Insurance Recoupment versus Refund in Medical Billing: What's the Difference
Insurance Recoupment versus Refund in Medical Billing: What's the Difference It is easy to get lost in medical billing with all the twists and turns involved, especially when encountering unfamiliar terms such as "recoupment" and "refund." Although both terms pertain to financial exchanges between insurance companies and medical offices, they are two different procedures with very different consequences. Since Texas Hill Country Consultants frequently encounters confusion about these terms, let's dive deeper into the differences. Insurance Recoupment: Reclaiming What Has Already Been Paid Recoupment, where it applies in medical billing, is the activity through which an insurance provider reclaims money that has already been paid to a medical provider. This is generally done when the insurer detects a mistake or an overpayment when processing the first claim. These are some reasons why recoupment may take place: Audits: An insurer can audit a provider's ...