GeBBS Healthcare Blog

Compliance with Credit Balance Resolution Rules Does Not Have to Be Difficult

Posted on Wed, Jun 17, 2015 @ 05:00 AM

Credit balances are unavoidable and time-consuming. However, by law, they must be resolved. This activity does not have to be difficult even for already over-worked billing staffs. Professional outsourcing services are available to help with this growing challenge.

These services can be customized to fit into your specific workflow and increase your staff’s productivity, allowing you to increase the volume of accounts resolved on a daily basis, without hiring extra FTEs.

There are professional outsource companies that specialize in enhancing the financial performance of your revenue cycle management and related processes. They act as your partner to work within your legacy billing systems to research accounts in credit status, determine the root causes of the credit, and take appropriate corrective actions to resolve your credit balances. They leverage their healthcare expertise, technology, and qualified personnel resources. There is no capital outlay required.

Incorrect adjustments, erroneous credits, and misuse of debit codes make the credit balance task challenging without precision. 

In contrast, professional outsource analysts are diligent and well-trained to ensure outstanding credit balances are accurately resolved in an expeditious manner. Their services are highly client-centric. They understand a professional and cooperative environment is the key to resolving credit balances, many of which become account corrections, as opposed to actual refunds.

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Tags: Revenue Cycle Management (RCM), Accounts Receivable (A/R), Credit Balance Resolution

Six Benefits and Results of Having a Good Credit Balance Resolution Program

Posted on Wed, May 20, 2015 @ 09:00 AM

In today’s healthcare environment, credit balances are commonplace. The healthcare industry has a high incidence of credit balances due to multiple parties paying claims. The way that various information technology (IT) systems operate also creates credit balances.

Each provider must determine its credit balance strategy -- implement an internal program, which usually requires adding staff; outsourcing this work; or ignoring it. This last option is not optimal or realistic, given penalties for failure to comply with regulations on both the state and federal levels can be significant.

The common result is that healthcare providers do not want to add staff, if it can be avoided, and credit balance resolution provides a substantive distraction from the staff’s primary billing and collection focus. Among the reasons for this, is the provider belief that it’s painful to pay staff members to “give money away.” And, once behind in their credit balance resolution work, it is very difficult to catch up.

This leaves as the best alternative for handling credit balance resolutions – outsourcing! Following are the six top benefits and results for outsourcing your credit balance work:

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Tags: Revenue Cycle Management (RCM), Accounts Receivable (A/R), Credit Balance Resolution

10 Best Practices for Credit Balance Resolution

Posted on Tue, Apr 28, 2015 @ 07:00 AM

Credit balances are simply a part of everyday life in the delivery of healthcare services. Unresolved credit balance accounts can distort the profitability of a healthcare facility and foster financial risks. Researching and correcting posting errors, duplicate payments, overpayments, and misapplied credits are not only time consuming, but also expensive. However, failure to address these credit balances in a timely manner may result in missed billing opportunities, and when associated with government payers, may also bring compliance risks and penalties. Following are 10 best practices to help you with your credit balance resolutions:

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Tags: Revenue Cycle Management (RCM), Accounts Receivable (A/R), Credit Balance Resolution

Credit Balance Facts – What You Don’t Know Can Hurt You!

Posted on Tue, Apr 28, 2015 @ 07:00 AM

While credit balances are unavoidable, identified overpayments should be retained for as short a time as possible. Risks associated with unresolved credit balances include: Medicare/Medicaid penalties, class action litigation, misstated revenues, lost payment opportunities and wasted time and resources. 

There are several common causes of credit balances: insurer overpayments or duplicate payments, coordination of benefit conflicts, incorrect payment rates in billing systems, insurer refusal to accept provider-identified overpayment, incorrect upfront collections (coinsurance/deductibles), charge corrections, unintentional, erroneous over billing, and uncashed refund checks.

To assist facilities with dealing with credit balances, the Office of Inspector General (OIG) has made general recommendations in its compliance Program Guidance for Third Party Billing Companies:

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Tags: Revenue Cycle Management (RCM), Credit Balance Resolution