Credit Balance and Refunds Processing

HomeCredit Balance and Refunds Pro...

Who wouldn’t want to have a credit balance on their books? However, a Credit Balance for the Healthcare provider can pose serious risks and become a liability if not managed well. Why so? We deal with Credit Balances expeditiously when it comes to deciphering, processing and posting refunds or making account corrections, which is the key to protect revenue cycle integrity. A Credit Balance is not “extra cash” or an asset for the healthcare provider. It means that you actually lit the fuse and it can go off anytime damaging your reputation and corroding goodwill if not managed through an effective A/R process.

It is the fiduciary responsibility of the provider to manage this risk. Almost 55% of credit balances are due to incorrect postings as per data available in the industry. Misuse of debit codes, wrong adjustments and credits that are processed erroneously are quite challenging to clear. QWay establishes a strong working relationship with clients in order to process their credit balances in a timely fashion and reduce the backlog.

Credit Balance and Refunds Processing Services Process


Credit Balance with Payers.

  • Each refund requested is validated, post that processing of refunds and reconciliation of the patient accound is carried out.
  • If request is found to be invalid, it is reviewed again and is filed for an appeal with the payer.
  • Within 60 days after the date of the refund request, refunds to government payers shall be completed. Our staff rapidly processes requests from government payers and gives them first priority.


Patient Credit Balance

Each account with credit balance is carefully validated and refund checks are processed to the patient promptly.

What we do at QWay to reduce and resolve Credit Balances?
  • Complete analysis of the account along with the EOB.
  • Inspect patient liability and other issues on adjustment.
  • Check to see if a double payment was made and if so refund.
  • Check if there are two Insurance carriers and both are acting as primary.
  • Work towards increasing the number of CPAT (Certified Patient Account Technician) credit balance analysts.

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