Policy

WMC shall make an appropriate refund on a patient account that has a credit balance or where a billing error was made. In no instance shall a refund request from an insurance company be honored when the overpayment was a result of the insurance company’s error, unless the error results in a credit balance, in which case only the credit balance will be refunded. WMC will make all refunds necessary when governed by a contractual relationship.

Procedure

In these instances designated personnel will request a refund which shall be approved by the Patient Financial Services Manager or Coordinator.

  • Two designated personnel from the Patient Financial Services office will review the credit balance report and request refunds to patients where appropriate. The two staff assigned this duty will review each other’s refund requests prior to the refund being made. Refunds shall be approved by the Patient Financial Services Manager or Coordinator.
  • A daily report will be worked by the PFS billers that quickly identifies when a credit balance on an account exists after an insurance payment has been posted. A request for an adjustment will be made to the appropriate payer. All adjustments will be requested immediately to ensure the credit on the account is resolved within 30 days of the credit. Documentation will be added to the account to support the request being made.
  • Requests for refunds from insurance companies will be honored only under the following circumstances:
    • A credit balance exists. Only the credit balance shall be refunded.
    • A billing error was made by Wyoming Medical Center.
    • A contractual arrangement exists which dictates specific refund policy.
  • Designated personnel shall issue a notice to insurance companies when a request for refund is not honored. Such notice is included in this policy.
  • Refunds will be made every week unless situation dictates a more prompt refund be made.
    The request for a special check to be issued must be approved by the PFS Director or Manager and approved by the Director or Manager of the Finance Department.
  • A quarterly report will be sent to CMS reporting any credit balances requested and not yet completed. It is required to report a credit balance report on each provider number issued to Wyoming Medical Center. The reports are due by the last day of the month following the quarter.