Is Your 'Free' Credit Balance Vendor Actually Costing You Money?

The challenge of managing credit balances is a common pain point for healthcare providers. When an organization receives overpayments from patients or payors, it creates a liability that must be resolved to maintain compliance and a healthy revenue cycle. To handle this administrative burden, many providers turn to third-party vendors. But while a vendor may seem like a cost-effective solution, a closer look at their business model can reveal a hidden cost.

Here's why your current credit balance vendor may be costing you more than you think.

1. Misaligned Incentives: Working for the Payor, Not You.

Many credit balance vendors operate on a contingency model with insurance payors. This means they are paid a percentage of the overpayments they identify and return to the payor. On the surface, this may sound like a win-win, but their primary loyalty is to the party paying them.

This creates a fundamental conflict of interest. A vendor who gets paid to find overpayments for a payor has a vested interest in finding as many as possible, potentially leading to over-refunding. This can result in your organization inappropriately refunding money that was actually a legitimate payment, or even a disguised underpayment. In essence, you are paying a third party to take money out of your pocket.

2. Ignoring Complex Accounts and Overlooking Underpayments.

When a vendor's pay is tied to the volume of overpayments, they often "cherry-pick" high-dollar, low-effort accounts. This leaves behind the complex, time-consuming credit balances that require deep analysis. These are the very accounts that often hide billing errors or underpayments that, with a proper review, could be converted into legitimate revenue for your organization. By not working these accounts, your vendor is leaving money on the table that is rightfully yours.

3. Increasing Compliance and Audit Risk.

Credit balances, especially those from government payors like Medicare and Medicaid, are subject to strict regulations. Failure to resolve and report these balances in a timely manner can result in significant fines and penalties under the False Claims Act. A vendor focused on quick, high-volume refunds for commercial payors may neglect the critical compliance requirements of these government accounts, increasing your organization's risk exposure.

4. The Jenvin Healthcare Partners Difference.

At Jenvin, we believe in a different model. Our provider-first approach ensures our incentives are perfectly aligned with yours. We act as a trusted partner, meticulously working every credit balance to ensure you are compliant, retain every dollar you've earned, and protect your financial integrity. We don't get paid by the payor; we work for you.

By choosing a partner who prioritizes your interests, you can turn a compliance obligation into a strategic opportunity to reclaim revenue and strengthen your entire revenue cycle.