Adjustments

Adjustments are used to either raise or lower the accounts receivable total for the practice without adding either charges (services or products rendered) or payments received. Adjustments can be used to correct billing errors, process refunds, issue courtesy write-offs, etc…

Adjustment

The Adjustment type is used to enter codes that will be used to make adjustments that are not related to insurance carriers.


Code 1: Similar to payment codes, there are not pre-defined adjustment codes that must be entered. These codes are not billed to insurance carriers, and therefore there is not a standard for code setup.

Make Adjustment Negative: This field is the most important field when entering an adjustment code. You must first identify what you want to do to the accounts receivable amount by entering this adjustment. If you want to lower your accounts receivable, you will want to check this box. If you want to raise your accounts receivable amount, you will not want to check this box.

 

 

Tips and Tricks:

Refunds are actually raising your accounts receivable amount. Because money is flowing out of your office, your accounts receivable amount should go up, just as if services or products were leaving your office.

This is usually the result of collecting too much money for a specific charge, and because of this, your accounts receivable is artificially low.

Insurance Adjustment

Insurance adjustment codes are designed to allow you to write off amounts that were billed to the insurance carriers, but will not be paid by either the insurance carrier or the patient/guarantor. All fields will have the same functionality as standard adjustments, but these codes will be used for insurance write-offs only.

Tips and Tricks:

Insurance adjustments are necessary due to the allowed amounts issued by the carriers. If a doctor participates with an insurance carrier, they are subject to an allowed amount, which states the maximum amount the doctor is “allowed” to bill for each specific procedure code.

Doctors can and should send bills for more than the allowed amounts. They then need to enter an insurance adjustment to write off the difference between the billed amount and the allowed amount. This should be done because insurance carriers use the billed amounts to determine what changes will be made to the allowed amounts.

Insurance Withhold Adjustment

Insurance withhold adjustments are adjustments made when an insurance withholds money from an EOB that otherwise would have been paid by the insurance carrier. This could be due to prior overpayments, or contractual agreements with the providers.

This adjustment type is used to lower the accounts receivable by a higher amount than the payment is actually for. All fields have the same definitions as that for previous adjustments.

These adjustments are generally entered through the deposit list.

Insurance Take Back Adjustment

Insurance Take Back Adjustments are related to withhold adjustments. Take backs are used when an insurance company has overpaid on a specific patient, and they take that money back from another patient’s EOB. This code should always be used in conjunction with an Insurance Withhold Adjustment. The Take Back would be made on the account which was previously overpaid. The Withhold would be used on the account which was underpaid due to the previous overpayment.

Based on this definition, Take Backs are used to increase the accounts receivable on a patient’s account.

Like Withhold Adjustments, Take Backs are usually entered in the deposit list.

Other Codes

There are two types of procedure codes that do not result in an increase or decrease in the practice’s accounts receivable.

Comment

Comments are used to make notations on a patient’s account. They are also required if you are going to be using the Billing Note feature within the program.

Tips and Tricks:

If you plan on using the Billing Note feature within Medisoft, you should set up at least two different comment codes. The first comment code should be for your insurance billing notes, and the second should be for your patient statement billing notes.

These are then assigned within the Program Options screen.

Deductible

Deductibles are entered when an EOB indicates that an amount billed to the insurance company should be applied to the patient’s deductible. You would then enter a deductible in the amount that was applied to the deductible. That balance would then shift to the next responsible party.

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