November 09, 2015
The California Medical Association (CMA) often receives questions from physician members regarding the amount of time that physicians have to refund monies owed to patients. Patient refunds are necessary when a patient has overpaid his or her portion of the claim. If an overpayment does exist, the physician must return the money even if it’s a small amount.
However, if the refund doesn’t involve a duplicative payment from the payor and if the patient will be returning, the physician can suggest that the amount be applied as a credit toward the next visit. If the patient does not want to apply it, however, the physician must refund the overpaid amount to the patient. Business & Professions Code §732 states that if the patient has not requested the refund within 90 days of the date when the physician discovers, or should have discovered, the receipt of the overpayment, the physician must notify the patient of the overpayment. Within 30 days of that, the physician must refund the overpaid amount.
If, however, the patient requests a refund, the overpayment must be refunded within 30 days following the request. If the overpayment has not yet been received at the time of the patient's request for refund, the refund must be made within 30 days of receipt of the overpayment. For more information, see CMA ON-CALL document #7600, "Billing Patients."