General Policy Statement
Standards of Conduct state that submission of any claim or request for reimbursement or payment that is false or inaccurate will not be tolerated. If inaccuracies are discovered in claims already submitted for payment or reimbursement, the payor shall be immediately notified and appropriate action taken to remedy the matter.
Personnel will promptly refund to any federal government, state agency or private payor any overpayment received in error due to incorrect billing or for services found on audit not to meet coverage requirements. The refund process will be completed within 30 days from the discovery of the overpayment.
Suggested Elements
- Anyone who determines there may be an overpayment must notify his/her supervisor immediately with the following information:
- Patient name
- Type and amount of overpayment
- Date
- Payor
- The issue should be researched promptly and discussed with all department managers involved in the service rendered in order to substantiate the overpayment.
- As soon as it is determined that the overpayment exists, a refund to the appropriate payor should be completed as soon as possible but not later than 30 days.
- If an electronic adjustment can be completed, it should be completed as soon as possible but not later than 30 days.
- Routine processing errors should be reported to your immediate supervisor and corrected as soon as they are identified using the above procedures.
- Follow all standard business office procedures.
- If unable to resolve an issue, consult with your Regional Account Manager as soon as possible.