Insurance payment for late cancelled appointment, How do I refund them?
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I submitted my first batch of insurance claims for a client and one of the sessions was a late cancel but the CPT code had not been changed and was listed as 90837.  The insurance company paid the claim.  How do I correct this?  Can I re-submit the claim?  How do I refund the money?

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    Nora

    Hi Tami,

     

    My name is Nora and I'm an Insurance Specialist here at SimplePractice. I'll be happy to help with this.

     

    I understand that you marked an appointment as Late canceled after a claim was already created in your SimplePractice account. The claim was then submitted and the insurance company processed and paid for the appointment incorrectly.

     

    In this case, I recommend that you contact the payer directly to let them know that a claim was submitted in error. The process for voiding an incorrectly paid claim will vary from payer to payer, so working with a live representative will ensure that you have the correct requirements for this particular payer.

     

    During this call, you can reference the claim using the client's name, member ID, and dates of service or using the Payer Claim #. 

     

    If the payer requires a voided/cancelled claim to be submitted, request the original claim number. This number will come directly from the payer and will need to be listed on a cancelation claim.

     

    To create a cancelation claim, you will want to:

     

    1. Open the claim that was submitted in error and click Edit to Resubmit.
    2. Scroll down to box 22 and select Cancellation. Please note that when you submit a claim electronically through SimplePractice, (you do not need to include a frequency code).
    3. Enter the claim # provided by the payer in the Original Ref. Number field.
    4. Next, click Save and Submit.

     

    Each payer will also have varying processes in place for returning the original payment. Some will allow you to keep the payment and will put it toward future claims. Though, others may request that you return a check to them by mail. You will want to work with the payer to determine what method they use.

     

    Please let me know if you have any follow up questions for me after speaking with the payer. We're always happy to help and I would be glad to continue working with you.

    Hi Tami,

     

    My name is Nora and I'm an Insurance Specialist here at SimplePractice. I'll be happy to help with this.

     

    I understand that you marked an appointment as Late canceled after a claim was already created in your SimplePractice account. The claim was then submitted and the insurance company processed and paid for the appointment incorrectly.

     

    In this case, I recommend that you contact the payer directly to let them know that a claim was submitted in error. The process for voiding an incorrectly paid claim will vary from payer to payer, so working with a live representative will ensure that you have the correct requirements for this particular payer.

     

    During this call, you can reference the claim using the client's name, member ID, and dates of service or using the Payer Claim #. 

     

    If the payer requires a voided/cancelled claim to be submitted, request the original claim number. This number will come directly from the payer and will need to be listed on a cancelation claim.

     

    To create a cancelation claim, you will want to:

     

    1. Open the claim that was submitted in error and click Edit to Resubmit.
    2. Scroll down to box 22 and select Cancellation. Please note that when you submit a claim electronically through SimplePractice, (you do not need to include a frequency code).
    3. Enter the claim # provided by the payer in the Original Ref. Number field.
    4. Next, click Save and Submit.

     

    Each payer will also have varying processes in place for returning the original payment. Some will allow you to keep the payment and will put it toward future claims. Though, others may request that you return a check to them by mail. You will want to work with the payer to determine what method they use.

     

    Please let me know if you have any follow up questions for me after speaking with the payer. We're always happy to help and I would be glad to continue working with you.

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    Audrey Isaacson

    We are having to refund an insurance company for overpayment. What is the best way to post a refund to an insurance company in simple practice?

    We are having to refund an insurance company for overpayment. What is the best way to post a refund to an insurance company in simple practice?

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    Nora

    Hi Audrey,

    Our billing system doesn't have a formal way to record insurance payment take-backs at this time. Therefore, I recommend adding a chart note or administrative note to the client's Overview page to explain how much the insurance payer initially paid you, and how much they requested that you send back. 

    Then, make adjustments to the original insurance payment that was recorded in SimplePractice to reflect the most current information. 

    To do this, please go to the insurance payment in question, click Edit, then adjust the total Amount field at the top of the insurance payment to reflect the amount minus the take-back. Finally, you can adjust the Insurance Paid amounts for the appropriate appointment(s). Please refer to the following guide for a detailed explanation on this: How to make adjustments to a manually added insurance payments.

    I also recommend that you review the following resources to learn more about recording insurance payments:


    We're currently investigating a way to make the insurance payments recording process more flexible in SimplePractice, but I don't have an exact timeline on this enhancement. If you'd like to learn more about how our team receives feedback and develops our platform, you can refer to this guide: Customer feedback: How a customer idea can become a feature in SimplePractice.


    Please give this a try and feel free to reach back out to our team if you have any other questions. 

    Hi Audrey,

    Our billing system doesn't have a formal way to record insurance payment take-backs at this time. Therefore, I recommend adding a chart note or administrative note to the client's Overview page to explain how much the insurance payer initially paid you, and how much they requested that you send back. 

    Then, make adjustments to the original insurance payment that was recorded in SimplePractice to reflect the most current information. 

    To do this, please go to the insurance payment in question, click Edit, then adjust the total Amount field at the top of the insurance payment to reflect the amount minus the take-back. Finally, you can adjust the Insurance Paid amounts for the appropriate appointment(s). Please refer to the following guide for a detailed explanation on this: How to make adjustments to a manually added insurance payments.

    I also recommend that you review the following resources to learn more about recording insurance payments:


    We're currently investigating a way to make the insurance payments recording process more flexible in SimplePractice, but I don't have an exact timeline on this enhancement. If you'd like to learn more about how our team receives feedback and develops our platform, you can refer to this guide: Customer feedback: How a customer idea can become a feature in SimplePractice.


    Please give this a try and feel free to reach back out to our team if you have any other questions. 

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    Kim Sullivan

    It would be very helpful to add a step allowing us to review batch claims before they are sent - something that might indicate if extra claims were about to be filed.  For example, when individual claims are created, SP asks something like "Create claim for 1 client?" and you have to click enter again.  Perhaps adding a similar second step to batch claims (like maybe clarifying "Submit batch for __ Claims" might alert therapists to a mistake before it is submitted - alternatively, adding a feature to allow you to review the claims that are included in the batch before the final submit might also work. 

    A second step such as these might lower the need for adding adjustments later.

    It would be very helpful to add a step allowing us to review batch claims before they are sent - something that might indicate if extra claims were about to be filed.  For example, when individual claims are created, SP asks something like "Create claim for 1 client?" and you have to click enter again.  Perhaps adding a similar second step to batch claims (like maybe clarifying "Submit batch for __ Claims" might alert therapists to a mistake before it is submitted - alternatively, adding a feature to allow you to review the claims that are included in the batch before the final submit might also work. 

    A second step such as these might lower the need for adding adjustments later.