Credit Balance Services

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.

A credit balance is any account in a negative balance, caused by improper or excess payment made to a provider. Though credit balances can represent actual overpayments made by the payer, they often result from preventable billing errors such as improper coordination of benefits, duplicate payments posted, errors calculating coinsurance, and many more.

Patient Credit Balances

Patient credit balances are those caused by improper payments from patients, typically resulting from miscalculating their coinsurance or out-of-pocket costs.

Commercial Payer Credit Balances

Commercial credit balances are caused by improper payments made by commercial insurance payers, often caused by registration errors, improper coordination of benefits, and contract issues.

Medicare/Medicaid Credit Balances

Medicare and/or Medicaid credit balances are improper payments made by government payers, they carry with them the strictest regulation and highest probability of fines and penalties if mismanaged.

Medquik Solutions, on the other hand, has built a complete credit balance solution designed to properly resolve ALL credits (regardless of source or dollar amount) then identify their root-causes and implement corrective actions to prevent them. Discover the complete credit balance solution today by requesting a consultation with Medquik Solutions.