Oklahoma patient overpayment and physician refund laws

So, processing and returning overpayments (a.k.a. “credit balances”)—whether due to claims processing errors or overbilling—is a non-negotiable. To that en here are three instances when. Requesting a refund after months from the date the claim was paid is considered an unfair claim practice. Is an overpayment refund a false claim? How long does a patient have to pay overpayment?

We are concerned that without further clarification.

No statute or regulation explicitly requires refund of overpayment to the government – Except for Stark Law regulations , CFR 411. Notify the patient of the overpayment. Yes, you can and you should have a written policy and make it known to patients.

If the patient doesn’t want to apply it toward a future visit, the overpayment must be returned. If a patient overpays a physician , the physician must refund the amount of the overpayment not later than the 30th day after the date the physician determines that an overpayment has been made. CMS instructs carriers not to recover overpayments discovered later than full calendar years after the year of payment, unless there is evidence that the physician or beneficiary was at fault with respect to the overpayment. Liability of the physician for refunding an overpayment is based on fault- if the overpayment was a result of a lack of disclosure or information from the Medicare beneficiary, the liability may shift to the beneficiary. Refund of overpayments , duplicate payments and erroneous payments - Rebuttable presumptions.

What does the law provide?

While merchants are required to accept returns in only certain situations, some states have laws governing the disclosure of refund and return policies. You are required by law to refund Medicare and Medicaid overpayments. Also, some managed care contracts specify that you must process refunds for overpayments within a specific time period. Healthcare providers are also subject to abandoned property laws , which are pertinent in determining patient refunds.

Collecting from patients at the front desk can result in patient overpayment. An over- refund is when a patient is refunded more than what they over-paid in the first place. When this occurs, your organization has to go through the process of collecting the over- refund , which is a negative consumer experience and a waste of time and effort for staff. Doctors have a right to collect all reasonable co-pays and deductibles.

It is a known practice that physicians do not disclose refunds owed to patients. I have worked with several doctors and it is amazing that credits owed to patients are to be kept a secret. That is a practice that should be stopped because that boils down to stealing. Importantly, any overpayment retained is an obligation under the Federal False Claims Act. In dragging out the refund process over two or three months, the doctor hopes to discourage patients from seeking refunds of a few dollars.

In your case, you are probably familiar with your patient , so fraud is not a concern. And since the transaction was a debit car the fees are probably lower than with a credit card. Since the medical expense was paid by an HSA, when you refund the money the expense becomes one that is no longer a qualified medical expense for the patient ’s HSA.

Most common was law enforcement - 17. It seems Oklahoma physicians need to take off the blinders and heighten their index of suspicion.

A reportable payment can be anything of value given to a patient or caregiver, including a refund of previously paid medical bills, forgiveness of outstanding medical bills, free services, gift cards, or any sum of money. The purpose of these limits is to help ensure that evidence (including witness testimony) does not deteriorate and to prevent people from threatening lawsuits, or criminal charges, indefinitely. Each state has an escheat law that directs how your practice should handle refunds to the payers or patients. Failure to comply with the timely investigation of overpayments exposes the practice to considerable risk.

The courts recognize that by requiring providers to refund overpayments , providers may be left uncompensated for their services. An insurer, however, can request a refund long past the deadline that a provider has for billing a patient , billing a secondary or tertiary carrier, or securing alternate sources of coverage. A year and a half ago my husband went to a doctor, had surgery, and the medical problem was over.

No follow-up appointments scheduled. Last week, he goes back to the same doctor for an unrelated issue and is told he has a “little credit” there so we don’t have to pay the co-pay today ($20). Action Step When an overpayment is identifie a physician should identify the full scope of the problem. A physician should work closely with legal counsel. In most cases, it is in the physician ’s best interest to seek a global resolution of overpayments to all federal health benefits programs, not just Medicare.

OVERPAYMENT DEFINITION. A Medicare overpayment is a payment that exceeds regulation and statute properly payable amounts.