Six Insurance Recoupment Scenarios, and How to React
Alex Trent, MA, MS
Mental health professional offloading the stress of dental and medical professionals that billing can bring them, so they can get paid and help more people, while doing what they love--which is not billing!
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 client forgot to tell you they have secondary insurance
Call the client 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 client.
2. Your client’s policy terminated
You’ll need to contact the client 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 client.
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.