Processing Credit Balances

Introduction

Date of Last Review 4/8/08
SME: Director of Financial Operations

Overpayments are to be researched and refunded expeditiously to the patient or third party payor

A credit balance listing provided by the patient accounting system will be thoroughly researched and acted upon.

PROCEDURE

HCPC Staff:

1. Request the credit balance report via patient accounting system at the beginning of the month. The report will be a tool for resolving credit balances on a monthly basis. In addition, to comply with Texas Unclaimed Property Law, credit balances remaining unresolved for three years as of August 31 of any year will be remitted to the State Comptroller’s Office by November 1 of same year.
2. Patient Accounting staff will determine the validity of the balances due to the payor within 30 days of the previous month end.
1. If the payment(s) was posted incorrectly, the payment(s) will be transferred to the patient account.
2. If the payment(s) was posted correctly, the patient account will be noted on the Credit Balance Log and refunded to the patient.
3. If the credit balance is attributed to incorrect data entries in the insurance screen in Patient Accounting system, Patient Accounting staff will review document imaging for the correct insurance information and make the necessary changes in the insurance screen to resolve the credit balance.
3. Patient Accounting staff will prepare the required and necessary documentation to initiate a refund and submit the request to the Director, Financial Operations or delegate for approval.
4. The approved request for refund will be processed according to policies and procedures dictated by the UTHSC.

Outsource Provider:

1. Routinely assess credit balances for refunds.
2. Site Director will notify Director, Financial Operations or delegate of any candidate for  refunds.
3. Director, Financial Operations or delegate will provide request Patient Accounting for verification. See this guideline HCPC Staff #2

Related standards

The Joint Commission : Leadership

JCAHO MA 4
UTHSC-H Handbook of Operating Procedures

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