Wednesday, June 24, 2009

Making Adjustments

To transfer a balance/credit to the patient/insurance:
Example: There is a balance on the patient's side of the ledger but their insurance carrier has decided to pay more for the procedure than was originally esitimated.

  1. Highlight the appropriate transaction, click the Add button and select Adjustment.
  2. From the Adjustment Type drop down menu select Transfer Charge to Insurance (+Ins -Pat).
  3. In the From Ins: field choose the insurance company that is going to be paying for the charges.
  4. If the Insurance is going to cover the entire outstanding balance press Adjust All and then Ok. The remaining patient balance will now have changed to an insurance balance.
  5. If only a portion of the remaining patient balance will be covered by insurance click on the circle beside Manual Enter and enter the amount that will be covered. You can detail how much of that total is going to be moved for each code in the Adj. Amount window on the right hand side of the screen and then click Ok afterwards.
*It is important to remember that by default adjustments will not affect your new payments for the bank deposit. If doing an adjustment and the deposit should be affected (ie. Giving a patient a refund) then check off the Affect Today’s Deposit.
If you were to refund $20 and check this box off then the new payments section in the bank deposit will show a listing for -$20.

To Transfer a balance/credit between Insurance Claims
A similar situation may occur when the patient has dual insurance coverage and the breakdown that each will pay is different than was originally estimated. Now the claim to one carrier shows a credit and the other carrier shows a balance due.
  1. After selecting the transaction and clicking Add and then Adjustment, choose the Transfer Charge From Ins to Ins (-Ins +Ins) from the Adjustment Type drop down menu.
  2. In the From Ins. field choose which carrier the charge is coming from.
  3. Select the Manual Enter option and enter the amount that is to be moved from the carrier you selected in step 2.
  4. Either press Adjust All to automatically disperse the amount entered above against the codes in the transaction or enter the specific amounts for each code in the Adj. Amount column.
  5. Pressing Ok will complete the adjustment and the claim for the carrier chosen in step 2 will have the amount specified in step 3 removed from it and the claim for the other carrier will increase by that amount.

To Transfer a credit between transactions
A patient's bottom line balance shows as $0.00 but several transactions are displayed in red as they have balances and other transactions show having credits. ClearDent has a nice trick built in to assist in this kind of scenario.

  1. Choose to Add a Patient Payment.
  2. Select a payment type in the Pay By: field (this choice is arbitrary and does not matter, you just need to select something.)
  3. Switch to the Manual Enter option and leave it at $0.00.
  4. Press Allocate and then Ok.
The available credits will be dispersed against remaining balances from oldest to newest. This will change a ledger that looks like this:

To one that looks like this:

This same process can be used with a Family Payment to move credits appropriately amongst family members and with an Insurance Payment to move insurance credits amongst transactions.

What is the difference between Reverse/Refund/Write-Off?

A refund is used when a patient (or insurance company) has paid more than they were supposed to and you want to give the money back to them (either by cash, credit card or cheque.) After choosing to Add an Adjustment, select either Refund Patient Payment (+Pat) or Refund Insurance Payment (+Ins). If you are refunding an insurance payment you will need to also select which carrier it is for in the From Ins: field. If you leave the amount field set to Auto Calculate and press Adjust All then any credit on that transaction will be refunded in full. Otherwise you can choose to Manual Enter the amount to be refunded and apportion what amount of each code is to be returned in the Adj. Amount column.

A Reverse Payment is used to undo a payment that was entered erroneously. Imagine that based on a patient’s history you entered a payment for their entire bill but they actually did not pay for it before leaving the office and that this was not noticed until the next day. In this case you would choose to Add an Adjustment and select Reverse Patient Payment (+Pat.) Clicking Adjust All and Ok will reverse the entire payment that was made. Just as in the previous examples you could also manually enter an amount if needed.

A Write Off is used to indicate the office taking responsibility for fees. An example of where to use this would occur if a patient was given a recall exam that was NOT covered by insurance. If the office was at fault for performing the recall in the first place you can use either or both the Write Off Patient (-Pat) and Write Off Insurance (-Ins) adjustment type to 'write off' the necessary fees.

Fee Reversal is used when a charge for a treatment was entered in error. Say you put in code 11114 but only 3 units of scaling were performed. You can use the adjustment type Reverse Patient Fee (-Pat) to reverse the fee for 11114 and then re-invoice the correct code of 11113.