Credit Balance on Medical Invoice

As the name implies, a Credit Balance occurs when more money is collected compared to the Fees of a service provided by the Provider. This can be for many reasons and needs to be corrected during the final stages of medical demand procedures. Credit Balance can be due to excessive patient payment in the form of Co-Insurance or Interruption; or because of the overpayment of the Insured Payees. Let’s analyze why some scenarios and their immediate handling are important:

Patient Credit Balance:

Patients may have made some prepayment on the basis of what the Payment Areas would cover. After the medical claims are processed and the Payer has completed the payment, the patient has a high payout. The doctor billing solution can call the patient and offer the option of adjusting this surplus to future visits or sending checks. However, in both scenarios, the patient’s consent must be obtained and compulsory.

Payee Credit Balance:

Credit Balance is usually made due to Overdue Payers. Even the Patient’s Credit Balance is usually due to the Payer paying more than expected. In the case of medical damage claims, it is very important to consider the payments of the Payers as a priority. This not only reflects the correct Cash flow as a result of a physician billing solution, but also raises the inflated AR. Some scenarios for the Borrower Receivable Balances:

1) Pay as both Primary and Secondary Payment Unit
2) The taxpayer shall inadvertently pay more than the Allowable amount.
3) Transition errors, especially between Medicare and Medicaid
4) Plans purchased privately – always pay as Primary, albeit a Primary


In all these cases, as is the case, too much money has very strict rules and time frames that must be returned to the Payer or Patient. In case of payment errors, the payment must be reported within 30-120 days depending on the payment. Failure to report within the time frame could be seen as “Fraud”; Fines by the Borrower and the State. If the Payer rejects the refund (as in the case of the specially purchased plans), the money belongs to the patient and must be notified to the Patient. Medical claims processing and physician billing solution providers must take these requirements into account and operate the Credit Balances on a daily / weekly basis to avoid any problems with the Supplier and the Application.

Recoupments and Offset:

Some taxpayers will arrange payments for their current and future claims against the Credit Balances that are owed to other Taxpayers who are Recoupments. When Payers make payments in their Plans for current and future claims against past payments, they are called Offset.

The best option for dealing with Credit Balances is to use medical billing as a professional medical damage processing company.

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