Those of you who are entering insurance payments manually from a ERA must enter payments slightly differently to prevent patient adjustments from being created.
If your payments are automatically getting entered from Claim.MD, this does NOT apply.
When you first click on the Insurance Payments tab in your mail billing area, the following warning will appear.
Please read the message do you understand how to enter payments manually from an ERA. If you don't have a copy of the ERA, get one before proceeding.
The warning message can be turned of by clicking the "Do Not Show Again" button.
Here is what you need to do going forward.
If the patient’s invoice already has a patient charge and patient payment (like a copay), manually record the insurance payment and patient responsibility information from the ERA by doing the following:
Enter the information from the ERA or Remittance Advice in each applicable box. For example, enter the Payment Amount, if the ERA shows a patient responsibility be sure to enter it into one of the highlighted boxes shown below.
For example if the ERA shows a patient responsibility of $20 for a copay, enter that amount in the Copay Adj. $ box even though there may be a patient charge and patient payment on the invoice. This will not duplicate the patient charge. If you leave the Copay Adj. $ blank the patient charge on the invoice will change to a patient adjustment and the copay that you collected will become a credit. Leaving the box blank tells TherapyMate that no copay is required so our system will change the invoice and turn the patient payment into a credit.
For example if the ERA shows a patient responsibility of $20 for a copay, enter that amount in the Copay Adj. $ box even though there may be a patient charge and patient payment on the invoice. This will not duplicate the patient charge. If you leave the Copay Adj. $ blank the patient charge on the invoice will change to a patient adjustment and the copay that you collected will become a credit. Leaving the box blank tells TherapyMate that no copay is required so our system will change the invoice and turn the patient payment into a credit.
If the patient's invoice didn't have a $20 patient charge and patient payment, the system will add one for you.
Here is a test example where the ERA shows an insurance payment of $45.40, along with a copay and co-insurance requirement.
Enter this information as shown below:
If you follow these steps, a credit adjustment will not be created.
If you follow these steps, a credit adjustment will not be created.
Correcting Credit Adjustments
If you didn't enter the patient responsibility and the invoice shows a credit adjustment and the client now shows a credit, follow these instructions to correct the problem.
Go to the client's payment page and look for any Credit Adjustment/Refund lines. Example below:
Click on the invoice number
When you see the invoice, click the edit button.
Remove the patient adjustment line from the invoice by click on the "x" on the right side
Add a new line for a Patient Charge. Make sure the date is the date of service. Add a description (like copayment or similar) and enter a dollar amount that matches the payment amount. Example below:
7. Click Save
8. Go back to the client's payment page and delete the adjustment refund line.
This completes the correction process.