AUTO adjustments occur when an office uses PPO-type fee schedules for patient charges, and submits on the insurance claim a usually higher fee from the UCR fee schedule.
AUTO adjustments may also occur when payment between both patient and insurance is more than the fee charged. Perhaps the office manually reduced the procedure fee, yet the insurance plan setup indicates to submit “Office UCR” on claims.
AUTO adjustments are programmed to appear in the ledger screen when an overpayment is made during an insurance payment process.
The counterbalancing entries are automatically entered by Denticon when the insurance reimbursement payment is more than what was charged for the procedure:
- AUTO - Insurance Adjustment
- AUTO - Xfer Ins Amt To Patient
The insurance overpayment creates a credit on the insurance side. Denticon is programmed to not allow a credit to remain on the insurance side of the ledger.
The AUTO adjustment moves the insurance-side credit to the patient side.
Whenever an AUTO adjustment is entered into the ledger, the office should review the applicable insurance fee schedule to ensure that an appropriate fee is entered.
- In some cases, the credit which occurs truly should “belong” to the office. When this occurs, a corresponding manual adjustment should be made to offset the overpayment credit. A suggested adjustment is “Insurance Agreement” (a positive + adjustment) if the overpayment relates to a PPO fee schedule issue.
- In some cases, the credit which occurs truly should “belong” to the patient. When this occurs, a corresponding manual adjustment should be made to offset the overpayment credit. A suggested adjustment is “Refund Patient” if the overpayment results because a deductible was not calculated, but should have been. That is, when the patient has previously paid the deductible amount which created a “legitimate patient overpayment”
NOTE: The AUTO adjustments are necessary for correct account balancing when entering a larger-than-expected insurance payment. Denticon does not allow to delete an individual AUT0 adjustment entry from the ledger. The insurance payment must be deleted in order to remove the payment’s associated AUTO adjustment(s).