One of the most significant risks in the healthcare revenue cycle is Credit Balance – the excess money received compared to the medical services rendered charges. While there are many reasons for credit balance situations to occur, over-payments from payers and excessive payments could be from deductibles, and co-pays are the primary reasons for credit balance. The healthcare provider must refund such amounts to the appropriate party – payer or patient.

Compliance Risks from Credit Balances

• Litigation and Fines. Failure to refund credit balances promptly could result in Litigation and significant fines or even imprisonment.
• Inaccurate understanding of the A/R situation. An excessive credit balance can provide an inflated view of the practice’s financial health and lead to erroneous financial decisions.
• Impact on the productivity of A/R team members. Deployment of additional resources or shifting resources from the A/R team to resolve credit balance reduces team productivity.
• Loss of Credibility. Litigation creates negative publicity that reduces patient flow to the practice.

Refunding Credit Balances

• Patient Credit Balance. We analyze each patient’s account, identify and validate credit balances, and initiate refund checks to zero out the account balance.
• Credit Balance with Payers. Providers should process refunds within 60 days from the date of the refund request. We validate each request, and if found to be valid, we process the refund. If the refund request is invalid, we raise an appeal after thorough validation.