Post Insurance Overpayments, Takebacks, and Refunds (Advanced Training Session)

Insurance companies sometimes pay you more than the allowable amount for a charge, or pay you more than the remaining balance due for a charge. Since you can not post more money than was due, how can you track the extra money in Partner? The guide below illustrates one possible solution to this problem.

From time to time, insurance companies will ask you to reimburse them for an overpayment. Sometimes, the company will ask you to send them a refund check. Sometimes, they will underpay you for more recent charges in order to make up for the overpayment on an old charge.

After a payer reviews your electronic claim, they will send your practice an explanation of what charges are paid, adjusted, or denied. On paper, this information arrives as an Explanation of Benefits (EOB) and a check. The electronic version of an EOB is called an Electronic Remittance Advice, or ERA. An ERA usually arrives in coordination with a direct deposit to your practice's bank account. You can use PCC software to post payment and adjustment information from both ERAs and traditional EOBs.

Occasionally, insurance carriers will pay you interest for charges they have failed to pay in a timely manner. How can you record that interest in Partner, without throwing off your Accounts Receivable? An interest payment is unexpected revenue that should not be posted against the original charges. Is there a "correct" way of keeping track of the income in Partner? The procedure below will teach you one common method.

Use the Autopost program to quickly post payments and adjustments from payors. If a payer does not send electronic remittance advice (ERAs) to your practice, or a response requires manual attention, use the Post Insurance Payments program to record payment and adjustment information manually.