Overpayment Compliance for Chiropractors: Patient vs. Insurance Credits

Chiropractic Overpayments:

What the 60-Day Rule Means for Your Practice

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Overpayments are a common reality in chiropractic offices, but handling them incorrectly can lead to compliance headaches and financial risk. Whether the credit belongs to the patient or the insurance company, it’s your responsibility to return it promptly and properly.

Understanding the 60-Day Overpayment Rule Regarding Chiropractic Overpayments

In February 2016, CMS introduced the 60-day overpayment rule. This requires providers to return any identified overpayment within 60 days of discovery or 60 days from an insurance company’s notification. Ignoring this rule—or holding onto funds that don’t belong to you—can lead to serious consequences.

Step 1: Investigate the Credit

When reviewing your accounts receivable, you may see a credit on a patient’s account. At that point, you must determine who the credit belongs to:

• If the credit belongs to the patient: Contact them directly to find out how they’d like it applied. They might use it toward their next visit or request a refund. In fact, if the patient hasn’t been in for months, this can be a great recall opportunity to bring them back for care.
• If the credit belongs to the insurance company: Reach out to the payer to confirm how they want the funds returned. Some may request a check, others may have a specific form to complete, and some will deduct it from a future payment.

Step 2: Never Treat Overpayments as a “Gift”

It’s important to remember that an overpayment is never yours to keep. Whether it came from a patient or an insurer, it must be returned to the rightful party. Failing to do so violates compliance rules and can damage your practice’s reputation.

Best Practices for Handling Chiropractic Overpayments

• Act quickly once you discover the credit—start the investigation immediately.
• Document your actions in the patient’s record and financial files.
• Use patient credits as a re-engagement tool to encourage them to return for care.
• Follow payer-specific guidelines for insurance overpayments.
• Train your staff on the proper handling of overpayments to ensure consistency and compliance.

Protect Your Practice and Stay Compliant

Managing overpayments the right way keeps your chiropractic practice compliant, protects your relationships with patients and insurers, and avoids unnecessary legal or financial risk. If you’re unsure about your procedures or need guidance, schedule a free Discovery Assessment! We’re here to help you make sense of the complex world of chiropractic reimbursement and compliance.