Many providers, when receive overpayment notices from commercial insurance payers, start investigating the reasons, digging into the old documentation, writing appeals or some providers just pay the balance. Billing department specialist Alla Keinig, knows the first and very important step that primarily must be taken before any other process has begun.
Case: In May provider received an overpayment request from the GHI insurance payer. The reason of the overpayment was back date coverage termination. The coverage was retroactively terminated nine months prior to the dates of services in question. The services were performed and paid in 2013 and provider just got the notice four years later.
Alla knew, from her experience, that recoupment requests do have time limitation, however she did not know that there was a New York State Insurance Law that protects providers from incorrect recoupment requests.
With the help of her WCH colleagues, she had obtained a copy of the Law. Under the NY state Insurance Law § 3224-b(b), the 24-month limitation applies to any recoupment attempted which is commenced on or after the January 1, 2007 effective date of the statute.
Alla contacted GHI Claims Refund Unit and spoke to their supervisor. She was surprised by the fact they were not aware about the NY State Insurance Law, more over the reference to the Law was also published in the GHI recoupment processing policy. Alla faxed both the policy and copy of the Law to the GHI Refund Unit and the recoupment request was immediately cancelled.
“We never stop educating ourselves, and the results that we bring shows our clients our professionalism,” Says Alla.