Policy
Advanced Pain Institute of Texas shall make an appropriate refund on a patient account that has a credit balance or where a billing error was made. In no instance shall a refund request from an insurance company be honored when the overpayment was a result of the insurance company’s error, unless the error results in a credit balance, in which case only the credit balance will be refunded. Advanced Pain Institute of Texas will make all refunds necessary when governed by a contractual relationship.
Procedure
In these instances designated personnel will request a refund which shall be approved by the Patient Financial Services Manager or Coordinator.
- Two designated personnel from the Patient Financial Services office will review the credit balance report and request refunds to patients where appropriate. The two staff assigned this duty will review each other’s refund requests prior to the refund being made. Refunds shall be approved by the Patient Financial Services Manager or Coordinator.
- A daily report will be worked by the PFS billers that quickly identifies when a credit balance on an account exists after an insurance payment has been posted. A request for an adjustment will be made to the appropriate payer. All adjustments will be requested immediately to ensure the credit on the account is resolved. Documentation will be added to the account to support the request being made.
- Requests for refunds from insurance companies will be honored only under the following circumstances:
- A credit balance exists. Only the credit balance shall be refunded.
- A billing error was made by Advanced Pain Institute of Texas.
- A contractual arrangement exists which dictates specific refund policy.
- Designated personnel shall issue a notice to insurance companies when a request for refund is not honored. Such notice is included in this policy.
- The request for a special check to be issued must be approved by the PFS Director or Manager and approved by the Director or Manager of the Finance Department.