Adjust Insurance Payments

When necessary, you can adjust an insurance payment using one of several adjustment methods directly from the Transactions module > Insurance Payment tab:

• Refund Payments: This is used to refund part or an entire insurance payment.

Note: This can be used for overpayments and unallocated payment portions.

• Reverse Payments: This is used when the payment was entered in error by a staff member. Any allocations to treatments will be unallocated automatically.
• Reverse Adjudications: This allows you to adjust an insurance payment if the company changes a previously assessed decision and recoups part or all of a previous payment using a subsequent EOB.
• Insurance Adjustments: This allows you to complete a number of adjustments for insurance payments as permitted by the adjustment codes available at your institution.

To adjust an insurance payment:

1. Open the Transactions module and click the Insurance Payment tab > Ins. Payments (All) sub-tab.



2. Search for and select the insurance company.

Note: The full list displays if the Load all Ins. companies in list checkbox is selected in the Transaction Options window > Payment Options section.

1. Enter the first character(s) of the company you are searching for based on the column headings and click the applicable heading to sort.

Tip: You can enter an underscore (_) to display all results within the column.

Note: You can select the Include Inactive checkbox to include inactive insurance companies in the search.

2. Select a listed insurance company.
3. Review the listed payments.
4. Complete any of the following:
Refund Insurance Payments

1. Right-click a listed payment and select Refund Payment or Refund OverPayment to display the Refund Insurance Payment window.

Note: The Refund Payment right-click option is only available from the Ins. Payments (All) sub-tab and the Refund OverPayment right-click option is only available from the Ins. Payments (for Selected Patient) sub-tab.



2. Complete the fields as necessary and click OK.

Field	Description
Date	This defaults to the current date. If necessary, select another date from the calendar drop-down.
Code	Enter the adjustment code or click the ellipsis to select from the Adjustment Codes window.
Description	This field displays the description of the adjustment code. Note: If necessary, you can modify the description manually.
Affect Bank Deposit	Select the checkbox if this adjustment affects the bank deposit and will display on the next bank deposit report opposite the record(s) being adjusted. Note: If selected, the Bank field is enabled.
Amount	Enter the portion of the insurance payment you want to refund.
Bank	Note: This field is only enabled if the Affect Bank Deposit checkbox is selected. Enter the bank code that identifies where the payment was processed or click the ellipsis to select from the Bank Codes window.

Reverse Insurance Payments

1. Right-click a listed payment and select Reverse Payment to display the Reverse Insurance Payment window.



2. Complete the fields as necessary and click OK.

Field	Description
Date	This defaults to the current date. If necessary, select another date from the calendar drop-down.
Code	Enter the adjustment code or click the ellipsis to select from the Adjustment Codes window.
Description	This field displays the description of the adjustment code. Note: If necessary, you can modify the description manually.
Affect Bank Deposit	Select the checkbox if this adjustment affects the bank deposit and will display on the next bank deposit report opposite the record(s) being adjusted. Note: If selected, the Bank field is enabled.
Amount	This field displays the payment amount.
Bank	Note: This field is only enabled if the Affect Bank Deposit checkbox is selected. Enter the bank code that identifies where the payment was processed or click the ellipsis to select from the Bank Codes window.

Reverse Insurance Adjudications

An adjudication is the process of paying or denying submitted claims after comparing a claim to the patient’s coverage. In some cases, an insurance company may pay for a treatment, then reverse their adjudication, choosing to recoup part or all of a previous payment using a subsequent EOB.

Example: An insurance company realizes they made a mistake and overpaid for a treatment or paid for a treatment that should not have been covered. Because they cannot modify the payment they sent before, when they next send a payment, the EOB indicates they have corrected their mistake by making this latest payment less, allowing them to recoup their previous overpayment.

If an insurance company reverses an adjudication, the insurance payment that was previously allocated in axiUm is now less by the designated amount of money and your institution is now short that amount of money. You must correct the insurance payment to adjust the patient's record manually. This removes that designated amount from the previous payment and adds the amount to the current payment so that the whole allocation balances.

Tip: You should record the reason an insurance payment was reversed using a patient note. This will help explain the current financial status of the record.

To reverse an insurance adjudication:

1. Select a listed payment and click Pt. Allocate… to display the Applying Ins. Payment window.



2. Click Load All.
3. Select the previously paid treatment/charge and select the Adjudication Reversal radio button.
4. Modify the Apply field to the amount being recouped.
5. If necessary, transfer the balance to clear the balance owing on the claim.

Tip: You can leave a balance if a future payment is expected from the insurance company or the claim is in dispute.

1. From the drop-down fields, select Transfer, Write-off, or Write-off credit to deal with the recouped amount.

Note: Depending on the circumstances, you may need to use one or both drop-down fields.

2. In the applicable text field, enter the amount you are transferring or writing off.
3. Click the Reason ellipsis to select a reason from the Adjustment Codes window.
6. Click Apply.

Important: If the amount does not match any previous allocation amounts for this treatment and insurance company, a warning message displays. Click Yes or No as necessary.

The recouped amount displays in the Applied column as a negative amount next to the treatment/charge(s).

7. Click EOB… to display the Explanation of Benefits (EOB) Details window.

Note: This button is only enabled if the selected record has an EOB attached automatically to it via the EDI Remittance module or if you have already allocated an insurance payment to the record.

1. Review or add the EOB information as necessary.
8. Click Close to close the Applying Ins. Payment window.

The insurance payment displays in green text to indicate it is no longer fully allocated. There is now an increase in the amount of funds that can be allocated to other treatments on the EOB.

Manage Insurance Adjustments

1. Right-click a listed payment and select Insurance Adjustment to display the Insurance Adjustment window.



2. Complete the fields as necessary and click OK.

Field	Description
Date	This defaults to the current date. If necessary, select another date from the calendar drop-down.
Code	Enter the adjustment code or click the ellipsis to select from the Adjustment Codes window.
Description	This field displays the description of the adjustment code. Note: If necessary, you can modify the description manually.
Affect Bank Deposit	Select the checkbox if this adjustment affects the bank deposit and will display on the next bank deposit report opposite the record(s) being adjusted. Note: If selected, the Bank field is enabled.
Amount	Enter the portion of the insurance payment you want to adjust.
Bank	Note: This field is only enabled if the Affect Bank Deposit checkbox is selected. Enter the bank code that identifies where the payment was processed or click the ellipsis to select from the Bank Codes window.