Dealing with the negative insurance balance of your practice
Recently some healthcare providers have reported having a negative balance with certain several insurance carriers they are participating with. Having a negative balance leads to a significant disruption in insurance payments, but it is not the end of the world. There are several ways of "fixing" your financial record with a payer. Let us examine this issue in detail.
First, a negative balance is a specific dollar amount that is being recovered from a healthcare provider in ways of subtraction from a new payment caused by a recoupment request. To put it simply – it is when insurance wants to get their money back from you, and they are now recouping it from the new payments issued to you.
Now, you might be wondering – what is the reason behind recoupment? Is there anything wrong with my contract? Am I getting audited?
Recoupments often occur when a payer determines that they have issued an invalid payment to you some time ago. For example, let us say that you had a patient back in 2020. You submitted a claim for your services and received a decent payment from his/her insurance. This amount may be deducted from your provider balance if a payer determines that your claim has been paid in error. In this case, you would receive a $0.00 check from the insurance for the services of another patient that have not been denied nor applied to their out-of-pocket costs. There would be no actual payment because it has been applied towards your negative balance in the amount of …. The question is – how do I fulfill this amount and start getting paid again? Should I send the money back?
You need to verify that the recoupment is valid. If it is – just wait for a while until the mentioned amount is fully deducted from your future checks (you can check this information in a provider balance report). Then, you would need to resubmit your claim appropriately, if applicable, and get your recouped money back. That’s it!
If you believe that you have been recouped incorrectly, however, you would need to appeal those old claims that have been recouped. The more evidence you provide - the more likely the positive outcome will be.
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