Patient Refund Policy

Lavenburg Medical group will monitor credit balances on patient accounts. Credit balances will be investigated and resolved promptly by designated staff. All actions taken will adhere to payer-specific guidelines, organizational standards, and regulatory requirements, including appropriate documentation and audit trails.

Definitions

• Credit Balance: A situation where the payments and adjustments on an account exceed the charges.
• Small Balance: Defined as a credit balance of $10.00 or less, unless otherwise defined by payer or state/federal guidelines.

Insurance Refund Process

Recoupments

• Record payer recoupment notification.
• Post recoupment adjustment to affected account(s).
• Reconcile with Explanation of Benefits (EOB).
• Document with payer correspondence.

Paper Check Refunds

• Submit a refund request through the appropriate payer process.
• Include claim number, patient details, and refund rationale.
• Mail refund with supporting documentation.
• Retain proof of delivery or confirmation

Credit Card Refunds

• If original payment was via payer card, refund through original method.
• Document payer authorization if manual refund is issued.
• Maintain refund receipt and ledger update.

Patient Refund Process

Paper Check Refunds

• Confirm patient mailing address.
• Issue check within 30 business days of identifying valid overpayment.
• Mail with explanation of refund.
• Track check issuance and clearance.

Credit Card Refunds

• Refund to the original card if payment was within 120 days (or processor limit).
• For expired cards or processor denial, issue paper refund.
• Document transaction and retain refund receipts.

Handling of Small Balances

• Credit balances ≤ $10.00 will be maintained on the patient account and refunded if the patient has not received services in twelve (12) months.

Regulatory Compliance

• Federal: Comply with CMS credit balance reporting requirements (CMS-838), and other federal overpayment rules (e.g., 60-day repayment rule under ACA).
• State: Adhere to state-specific unclaimed property laws and refund thresholds (e.g., escheatment timeframes).
• Payer-Specific Rules: Refund within payer-specified timeframes (e.g., 30–60 days), using payer-specific forms or portals as needed.

To Check If You Have a Credit Balance

Please call the Billing Department at (774) 320-3040 extension 4299.

If You Have a Concern or Complaint

Your voice matters. If you have any concerns, please let us know — we want to help resolve it. You may file a complaint in person or in writing with our Compliance Department at [email protected].