Refund & Recoupments

Many overpayments, such as duplicate payments or clearly erroneous payment amounts, are often easy to detect due to credit balances. More problematic, however, are refund requests received which request reimbursement for claims that appear to have been paid correctly by the carrier. Such requests may result from post-claim medical necessity reviews or from retroactively activated coding/bundling edits which may not be widely agreed upon within the billing industry. Learn how to contest unsubstantiated refund/recoupment requests and how various regulations read.