PURPOSE

To establish a procedure for researching and resolving credit balances on the HB portion of a patient account. Also, to establish a procedure to request a patient refund for Professional Billing.

BACKGROUND

Patients often call into the SBO department line to inquire about an overpayment when reviewing their EOB’s sent by their insurance company. Patients can also see their account balance when signing into their MyChart account. It is UC Irvine Health’s responsibility to ensure we review the account in question to determine if a refund is needed. Also, accounts fall into a designated workqueue list when the total balance is a credit and the credit is in the self-pay bucket within EPIC. Patient credits of over $4.99 will be refunded to the patient.

POLICY

Initial research of the credit balance:

Assigned Biller will work the EPIC Account Workqueue 1310 – UCI HB Self-Pay credit balance on a daily basis.

SBO will review accounts as needed when they receive an inquiry from a patient or patient representative.

Determine the cause of the credit balance:

Patient overpayment

Misapplied payment

Incorrect adjustment/contractual allowance

Small balance adjustments

Verifying Refunds for straight self-pay

Please review charges posted to the account to ensure all charges are captured. There should not be a credit on a price quoted to the patient.

Review to ensure there are no self-pay adjustments to reverse.

Verifying refunds for balance after insurance

Review insurance EOB to verify patient liability and ensure the account is sitting with the appropriate credit balance.

Review other open accounts ( including Legacy inventory ) and determine if the patient overpayment can be applied to any other HB, PB or bad debt accounts.

If there are any open self-pay balances, do not process patient refund. Transfer the credit to open accounts.

Do not issue a refund for a patient credit under $5.00 unless specifically requested by the patient. Credit balances in the patient bucket will be automatically written off by the system for amounts under $5.00 as a small balance write off.

Interest on patient overpayments shall be calculated as per HSC 127440. UC Irvine Health shall reimburse the patient any amount actually paid in excess of the amount due under this article, including interest. Interest owed by UC Irvine Health to the patient shall accrue at the rate set forth in Section 685.010 of the code of Civil Procedure, beginning on the date the payment by the patient is received by the hospital. However, UC Irvine Health is not required to reimburse the patient or pay interest if the amount due is less than five dollars. The hospital shall give the patient a credit for the amount due for at least 60 days from the date the amount is due. The calculated interest will be credited to the account by using a credit adjustment code in EPIC. See attachment A, Interest on Patient Refunds Worksheet, for calculating the total patient refund including interest.

Patient overpayments made by credit card, will be refunded directly back to the patient’s original credit card. Overpayments made by cash or check, will be refunded in form of a check payment processed thru Kuali.

Refunds must go to the person or company who made the payment. Before refunding via check, ensure that the refund is being made to the correct party. In the event the patient is expired, make the refund payable “ to the estate of …”.

Once refund is deemed appropriate and ready for processing, choose Post self pay refund under the self-pay Liability Bucket and approve refund processing.

Once a refund is requested in EPIC by a specific user, the HB account is routed to an Adjustment Review workqueue by dollar amount listed below for approval. Once the account is reviewed and approved, the refund is posted to the account to relieve the credit. For PB, the account is routed to a refund PB approval workqueue managed by the Professional Billing department.

Supervisor	$5.00	- $2,499.00

Assistant Director	$2,500.00 - $9,999.00

Director	$10,000.00 - $49,999.00

Senior Director	$50.000.00 +

If a patient refund is returned to UC Irvine Health from the post office and we are unable to contact the correct party, we will debit the credit balance using an Administrative Credit Adjustment. Be sure to fully document all actions that support our diligence and the adjustment.

Unclaimed Cash and Negotiable Property:

The University of California is exempt from the provisions of the escheat statues of the California Civil Code Procedure ( 1500 et seq. ) in accordance with the Regents Policy on Found and Unclaimed Property. All unclaimed cash and negotiable property, which remain unclaimed after the procedures set forth in this manual are followed, shall become the property of the Regents. Also, see Policy C-173-78 of the University Accounting Manual.

ATTACHMENTS