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  • Writer's pictureJennifer Murphy

Spotting Themes for Process Improvement in Credit Balances

Updated: Mar 26

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Credit balances represent an administrative complexity for healthcare providers that is often deferred in favor of more pressing matters, such as billing and denial management. Since credit balances occur due to provider or payer process issues, a deep analysis of credit balances can be a valuable source of insight into major themes and revenue cycle process improvement opportunities.  

At Jenvin Healthcare Partners, we have developed software using proprietary algorithms that analyze and organize credit balances to give providers immediate insight into major themes and the underlying process issues, which can be used to more efficiently manage credit balances and reduce their occurrence going forward. Here are a few examples of how Jenvin Healthcare Partners’ tools can assist providers in managing and reducing credit balances: 

Front-end collections: Because balances due after insurance cannot be easily estimated, front-end collections often result in credit balances. Jenvin Healthcare Partners can provide detailed insight into credit balances due to front-end collections, for example, volume by site of service, credits resulting from standard amounts requested from all patients, and payments received from uninsured patients who later qualify for Medicaid or charity. 

Duplicate insurance payments: Duplicate insurance payments can result from a variety of issues including payer errors, claim resubmissions, and billing system errors. Jenvin Healthcare Partners’ analysis can provide insight into root causes, for example, by analyzing volumes by payer, claims re-submitted without a reversal of the initial claim or type of claim. 

Secondary payer pays as primary: Similar to duplicate insurance payments, secondary payer billing, and payment errors can result in credit balances. Jenvin Healthcare Partners’ analysis can identify payers or billing situations that are more susceptible to these types of overpayments. 

Adjustment errors: Adjustments, especially administrative or non-contractual adjustments, can be a frequent cause of credit balances. Jenvin Healthcare Partners’ analysis can quantify credit balances due to this cause, as well as the types of adjustments that are the most common “offenders”. 

Trending over time: A necessary component of all process improvement efforts is the ability to measure the success of these efforts over time. Jenvin Healthcare Partners’ analysis provides trending information that measures the volume of credit balances over time and will assist them in targeting additional process improvements. 

Jenvin Healthcare Partners is committed to simplifying the credit balance resolution process. By partnering with Jenvin Healthcare Partners, your organization will develop a systematic and thorough approach that will transform credit balance reports from mere financial documents into powerful tools for optimizing revenue cycles and ensuring financial sustainability. 

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