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.

A professional credit balance outsource company will:credit_balance_img-resized-215

   ● Analyze accounts along with EOBs
   ● Work all assigned accounts - big and small-balances
   ● Resolve all accounts - inspect for patient liability or other adjustment issues
   ● Determine if double payments were made - if so, refund as required:
        -- By patient and insurance carrier
        -- By two insurance carriers (both acting as primary)
   ● Check for duplicate payments made for the same account
   ● Provide credit balance analysts who are certified Patient Account Technician (CPAT) from AAHAM
   ● Offer the highest levels of security, with a SAS 70 Type II internal-controls audit, and HIPAA compliance

By allowing a professional outsource company to take charge of your credit balances, you can expeditiously decipher, process and post refunds, and/or handle account corrections to consistently ensure the overall integrity of your revenue cycle.

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:

Six Credit Balance Benefits:

1.   Significantly reduces staff time spent on credit balancescredit_balance_img-resized-215

2.   Allows staff to focus on billing and collection activities

3.   You can accurately quantify your cash exposure

4.   Reduces interest costs for patient refunds

5.   Provides regulatory and Sarbanes-Oxley compliance

6.   Cost-effective to implement and use


Six Credit Balance Solution Benefits:

1.   Significantly reduces overall credit balances

2.   Increases staff productivity

3.   Resolves more credit balances with same number of staff

4.   Fewer payer and patient inquiries

5.   Better compliance with payer contract terms

6.   Escheat (uncashed payment checks) compliance



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:

1.   Identify true overpaymentscredit_balance_img-resized-215

2.   Work balances oldest to newest

3.   Analyze credit balances using:

Patient admissions forms
 Payer remittance advices
 Patient accounts receivable details
 Other hospital records

4.   Identify whether the patient is an eligible Medicare beneficiary

5.   Adhere to applicable Medicare payment rules

 Medicare recommends identification of credit balances on a daily basis with immediate resolution

6.   Identify primary payer and other liable insurers

7.   Verify validity that all credit balances are due and refundable

8.   Monitor staff compliance with policies/procedures

9.   Identify preventable causes of credit balances

10. Seek professional outsourcing assistance if your staff cannot handle credit balance resolutions in a timely manner

Credit balance accounts are a natural part of today's complex reimbursement environment, and resolving these credits puts a burden on already limited business office resources. However, ignoring credit balances can lead to bigger problems.


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:

• Establish policies and procedures that contain steps for timely and appropriate resolution of overpayments.

• Ensure information systems have the ability to print out the individual patient accounts that reflect a credit balance in order to permit simplified tracking of credit balances.

• Maintain a complete audit trail of all credit balances.

• Designate at least one person as having the responsibility for the tracking, recording, and reporting of credit balances.

• Assign a controller or reasonable equivalent thereof to review reports of credit balances and adjustments on a monthly basis as an additional safeguard.

Not all credit balance accounts are the result of overpayments. In fact, on average, 65% are the result of mis-posted contractual allowances or misapplied payments.

Many facilities often prioritize working unresolved credit balances based on dollar value, working their high dollar credits first. In many cases, due to the volume of new credits created each month, the volume of accounts requiring a review increases over time creating a significant backlog. Often this backlog turns into a “special project” and taxes already stressed internal resources.

In today's environment, on average, patient accounting staff can resolve only two to four credit balance accounts per hour, which includes the completion of necessary hospital paperwork and document gathering. Hospitals are forced to dedicate significant staffing to work credit balances and avoid the risk of having them spiral out of control.

One solution to this challenge is to outsource this important work to a professional company that has expertise in credit balance resolutions. This solution requires no capital outlay, minimal/no hospital information systems department involvement, and there is no need to install any special hardware or software.

These companies will provide the highest levels of security, with a SAS 70 Type II internal-controls audit, and HIPAA compliance. By engaging a professional outsource company to take charge of your credit balances, they can expeditiously decipher, process and post refunds and/or account corrections to consistently ensure the overall integrity of your revenue cycle, and just as importantly, help you avoid the penalties associated with non-compliance.

What you don’t know about unresolved credit balance can hurt you.

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