Reverse an Insurance Payment (Post a Takeback)
When you receive an insurance payment reversal or “takeback”, PCC EHR can sometimes post it automatically when you process the ERA. Otherwise, use the Insurance Payments tool to manually reverse the payment so you can then post the corrected payment and adjustment amounts.
Video: Watch Reverse an Insurance Payment (Post a Takeback) to learn more.
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Automatically Post Reversals
When you autopost an incoming ERA that contains a payment reversal, PCC EHR will automatically post a reversal adjustment and (if present on the ERA) post the updated adjudication from the payer. The payment reversal adjustment will be associated with the provider of the originally linked charges, so your reporting will reflect the reversal occurred for that provider.
However, your PCC system will not automatically post a reversal if any charge, payment, or claim detail indicated on the ERA does not match what is found in your PCC system. For example, if the payment amount reversed does not match, or the payer fails to provide identification information, the takeback will not autopost and you will see it when you review the ERA after autoposting. Read Post Insurance Payments to learn more.
If a reversal can not be automatically posted for some reason, you can manually post it in the Insurance Payments tool using the procedure below.
Manually Reverse an Insurance Payment
Open the Insurance Payments Tool and Find the Patient
Open the Insurance Payments tool and find the patient for the takeback.
Select the Payment the Payer is Reversing
On the History tab, find and select the payment that must be reversed.
You can use the Search Filter and the disclosure triangles to ensure you have identified the payment and adjustment indicated by the payor.
Click “Reverse Payment”
After you’ve selected the correct payment and adjustment, click “Reverse Payment”.
Update the Transaction Date and Select a Transaction Type
On the Reverse Payment screen, optionally update the transaction date for the reversal. Then select an appropriate Transaction Type, such as a “Takeback” adjustment.
As you finalize your selection, you can use the original payment details on the screen to double-check that you are working with the correct encounter.
Click “Save” and Review
Click “Save” and review the outcome of the reversal.
The payment will be reversed and any adjustment(s) will be deleted. The encounter charges will pend the original payor.
Back on the History tab, you can review that the original payment has been struck through, with the date and reversal transaction listed in the Refunds/Reversals column.
Reversing a Payment Posts an Adjustment: When you post a payment reversal (“takeback”), you create an adjustment that links to the original payment. The adjustment behaves like any charge or procedure on your PCC system, and it is associated with the provider of the original charge or charges paid off by the payment.
Post Updated Payments and Adjustments, or the Denial, and Add an Account Note
Now that you have reversed the original payment and deleted any associated adjustments, you can return to the Posting tab and post updated payment and adjustment information provided by the payor.
Typically, an ERA or EOB that indicates a reversal also includes updated adjudication information for the encounter. For example, if the patient was not enrolled, you can post the rejection or denial.
As you post the updated payor response, you can use the components on the screen to update policy information, contact the family, and record additional details about the reversal in Account Notes.
Reapply the Money “Taken Back” or Send a Check
After you post a takeback, you can continue posting any remaining payments for other encounters that appear on the same ERA. Often, the takeback amount was accounted for in the check’s total. When you run reports to review posting, you will see the takeback among the other payments. Finally, in some cases you may be required to mail a check to the insurance company.
Undo an Insurance Payment Reversal
If you post a takeback incorrectly, you can use the Correct Mistake (oops) program to unlink the original payment from the Insurance Takeback, delete the Insurance Takeback adjustment, and then link the payment back to encounter charges.
Configure Transaction Types for an Insurance Payment Reversal
When you post an insurance payment reversal or “takeback”, you select a Transaction Type to record the event.
Your PCC system should already have an “Insurance Takeback” or “Insurance Reversal” transaction type, which you can pick from the drop-down menu.
If you need to edit or update the available transaction types, use the Procedures table in the Tables tool. All procedures with an accounting type of “Receipt – Refund” will be available in the Transaction Type drop-down menu when you post an insurance reversal. For help making changes, contact PCC Support at 802-846-8177 or 800-722-7708 or support@pcc.com.
Reverse an Insurance Overpayment from an Overpayment Holding Account
You may receive an insurance reversal for a payment you posted to an overpayment holding account. If so, you can post a refund to that account and link the payment to that refund, releasing the amount to either be sent back to the insurance company or applied to charges on the new ERA.
To learn more, read Post Capitation Checks, Incentive Payments, Interest Payments, Overpayments, and Withhold Payments.
Review Insurance Reversals on End-of-Day Reports
You can review insurance reversals, along with all payments and adjustments, on the daysheet report. Run daysheet, choose the “wide” report, and review the payment column.
Insurance reversals do not show up on the deposit report. Posting the reversal along with other payments on an ERA will increase the day’s deposit total, but deposit does not display “negative” payments. When you perform an insurance takeback, you should note this variance and share your actions with the other billers in your office. You can use the daysheet report to ensure your end-of-day numbers match expectations.