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Tag Archives: Refund

refund request for an assistant surgeon

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Do we need to refund an insurance company that we do not PAR with if they paid us the whole amount for the surgery? A third party now is requesting 84% TAKE BACK of our claim that was submitted correctly with the 80 modifier. It is well over a year and we have no relationship with the insurance company. What are our options<

thank you
New Jersey

Medical Billing and Coding Forum

Ins Refund laws for the State of Illinois

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As per my understanding insurance can recoup or request refunds for the payments issued in last 18 months. I was trying to find some supporting documentation but there was nothing specifically for the state of Illinois. We have BC IDPA and BCBS coming back from 2014-2015 and taking the payments back. This is getting out of control now. Please help.

Medical Billing and Coding Forum

WHO SHOULD GET THE REFUND? Both Medicare and Aetna paid as primary

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We have a patient in which both Medicare and Aetna paid for multiple dates of service as primary payers. Our office contacted both insurance companies who assured our office that they were in fact the primary payer.

In turn, we contacted the patient to ask that they contact Medicare and Aetna to update their coordination of benefits. The patient has since expired and we even called the patient’s spouse to ask them to contact the insurance companies regarding COB as well, with no success.

We are left with the question of who or how we should refund the overpayment(s) received. Any advice or input would be much appreciated.

Medical Billing and Coding Forum

Confidently Appeal a Special Investigation Unit Refund Request

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Communication is essential to a smooth appeals process. Your practice was the subject of a special investigation unit (SIU) audit, and now the payer is asking for a refund. You have two choices: pay or appeal. If you disagree with the findings, the smart choice is to meet with the payer, appeal the findings, and […]
AAPC Knowledge Center