What is a recoupment in medical billing?

It's when a payer recovers money it says it overpaid by withholding it from a later payment. It shows up as a provider-level adjustment (PLB) on the 835 remittance.

How far back can an insurer recoup payments in Tennessee?

Tennessee law generally bars a health insurer from recouping a payment more than 15 months after it was made (Tenn. Code Ann. § 56-7-110). Confirm how it applies to your contract and plan type.

Recoupments.

A recoupment is money a payer takes back for what it says was an overpayment, by withholding it from a later payment instead of asking for a refund.

Why it happens

Offsets appear as provider-level adjustments at the bottom of a remittance, not on the claim they're about, so they're easy to miss. State law limits them: in Tennessee, a payer generally can't recoup a commercial claim more than 15 months after paying it (Tenn. Code Ann. § 56-7-110).

How Owed checks

01
Owed reads the provider-level adjustments (PLB) on every remittance and flags recoupment reason codes WO, FB, WU, 72, J1.
02
Where the payer references the original claim, it finds that claim's payment and works out how long ago it was paid.
03
For Tennessee commercial claims, it marks recoupments taken more than 15 months after payment as likely barred, citing Tenn. Code Ann. § 56-7-110, and sets a dispute deadline 30 days from the payment the money was taken from.
04
State insurance law reaches fully insured plans, not self-funded employer plans (ERISA) or Medicare and Medicaid plans. You tell Owed how each payer's plans are funded: it leaves the finding out for payers you've marked self-funded or government, says so when you've confirmed a payer is fully insured, and marks it unconfirmed otherwise.

What you'll see

The amount taken and the reason code
The original claim's payment date and how many months ago it was, when the payer says which claim
The statute, when it applies
A dispute deadline

Rules decide, never AI: the same file always gives the same findings, and every finding shows its math.

What to do

Get the payer's overpayment notice and check the basis, amount and timing. Where state law limits the look-back period, dispute the recoupment within the statutory window.

Questions

What is a recoupment in medical billing?: It's when a payer recovers money it says it overpaid by withholding it from a later payment. It shows up as a provider-level adjustment (PLB) on the 835 remittance.
How far back can an insurer recoup payments in Tennessee?: Tennessee law generally bars a health insurer from recouping a payment more than 15 months after it was made (Tenn. Code Ann. § 56-7-110). Confirm how it applies to your contract and plan type.