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Credit Balance Resolution

HFMA calls credit balances the “stealth aircraft of hospital patient accounting.” This is because the credit balance is a liability that is hidden within the accounts receivable ledger. This liability carries with it real and serious financial and compliance risk. It is your fiduciary responsibility to manage these real risks.  Industry data shows that over 55% of credit balances are a result of incorrect posting of allowances.

Federal Register published rules that went into effect in mid-March 2016 that:

  • Providers must repay Medicare overpayments within 60 days of identifying the overpayment, although they can take up to six months to investigate suspected overpayments.
  • Providers must repay identified overpayments occurring within the past six years.
  • Repayments can be made by refunds, claims adjustments, a credit balance, or another appropriate process.

Penalties are stiff for noncompliance. Providers that do not report and repay the overpayments are subject to penalties under the False Claims Act and could be prohibited from participating in federal healthcare programs, according to CMS.

GeBBS has built strong working relationships with our clients to consistently meet their needs as credit balance backlogs are prioritized and processed. Incorrect adjustments, erroneous credits, and misuse of debit codes makes this credit balance task quite challenging, requiring precision, attention to detail, and a focus on operational excellence.

GeBBS has maintained a team specialized in credit balances resolution since 2010. The team is comprised of highly-qualified individuals with a hospital accounting background and strong analytical skills. All GeBBS analysts are diligent and well trained to ensure outstanding credit balances are accurately resolved in an expeditious manner. We understand a professional and cooperative environment is the key to resolving more credit balances, many of which become ‘account corrections’ as opposed to actual ‘refunds’; hence, our operational model is highly client-centric.

Highlights of our capabilities:

  • 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
  • Many credit balance analysts have earned or are earning the designation of Certified Patient Account Technician (CPAT) from AAHAM
  • GeBBS provides the highest levels of security, with a SSAE 16 Type II internal-controls audit, and HIPAA compliance.

By taking charge of your credit balances, GeBBS can expeditiously decipher, process and post refunds and/or account corrections to consistently ensure the overall integrity of your revenue cycle.

Blog: Avoiding Credit Balance Crisis – The Importance of Closely Monitoring for Overpayments

If you’ve ever received a refund from a hospital or physician’s practice office months after a procedure or visit, that’s because credit balances are a frequent occurrence in the complex world of healthcare finance.

White Paper: The Compliance and Credit Balance Conundrum

Credit is a word we hear almost daily, and many people are already familiar with the fact that accounting uses credits and debits to ‘balance the books.’

At A Glance

  • System agnostic with extensive experience on all major hospital and physician billing systems
  • Increased first-pass rate due to 97% accurate charge entry and edits resolution
  • 24 to 48 hour turnaround
  • Accurate payment posting leads to reduced credit balances
  • We specialize in:
    • Demographic entry & updates
    • Charge entry
    • Charge & claim edits resolution
    • Payment posting
    • ERA posting & exception handling
    • Denials posting
    • Claims management

Get in touch with GeBBS and enhance your financial outcome

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