Defense of Refund Demands and Offsets

TGF works with medical providers that have provided invaluable medical services and expect proper payment in return.  These providers typically submit timely and clean claims, yet they still receive refund demands from payers.  TGF takes an aggressive approach to these improper and wrongful demands.  In almost every circumstance, providers are entitled under the law to keep voluntarily made payments.  Refund demands are often times cleverly used by payers as a business strategy to increase profit and cash flow. When a payer demands a refund, the provider is generally entitled to keep the payment, unless doing so would result in the provider receiving more than billed charges or the contractual amount for services provided.

Refund demands are further complicated by the payer’s ability to offset the amount of the refund against future amounts owed to the provider. TGF works swiftly and aggressively to halt offsets until the dispute can be resolved. Offsets wreak havoc on accounting systems and require skillful defense to avoid both lost revenue and increased accounting costs.

  • TGF routinely fights refund demands and protects providers’ rights to keep money voluntarily paid by insurers and GHPs
  • Often, refund demands and recoupment activities are based on unlawful or incorrect retro-denials­­­––TGF routinely obtains retractions and cessation of collection efforts.
  • Even when a payer has a legitimate reason to deny a claim, the provider is usually entitled to keep voluntary payments under the law.
  • Recoupments create accounting nightmares that cost providers a great deal of time and money—TGF does the work for you, freeing your staff, thereby increasing your profit.