As the name implies, a Credit Balance takes place when excess revenue is collected compared to the Charges for a service rendered by the Provider. This could be due to lots of causes and has to be fixed though the final methods of health-related claims processing are performed. The Credit Balance could be due to an excess patient payment in the type of Co-insurance coverage or Deductible or it could be due to more than-payments from the Insurance coverage Payers. Let us analyze some scenarios and why it is crucial to be handled promptly:

Patient Credit Balance:

Individuals could have paid an quantity up front primarily based on the assumption of what their Payers would cover. As soon as the health-related claims processing is completed and the Payer pays in complete, then the Patient’s payment is in excess. The doctor billing resolution can also contact the patient and give the alternative of adjusting this excess against future visits or sending a verify. But in either situation, the Patient’s consent has to be obtained and is mandatory.

Payer Credit Balance:

A lot of a occasions the Credit Balance takes place since of More than-payments by the Payers. Even the Patient’s Credit Balance is normally since the Payer paid extra than anticipated. In health-related claims processing, it is incredibly crucial to deal with the payments from Payers on priority. This not only projects the right Money flow as a outcome of the doctor billing resolution, but also prevents inflated AR. Some scenarios on Payer Credit Balances:

1) Each Key and Secondary Payer spend as Key

2) Payer pays extra than Permitted quantity by error

3) Cross-more than errors, in particular among Medicare and Medicaid

4) Privately bought Plans – often spend as Key, although there could be yet another Key


In all these situations, there are incredibly strict suggestions and time frames inside which the excess revenue has to be returned either to the Payer or to the Patient, as the case could be. In case of Payer errors, the Payer has to be notified of the error inside 30-120 days based on the Payer. Failure to notify inside the timeframe could be viewed as ‘Fraud’ by the Payer and the State with stiff penalties. If the Payers refuse the refund (as in the case of privately bought Plans), then that revenue belongs to the Patient and the Patient has to be notified. The health-related claims processing and doctor billing resolution providers have to retain these needs in thoughts and course of action the Credit Balances on a each day/weekly basis to stay away from any difficulty for the Provider and the Practice.

Recoupments and Offsets:

Some payers would adjust the payments for existing and future claims against Credit Balances owed to other Payers which are Recoupments. When the Payers adjust the payments for existing and future claims against the more than-payments created in the previous in their personal Plans, these are known as Offsets.