Manage Insurance Payments with Recouped Funds

Sometimes insurance companies recoup overpayments in bulk payments. This can be confusing, but don't worry - we've got you!

• In our example, insurance issued a multiclaim check. This check was for the following patients:

• Daniel Coller - payment of $500.
• Marvin Olson - payment of $250.
• Burrich Hall - insurance is taking back $200.

• Due to taking back funds for Burrich Hall, the check totals only $550.

Post the Check

It's important to post the check for its true total. Do this first, applying full payments to as many patients as possible. Here is what we would do with our example check:

1. Open Daniel Coller's chart; go to View > Patient Info... or press Command I.
2. Go to Action > New Transaction or press Command T.
3. In the Fee/Payment Type field, select Insurance Payment - Check.
4. The Multi-Claim Insurance Transaction window will display.
   1. Enter the Check Number and Check Total on the top right.
   2. Apply the full $500 to Daniel.
   3. Jump back up to the patient field in the same window and enter Marvin Olson.
   4. There is only $50 left on the check total; apply that to Marvin.
   5. Click Add Multi-Claim Insurance Transaction to Tops.

Enter Adjustments for Patients Who Didn't Have Their Full Payment Posted

No adjustments are needed for Daniel Coller; his full payment was posted. However, we need to account for the remaining $200 that needs to be posted for Marvin Olson.

1. Open Marvin Olson's chart; go to View > Patient Info... or press Command I.
2. Go to Action > Change Expected Insurance.
3. Select the option for I want to Decrease the Expected Insurance by: and enter $200 in the This Amount: field.
4. Enter a note explaining the reason for the change.
5. The After Change column shows you that after the change, the $200 will be removed from the Expected Insurance and the balance will move down to the Due Now.
6. Click Change Expected Insurance.

7. Go to Action > New Transaction or press Command T.
8. In the Fee/Payment Type field, select [-] account adjustment. Enter your Tops Ortho password.
9. In the Negative Account Adjustment Type window that displays, select [-] Account Adjustment. Click Use Selected Adjustment Type.
10. Enter the amount that needs to be credited to the patient's insurance in the Amount field and press Tab.
11. Enter the same note you entered when you changed the expected insurance. Press Tab.
12. Press Process Charges and Payments.
13. Adjust the amount in the Remaining Benefit field of the patient chart.

Enter Adjustments for the Patient who had Funds Recouped

Finally, we need to address Burrich Hall. Insurance recouped $200 from his account.

1. Open Burrich Hall's chart; go to View > Patient Info... or press Command I.
2. Go to Action > Change Expected Insurance.
3. Select the option for I want to Increase the Expected Insurance by: and enter $200 in the This Amount: field.
4. Enter a note explaining the reason for the change.
5. The After Change column shows you that after the change, the $200 will be added back to the Expected Insurance and a credit will move down to the Due Now.
6. Click Change Expected Insurance.

7. Go to Action > New Transaction or press Command T.
8. In the Fee/Payment Type field, select [+] account adjustment. Enter your Tops Ortho password.
9. In the Positive Account Adjustment Type window that displays, select Refund to Ins. Co. Click Use Selected Adjustment Type.
10. Enter the amount that insurance took back in the Amount field and press Tab.
11. Enter the same note you entered when you changed the expected insurance. Press Tab.
12. Press Process Charges and Payments.
13. Adjust the amount in the Remaining Benefit field of the patient chart.