When does money have to go back out?

Most of billing is money coming in. Sometimes it has to go back out, and there are four different reasons why. The first job is always the same: work out which of the four this is, because each is handled differently.

One: the payer reverses a payment. On the claim you see a reversing entry, a negative that backs the old payment out. Nothing is erased. The original payment stays in the history and the reversal sits right next to it, so the trail tells the truth.

Two: the payer asks for money back. It keeps its payment but sends a letter asking you to repay. You send money back to the payer directly. Compare this with a takeback, where the payer takes it out of a future check instead of asking.

Three: a duplicate. The same claim was paid twice. One of those payments has to go back, or your books will never balance.

Four: money owed to the patient. A patient paid, then insurance paid, and now the account holds a credit. That credit becomes a refund to the patient, recorded with a reason so anyone can see why the money left.

Only cases two and three are money you actually send back to the payer. In case one the payer takes it back itself, right on the remittance, usually re-paying a corrected amount beside the reversal. Case four is money owed to the patient. Telling the four apart is the whole job, and you never have to do it alone: ask the assistant and it identifies which case you are looking at.