In today's manual environment, on average, patient accounting staff resolve only 2-4 credit balance accounts per hour including the completion of necessary hospital paperwork and document gathering.
With the lack of automation, hospitals are forced to dedicate significant staffing or watch credit balances and the associated risk spiral out of control.
Medicare regulations require all providers to report credit balances quarterly on form 838. CMS regulations state "providers must develop and maintain documentation which shows that each patient record with a credit balance was reviewed to determine whether the credit balance is attributable to Medicare".
Not all credit balance accounts are the result of overpayments. In fact, on average, 65 percent are the result of misposted contractual allowances or misapplied payments.