Credit Balance in Medical Billing

March 8, 2017 | | Comments Off on Credit Balance in Medical Billing

As the name suggests, a Credit Balance occurs when excess money is gathered compared with the Charges for a service rendered by the Provider. This might be due to lots of factors and needs to be repaired while the last actions of medical claims processing are done. The Credit Balance might be due to an excess client payment through Coinsurance or Deductible, or it might be due to overpayments from the Insurance Payers. Let us evaluate some circumstances and why it is essential to be managed quickly:

Client Credit Balance

Clients may have paid a quantity in advance based upon the presumption of exactly what their Payers would cover. As soon as the medical claims processing is finished and the Payer pays completely, then the Patient’s payment remains in excess. The doctor billing option can likewise call the client and provide the choice of changing this excess versus future sees or sending out a check. But in either situation, the Patient’s authorization needs to be acquired and is obligatory.

Payer Credit Balance

Lots of time the Credit Balance occurs because of Overpayments by the Payers. Even the Patient’s Credit Balance is generally because the Payer paid more than prepared for. In medical claims processing, it is extremely important to deal with the payments from Payers on top priority. This not only jobs the appropriate Cash circulation as an outcome of the doctor billing service but likewise avoids inflated AR. Some situations on Payer Credit Balances:

1) Both Primary and Secondary Payer pay as Primary.
2) Payer pays more than Allowed quantity by mistake.
3) Cross-over mistakes, specifically in between Medicare and Medicaid.
4) Privately acquired Plans – constantly pay as Primary, though there might be another Primary.


In all these circumstances, there are really rigorous standards and timespan within which the excess money needs to be returned either to the Payer or to the Patient, as the case might be. In the case of Payer mistakes, the Payer needs to be alerted of the mistake within 30-120 days depending upon the Payer. Failure to alert within the timeframe might be considered as ‘Fraud’ by the Payer and the State with stiff charges. If the Payers decline the refund (as when it comes to independently bought Plans), then that money comes from the Patient and the Patient needs to be informed. The medical claims processing and doctor billing service providers need to keep these requirements in mind and procedure the Credit Balances on a daily/weekly basis to prevent any difficulty for the Provider and the Practice.

Recoupments and Offsets

Some payers would change the payments for existing and future claims versus Credit Balances owed to other Payers which are Recoupments. When the Payers change the payments for existing and future claims versus the overpayments made in the past in their own Plans, these are called Offsets.

The very best choice to deal with the Credit Balances is to contract out medical billing to an expert medical claims processing company.