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How To Combat Recoupment Requests

Getting a recoupment request can be scary and worrisome. Recoupment is a provision in most health insurance policies that allows the insurer to request a repayment of some or all of the cost of care after it has been provided. Most insurance companies have this provision, but it is not often used. 

Companies may also request repayment for certain services when they do not agree with the treatment they provided. There could be disagreement over in-patient and outpatient treatment, as well as disagreement over the use of imaging services and lab tests that were provided. 

If you need help with combatting a recoupment request, you may want to seriously consider getting a medical biller to help with the appeal process. 

What Exactly Is Recoupment?

As aforementioned, recoupment is a term used in the insurance industry to describe the process of recovering money from a third party.

The term is most commonly used in reference to health insurance, but can also be applied to other types of insurance policies. In the insurance industry, recoupment is a process wherein an insurer recovers money from a third party. 

This process can come as a result of either legal action or voluntary payment. Recoupment is often used to cover losses that occurred due to an accident between two parties. Hiring a medical billing company can help you fight any recoupment request. 

Common Reasons for Recoupment Requests

The recoupment process starts with a written request for repayment. This will be accompanied by a phone call or email to alert the medical insurance provider that there was an error. 

Just about every insurance company will give you up to 30-60 days to take action once the initial request has been sent and delivered. There are many reasons why a recoupment request can occur. 

The most common reasons for recoupment requests are:

  • Duplicate payments for the same service code/date
  • A duplicate claim was submitted in error
  • Payment sent to an incorrect healthcare provider
  • Payment for a service that happened after the patient’s insurance plan expired
  • Payment made for a supply or service that was not covered in the patient’s insurance plan
  • The insurance claim was paid for an ineligible beneficiary 
  • The patient’s total deductible was miscalculated

How To Fight A Recoupment Request 

As a healthcare provider, there are ways you can fight a recoupment request if you believe it’s not valid. One of the first steps you need to take is to ask for all relevant documentation from the insurance company relating to the patient’s claim and the recoupment request. This ensures that you have followed guidelines by verifying the payment against established contract guidelines.

If you have received a contested recoupment request, it’s important to get in touch with your state insurance commissioner as soon as possible. The state insurance commissioner is the best person to ask about the rules and regulations for this type of situation.

There are some states with firm timelines for recovering returns which can affect how the process goes if a breach of contract occurs later on. When analyzing these documents, be sure to look for those areas where the breach happened. It’s crucial to assess which party should be responsible for the compensation and know how much of the agreement needs to be fulfilled financially.

Avoiding Recoupment Requests

The practice of recoupment is typically done by collecting money from the patient or their family. There are many ways to avoid this situation, but one of the most important things to do is to hire a medical billing company for your office. They will not only handle all the billing, but they will also make sure that you don’t get any recoupment requests in the future.

This is where AMS Solutions comes in. The best medical billing company in Texas is AMS Solutions. We have over 20 years of medical billing experience and know exactly how to maximize your profits as a healthcare provider.  

Get a free practice audit today! 

You can also call us at 214-522-0210 or email us at info@ams-solutions.com