Скачать или смотреть What is Overpayment, Offset Adjustment, Reversal and Refund in US Healthcare?

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Overpayment: Overpayment occurs when a healthcare provider or organization receives more payment than the amount to which they are entitled for services rendered. This can happen due to various reasons, such as billing errors, duplicate payments, or incorrect coding.
When an overpayment is identified, it’s important to resolve it promptly. This can be done by returning the excess amount to the payer or by applying an offset adjustment to future claims, which essentially deducts the overpaid amount from future reimbursements.
Offset Adjustment: An offset adjustment is a financial transaction used to correct an overpayment by deducting the excess amount from future payments owed to the healthcare provider or organization. When an overpayment is identified, the payer may withhold a portion of subsequent payments until the overpaid amount is fully recovered. Offset adjustments help reconcile payment discrepancies and ensure that healthcare providers are reimbursed accurately for services provided.
Reversal: A reversal is a transaction that cancels or reverses a previous payment or adjustment made in error. Reversals may be initiated by the payer or the healthcare provider to correct mistakes, such as duplicate payments, incorrect payment amounts, or payments for services not rendered. Reversals help ensure the accuracy of financial transactions and prevent errors from affecting financial records or reimbursement calculations.
Refund: A refund is a payment made by a healthcare provider or organization to return an overpayment or excess payment received from a payer. Refunds may be issued voluntarily by the healthcare provider upon identifying an overpayment, or they may be requested by the payer after an audit or review process. Refunds are typically issued in the form of a check, electronic funds transfer, or credit adjustment to the payer’s account.