Issue a Refund to Insurance (Active Contract)

Sometimes insurance overpays and asks for a refund. Here is how to handle it when the contract is still active in Tops Ortho.

1. Open the patient chart; go to View > Patient Info... or press Command I.
2. In the case of our example patient, Mojo, the practice received $1500 from insurance, but the benefit decreased to $1000. Now the insurance company is asking for $500 back. Currently, the Expected Insurance shows zero because $1500 was entered as the Calculated Insurance in Mojo's contract.

3. We confirmed with the insurance company that Mojo will have to pay $500 more. Make sure you confirm this as well before you complete these steps.
4. Go to the Contracts/Ledgers tab.
5. Double-click on the contract to open the Contract Worksheet.
6. Add charges to the Copay column until the Calculated Insurance amount reflects reality. In Mojo's case, we added five more months of $100 payments:

7. Click Record Contract.
8. A window will display asking if you wish to change the expected insurance. Click Change and enter your Tops Ortho password.
9. You will now see a credit in the Expected Insurance. It should match the amount to be refunded to insurance.
10. Go to Action > Change Expected Insurance.
11. Select the option I want the Expected Insurance to be: and keep the This Amount: field as zero. As you see in the After Change column, this will move the credit down to the Due Now.
12. Click Change Expected Insurance.

13. Go to Action > New Transaction or press Command T.
14. In the Fee/Payment Type field, select [+] Account Adjustment. Enter your Tops Ortho password.
15. In the Account Adjustment Type window that displays, select Refund to Ins. Co. and click Use Selected Adjustment Type.
16. Enter the amount of the refund to be issued.
17. In the Notes field, enter the check number and other pertinent information. Press Tab.
18. Click Process Charges and Payments.