Introduction:
Occasionally an insurance company may accidentally pay for services that the patient was ineligible for, then request a refund of amount paid in error. Use the steps in the guide below to refund the insurance company.
Process description:
You'll need to delete the payment from the ledger, if you cannot due to an office close out, you'll need to apply an adjustment to the patient ledger to add the balance back onto the patient's responsibility.
Prerequisites:
To delete a payment, users will need to have the security right "Tranactions-Delete Insurance Payment" assigned to their security group. To enter an adjustment into the ledger, user will need to have the security right "Transactions-Add/Post Adjustment" assigned to their security group.
Step-by-step instructions:
If the office has not been closed out since the payment was posted:
- Select the patient.
- Go to the ledger.
- Click the blue hyperlink for the date of the payment.
- Delete the payment.
- Go back to ledger and click the blue hyperlink for the date of the claim.
- Click the "Insurance Payment" button.
- Enter in $0 and close claim to shift the estimated insurance portion of the claim to the patient's responsibility.
If you cannot delete the payment due to close out:
- Select the patient.
- Go to the Transaction Entry screen.
- Add in a "+" collection adjustment.
- A positive collection adjustment will add to the patient balance available to be collected against.
- A positive collection adjustment will add to the patient balance available to be collected against.
- Enter the adjustment under the same provider and location the services were recorded under.
- Make a note that the adjustment was entered to reflect an insurance reversal for the DOS and the date of the payment.
- Click Apply.
Tips and best practices:
Adjustments will not allocate properly unless the patient, provider, and office match between the patient, provider, and office entered with the adjustment and the ones attached to the services posted to the ledger.