Prepayments Presentation

Refunds and Prepayments Presentation

Pdf Summary

This document, authored by Carol Ittig, MBA, FACMPE, and Sondra Young, CPC, focuses on ensuring financial hygiene in medical practices, emphasizing refunds, prepayments, and collections. It addresses important aspects of managing patient and payer financial responsibilities with an aim to optimize revenue cycle management while maintaining compliance with relevant laws.<br /><br />Key learning objectives include understanding the financial implications of Time-of-Service (TOS) collections and prepayments, adhering to state and federal regulations such as the No Surprises Act of 2022 and prompt payment laws, and implementing effective workflows for accurate accounts and patient accountability.<br /><br />The document uses a case study of a Florida practice’s unclaimed property audit revealing $4 million in credits, highlighting the importance of system data cleansing and validation. It outlines a structured approach to achieving zero balance through pre-visit registration and insurance verification, collecting copays and outstanding balances, post-visit deductible collections, accurate claim scrubbing, and refund processing. Leveraging technology tools such as AthenaPractice, Phreesia, Availity, and automated reports aids in streamlining verification and payment workflows.<br /><br />Insurance verification is underscored as critical to minimizing claim rejections and accurately estimating patient financial responsibility. For self-pay patients, use of Good Faith Estimates ensures compliance with No Surprises Act timelines. Prepayment policies, particularly for elective surgeries, include deposit collection with strict timelines and coordination with other providers to avoid duplicate charges.<br /><br />The document explores causes of overpayments from billing errors, data entry mistakes, and patient misunderstanding, alongside state-specific unclaimed property laws and refund thresholds. It stresses prompt refund policies and managing duplicate accounts effectively.<br /><br />Collections strategies include segregating balances above and below $500 with tailored communication workflows and careful use of collection agencies. Recent CFPB rules removing medical debt from credit reports reinforce privacy and protect patients from unfair collection practices.<br /><br />Overall, the document promotes proactive, technology-driven financial processes and compliance-focused policies to minimize financial risk and enhance practice revenue integrity.

Keywords

financial hygiene

medical practices

refunds

prepayments

collections

revenue cycle management

No Surprises Act 2022

insurance verification

Good Faith Estimates

CFPB medical debt rules