3 things you must know about overpayment recovery (2024)

When a payer sends an overpayment recovery request—a retroactive denial or reduced payment of a previously paid claim—you may lose significant time from patient care while handling the issue. Learn what you need to know about the overpayment recovery process with these three tips and additional assistance from a free online overpayment recovery toolkit from the AMA.

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  1. Address the request as soon as possible. You have the right to challenge a request, but there may be defined time constraints for doing so in your contract with the health insurer. In some cases, the insurer will automatically recoup the payment if it doesn’t receive a check or appeal within a specified period of time. Learn how to address and resolve overpayment recovery requests.
  2. Improve your practice’s administrative workflow by automating the overpayment recovery process. Keeping track of overpayment recovery requests and using a payer follow-up log will help improve your practice’s process. Using electronic transactions to automate and standardize workflows in your practice can reduce the likelihood of these requests. Get more information on how to automate the tracking and monitoring process.
  3. Know your overpayment recovery rights. Many contracts between physician practices and insurers place few, if any, restrictions on the payer’s ability to recover alleged overpayments. However, you may have rights that, when exercised, can greatly reduce the administrative burdens these processes place on your practice. For example, 24 states have passed statutes or regulations that give physicians significant protections with respect to overpayment recovery practices. Find out more about your rights in this process.

Other newly updated resources available on the AMA’soverpayment recovery web pagecan help you automate and improve the process for overpayment recovery.

3 things you must know about overpayment recovery (2024)

FAQs

What is recovery of overpayment? ›

When an employee has been overpaid, an overpayment recovery plan is established to provide a method by which the overpayment can be recovered. Common reasons for overpayments include: Unpaid Exception Time: leave over-usage, unauthorized or unexcused absences.

What is the procedure to resolve an overpayment? ›

When a business receives an overpayment, it is required to notify the customer and to offer to refund the excess amount or apply it as a credit toward a future invoice. The agreed-upon resolution should be documented and implemented quickly.

What are some steps you would take to process a refund for a patient that overpaid? ›

Payer Overpayments

If the payer confirms that they did make an overpayment, they should reprocess the claim to show correct payment and send a request for the provider to return the overpayment. Sometimes the payer will just ask the provider over the phone to return the overpayment.

How to win an SSI overpayment case? ›

Remember, you must show both that the overpayment was not your fault and that you do not have enough money to pay back the overpayment. Some of the reasons that may show that the overpayment was not your fault are: You have trouble reading. You did not know what you had to report to SSA.

What is the risk of overpayment? ›

While overpayments can occur inadvertently, they can result in financial imbalances and complications for both the payer and the recipient.To prevent overpayments, it is essential to maintain clear communication, accurate invoicing, robust payment verification processes, and diligent reconciliation of accounts.

How long does a company have to recover an overpayment? ›

Accidental Error: When a payroll overpayment occurs due to an inadvertent mistake, such as a payroll miscalculation or administrative oversight, California law typically grants employers a window of three years to rectify the error.

What happens if an employee refuses to pay back overpayment? ›

Employees who defy their obligation to repay overpayments can be discharged, absent special circ*mstances. And if an employee is exhibiting dishonesty by refusing to repay money obtained in a windfall, then even the EDD may think twice, and deny unemployment benefits.

Can an employer take back money from an overpayment? ›

Under the Federal Labor Standards Act (FLSA) - the federal law governing wage and hour issues - employers can deduct the full amount of overpayments to employees, even if doing so would bring the employee's wages below minimum wage for the pay period.

Am I obligated to pay back an overpayment? ›

California offers the strongest worker protections against bosses clawing back money that they think was overpaid. First, an employer can only recoup money if the worker signs a written agreement outlining the exact terms of repayment.

How will you resolve if there is a patient's overpayment or credit on an account? ›

Start By Notifying The Patient Immediately

Most minor overpayment problems can be resolved by offering the patient a standing credit for future services. If they are unhappy with the credit or are no longer in your care, then you are legally obligated to repay the exact amount owed.

Does SSA forgive overpayments? ›

If you believe that you may have been overpaid, but feel that it was not your fault and you cannot afford to pay us back, you may ask for: A waiver of the overpayment. And complete form SSA 632 (Request for Waiver of Overpayment Recovery).

What is the burden of proof for Social Security overpayment? ›

The burden of proof for determining whether a beneficiary was at fault for an overpayment will shift from the beneficiary to the SSA. Most beneficiaries who request repayment plans will be able to get up to five years to pay off the debt.

What are the SSA rules about overpayment? ›

9. What Will Happen to My SSI If I Have an Overpayment? SSA will ask you to pay the full amount of the overpayment within 30 days. If you don't do this, and you are still eligible for SSI, then SSA will take the lesser of 10% of your total monthly countable income or your entire monthly income.

Do I need to pay back overpayment? ›

In most circ*mstances an employer has the right to claim back money if they've overpaid someone. They should contact the employee as soon as they're aware of the mistake. If an employee notices an overpayment in their payslip, they should talk to their employer as soon as possible.

Should you pay back overpayment? ›

If you do not pay back an overpayment or monetary penalty, the Department of Labor may take legal action to file a judgment against you. Once entered, a judgment is good and can be used against you for 20 years.

What does it mean if I have an overpayment? ›

Overpayment is the disbursem*nt of more federal student aid funds to a student than they are eligible to receive. An overpayment alert in "Account Dashboard" will let you know whom to contact to resolve the aid overpayment. Was this page helpful?

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