6 Recoupment Dilemmas, and How to Deal with Them

Oftentimes, insurance companies will ask money back from you because they claim to have overpaid you.  This obviously this can be frustrating!  Here are some of the pitfalls, and how you can avoid them:

1.   Your patient forgot to tell you they have secondary insurance

Call the patient and ask what their secondary insurance is, and find out what their primary plan is.  File with the new primary plan, and then the second.  You’ll have to pay back the insurance company, but you’ll get paid by the new insurance plan.  If you are out-of-network, you’ll need to collect from the patient.

2.   Your patient’s policy terminated

You’ll need to contact the patient and inquire about their new policy.  File the date of service again with the new insurance company.  If it isn’t an insurance you take, you’ll need to collect from the patient.

3.   There’s been a change in the fee schedule

Stay on top of all the mail you get from insurance companies–you never truly know when one of those pieces of mail you discard may be a fee schedule change.  You’ll need to appeal the decision by calling the insurance company.

4.   The insurance company paid you multiple times

Double check that you didn’t file the same claim twice.  If you didn’t, you need to appeal   the decision.  If you did, you’ll have to pay the insurance company back.

5.   The insurance company paid the wrong person

Be conscious of when and for what amounts insurance companies are paying you.  Payment may have gone to a different clinician in your practice, or deposited to you inadvertently due to improper data entry.  You’ll need to contact your insurance company for the former instance, and  return the funds immediately for the latter one.

6.   The insurance company performs an audit on you

Thoroughly read over any material provided by insurance companies, and ensure that you’re dotting your I’s and crossing your T’s when it comes to your clinical duties.  As long as you’re doing everything by the book, you should pass the Medical Record Recoupment process.