what is offset, refund, adjustment and payment reference number

Posting Reference Number:

This is the number which is given by the operator to the claims posted in order to keep track of the payment posted details. This is generally given in a specified format as per the client requirement.

For Example:-

01.3651.123103 here the 01 refers to the serial number, 3651 refers to the batch number and 123103 refer to the date and the year on which the file was received by us.

• Offset:

This is a kind of an adjustment which is made by the insurance when excess payments and wrong payments are made. If insurance pays to a claim more than the specified amount or pays incorrectly it asks for a refund or adjusts / offsets the payment against the payment of another claim. This is called as Offset.

For example:-

Let the total billed amount of two claims is $100.00 each and the specified payment for this is $80.00. The insurance pays $90.00 for the first claim. Here $10.00 is paid in excess. Now while making payment for the second claim the insurance pays $70.00 and sets $10.00 as offset. Now the insurance payment becomes normal as the excess payment had been adjusted off.

 Offset - Overpayments may be recouped by “offset”. Medicare reduces future checks issued to a provider until the amount of overpayment is refunded. When Medicare identifies an overpayment, the offset process is initiated. Providers are sent a letter specifying information regarding the overpayment and are given 30 days to refund the overpaid amount. Overpayment notices contain an accounts receivable number (AR#) which identifies the transaction.

If the refund is not received from the provider within 30 days, a second notice is sent out for overpayments over $50.00, indicating that the overpayment is still outstanding and interest is now accruing. If the overpaid amount is not received upon 40 days of the initial notification,

NHIC will proceed with ‘offsetting’ money from payments to the provider until the overpaid amount is recovered. Interest on the total overpaid amount begins to accrue after the 29th day from the initial notice. Providers may avoid paying interest when choosing the offset method by initially requesting an “immediate offset”. When an immediate offset is requested, a notice is sent with the specific information regarding the offset, but the 40-day period is waived and offset is initiated immediately.Definition of a Medicare Overpayment


• Refund:

This is the process of returning back the excess money paid by the insurance / patient on request. If payment is received in excess than the specified amount, insurance / patient request for a refund. The process of Refund is usually done as per the client specifications.

For example:-

Let the total billed amount of a claim be $100.00 and the specified payment for this is $80.00. The insurance pays $90.00 for the claim. Here $10.00 is paid in excess. Now the insurance requests for a refund of $10.00 which will be done as per the client specifications.

• Adjustment:

An adjustment is an amount which had been adjusted for some reason and may be recoverable. It can be an additional payment or correction of records on a previously processed claim. Adjustments are done based on the client instructions. One specific type of adjustment is the write-off.

For Example:-

Let the billed amount of a claim be $100.00 and the paid amount is given as $70 and $ 30 is given as participating providers adjustment. So this $ 30 has to be adjusted.
Write-Off:- It is an amount which cannot be recovered at all. This write-off is usually done when the insurance payments are made. It is the balance of what the insurance have allowed on a particular charge i.e. Total Billed amount – Allowed amount. The main difference between an adjustment and write-off is that Adjustment may be recovered whereas write-off cannot be recovered at all.

For Example:-

If the billed amount is $100.00 and the insurance allowed amount is $80.00. The payment amount is $80.00 then the remaining $20.00 is the write-off amount.

REFUND POLICY

BCBSKS must request refunds from providers within 15 months from the date of adjudication. Failure to do so will result in the provider being held harmless. Refund requests for fraudulent claim payments and duplicate claim payments, including other party liability claims, are not subject to the 15-month limitation. Providers shall promptly notify BCBSKS upon becoming aware of an overpayment to initiate the refund process.


RIGHT OF OFFSET

BCBSKS will, through auto deduction processes, exercise the right of offset for claims previously paid. This right includes offset against any subsequent claim(s) submitted by the provider, including those involving other members. To accomplish this, BCBSKS will supply providers detailed individual claims information on the remittance advice so amounts can be reconciled efficiently.


OVERPAYMENT PREVENTION AND DETECTION

Timely and accurate payroll processing

Overpayments are usually created by late processing of amendments or incorrect transactions on eduPay. The common types of amendments/transactions that cause overpayments are:

• Worker’s Compensation leave entry

• Late processing of employment terminations

• Late processing, incorrect or duplicated allowances

• Late processing of time fraction changes

• Incorrect salary levels/classifications

All payroll transactions should be undertaken, wherever possible, prior to the day of Pay Finalisation to allow sufficient time to check the results of these transactions.





Q. Can I request early or immediate offset of a demanded debt?


A. Yes. When you receive an overpayment demand letter indicating a refund is due, you can request immediate offset of the debt in writing.
The immediate recoupment process allows providers to request that recoupment begin prior to day 41. Providers who elect this option may avoid paying interest if the overpayment is recouped in full prior to day 31. The immediate recoupment process does not terminate appeal rights.
An immediate offset is considered a voluntary repayment. Keep in mind a request for an immediate offset will occur only as funds become available. Providers who choose immediate recoupment must do so in writing. However, a provider can terminate the immediate recoupment process at any time.

The advantages of utilizing this new process include:
• Avoiding the possibility of checks “crossing in the mail”
• Cost savings associated with check fees and postage
• Avoiding potential interest accrual due to late receipt of refund
To request immediate offset of demanded debt, complete the Medicare Debt Recovery: Request for Immediate Offset form pdf file and fax the form to:
Part A Debt Recovery (904) 361-0320 or Part B Debt Recovery (904) 361-0444.
Note: The fax numbers indicated are for immediate offsets of a demanded debt only. Any other financial concerns should be sent in writing to the appropriate Part A or Part B Medicare department.
To ensure your request is handled promptly, all requests must include:
• Date of Request
• Which option the provider is requesting?
• One-time request for immediate recoupment of a current overpayment letter (All ARs in the overpayment letter will be placed on immediate offset)
• Request for immediate recoupment of a current overpayment letter and all future overpayments (Future immediate offset requests must include a request for immediate offset of a current overpayment letter.)
• Letter Number
• Provider Name
• Provider Medicare number and/ or national provider identifier
• Signature of provider or Chief Financial Officer
• Telephone number
• The request must specifically state that the provider understands that they are waiving potential receipt of interest payment pursuant to Section 1893(f)(2) for the overpayments.

Incomplete requests may delay processing, which can cause interest to accrue on the debt. If there is a remaining principal balance after the initial immediate recoupment request has been processed, attempts to recoup immediately will continue. Interest will accrue from the date of the demand letter if a principal balance remains after 30 days from the date of the demand letter and further collection activities will be pursued. As with all transactions of this nature, the sooner you make the decision to request an immediate offset, the more likely the offset will activate prior to interest accrual.
Please indicate Immediate Offset on the fax cover sheet.
For information regarding the immeWhat do I do if I have been overpaid because of a duplicate primary payment


Q. What do I do if I have been overpaid because of a duplicate primary payment?

A. Medicare Secondary Payer (MSP) overpayments are processed differently than non-MSP overpayments and require a refund to be sent within sixty days of receiving a duplicate payment. Complete the appropriate Medicare Secondary Payer overpayment refund form (see below) and attach a check for the overpaid amount. In addition, the other insurer’s explanation of benefits is required for every claim involved.
• Medicare Secondary Payer overpayment refund form -- Florida pdf file
• Medicare Secondary Payer overpayment refund form -- Puerto Rico pdf file
• Medicare Secondary Payer overpayment refund form -- U.S. Virgin Islands




Q. What do I do if I have been overpaid because of a duplicate primary payment?
A. Medicare Secondary Payer (MSP) overpayments are processed differently than non-MSP overpayments and require a refund to be sent within sixty days of receiving a duplicate payment. Complete the appropriate Medicare Secondary Payer overpayment refund form (see below) and attach a check for the overpaid amount. In addition, the other insurer’s explanation of benefits is required for every claim involved.
• Medicare Secondary Payer overpayment refund form -- Florida pdf file
• Medicare Secondary Payer overpayment refund form -- Puerto Rico pdf file
• Medicare Secondary Payer overpayment refund form -- U.S. Virgin Islands


Q. What do I do if I have been overpaid on a claim?
A. Once an overpayment has been determined, providers are required to repay the debt. Complete the appropriate overpayment refund form (see below) and attach a check for the amount. Specific data such as patient name, Medicare ID # and Medicare claim number must be included for claim correction and remittance revision, where appeal rights are afforded. If this data is not returned and Medicare is unable to correct records, claim(s) included in the refund may be identified as an overpayment and demanded in the future.
• Overpayment refund form -- Florida pdf file
• Overpayment refund form -- Puerto Rico pdf file
• Overpayment refund form -- U.S. Virgin Islands


Q. What if the entire overpayment amount cannot be refunded at one time?

A. An Extended Repayment Schedule (ERS) can be requested if the debt cannot be paid in full. Follow instructions outlined in the Sole proprietor or Corporation/group ERS forms below and return the required documentation. Once a completed ERS has been received, a 30 percent withholding of claim payments will begin, and the withholding will continue until the review has been completed. The original documents must be mailed with the payment. Once approved, all ERS payments will be recouped from the provider’s future Medicare payments according to the approved amortization schedule, unless it has been determined that there is a valid reason for the provider to send a check.



Q. What happens when a redetermination or reconsideration appeal is requested?

A. After notice of a valid appeal request, if limitation of recoupment (Section 935 of the Medicare Modernization Act) provisions apply, all collection activities are ceased, including the withholding of future claim payments. Interest, however, will continue to accrue during the appeal process.



Q. What do I do if I receive an overpayment letter?

A. An overpayment letter is a formal request to repay a debt owed to the Medicare Trust Fund. Payment is due upon receipt of the notice. Send the payment with a copy of the overpayment letter received or request an immediate offset. Interest will accrue 30 days from the date on the overpayment letter and every thirty days thereafter. On day 40, we will immediately begin offsetting and claim payments will be withheld and applied until the entire debt is collected.
The letter number or AR number must be included with the payment in order to apply the refund properly, without delay.


Q. Can a request for offset/recoupment be made at the same time I notify Medicare of an overpayment?
A. No. A request must be submitted in writing. Click here for instructions.

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