Credit Balance Review
Less Than One-Third of Credit Balances Are Actual Refunds. The Rest Is Your Money.
Most credit balances aren't refunds you owe; they're posting and overpayment errors that researching turns back into your money. Named specialists disposition every balance, refunding only where required and keeping your compliance exposure low.
You're Probably Refunding Money You Don't Owe
Refunding without research means sending checks for money you earned, because less than a third of credit balances turn out to be genuine refunds.
The volume is real
The average hospital generates $2 million in new credit balances every year. At the HFMA benchmark of 1.5 accounts resolved per hour, a practice with 500 outstanding credits is looking at 330+ hours of staff time.
Most aren't real overpayments
More than half are posting errors that credited the wrong account, contractual adjustments applied twice, or patient payments that duplicated an insurance payment later corrected. "Just refund it" is only correct about 30% of the time.
Each one needs a decision
Every credit requires investigation to determine the correct resolution. Named specialists research the cause and refund only where a payer or patient is genuinely owed, so you keep what's actually yours.
Specialists Who Disposition Every Balance
Named credit balance specialists own the disposition of each account: research the cause, refund where a payer or patient is genuinely owed, and recoup where money is actually yours. Technology accelerates the routine part, detecting credit balances and overpayments across accounts and flagging them for review, so specialists spend their time deciding the right resolution instead of hunting for which accounts have a credit. That keeps refunds accurate, recoveries complete, and your audit risk down, because every balance is resolved by someone who can explain why.
Individual Balance Research
We don't batch-process credit balances with a default action. Every credit is researched to determine the actual cause: posting error, duplicate payment, contractual overpayment, or patient overpayment. The resolution depends entirely on the cause.
Backlog Clearance and Ongoing Resolution
We clear your existing backlog while handling new credits as they arise. Dedicated credit balance specialists work faster than the industry benchmark because they do this full-time, with the pattern recognition that comes from thousands of resolutions.
Prevention Through Root Cause Analysis
Every credit we resolve is categorized by cause. Over 50% come from posting errors. By improving posting accuracy and front-end processes upstream, we reduce the volume of new credits your practice generates quarter over quarter.
Compliant Refund Processing and Documentation
When a refund is genuinely owed, we process it in compliance with payer contracts and state regulations, with a complete audit trail: identification date, research findings, root cause, resolution action, and date of completion. Ready for any reviewer.
<1/3
Of Credit Balances Are Actual Refunds
The rest are corrections that return money to your bottom line.
50%+
Of Credits Come from Posting Errors
Corrected at the source, not refunded, and fed upstream so fewer recur.
$2M
New Credits at the Average Hospital, Per Year
A volume that demands dedicated resources, not ad hoc attention.
Credit Balance Review FAQs
Aren't most credit balances just refunds we owe?
No. Less than a third of credit balances turn out to be genuine refunds. The majority come from posting errors, duplicate payments, and contractual adjustments applied more than once, which created a credit that isn't real. That's why every balance is researched before any action: refunding without research means writing checks for money you actually earned.
How does technology fit into your credit balance work?
It handles the routine detection: surfacing credit balances and overpayments across accounts and flagging them for review, including the small balances a stretched team never gets to. That keeps named credit balance specialists focused on the disposition (research, refund where required, recoup where possible) rather than hunting for which accounts have a credit. People own the resolution and can explain every decision. The technology supports them, it doesn't replace them.
How does this reduce our audit risk?
Unresolved credit balances and missed refund deadlines are a compliance exposure, especially for overpayments that carry statutory return obligations. The Medicare 60-day rule requires identified overpayments to be reported and returned within 60 days. Specialists disposition each balance with a complete audit trail: identification date, research findings, root cause, resolution action, and completion date. When a refund is genuinely owed it's processed in compliance with payer contracts and state regulations, so a reviewer sees a documented decision on every account.
Will you clear our existing backlog and the new credits too?
Both. Specialists work down your existing backlog while handling new credits as they arise, so the queue doesn't rebuild behind them. Because every resolution is categorized by cause, the recurring sources (posting errors are over half) get fed back upstream to reduce the volume of new credits your practice generates quarter over quarter.