Correcting a Contract with Insurance

If you've opened this article, chances are you either activated a contract by mistake or activated a contract that was set up incorrectly. Before adjusting the contract, deleting charges, or deactivating the contract, follow the steps below to determine the best course of action.

Step 1: Review the Contract Status

The contract status will determine what changes can still be made.

Uncharged

If a contract status shows as Uncharged, the contract has not yet been activated and all contract details, including the initial fee, can still be modified.

Active

If a contract shows a status of Active, the contract has already been activated. Review the contract details carefully to determine what corrections can still be made and whether additional adjustments are necessary.

Step 2: Contract Type - Created with Insurance or Without?

The appropriate solution will depend whether the contract includes insurance.

• If your contract reflects a single column, head on over to this page  - Correcting a Contract Without Insurance. The screenshots above represent contracts created with Insurance (Accept Assignment is √ checked).
• Before making any corrections to a contract with insurance, determine which column in the contract worksheet contains the error.

Quick Review: Understanding the Amount and Patient Copayment Columns

Amount Column

• Represents the treatment fee distribution across the contract term.
• Is used in insurance claim calculations and treatment fee allocation.
• Typically reflects an initial fee that is 25-30% of the contract value.
• Typically reflects the number of treatment months and the monthly treatment fee.
• Should accurately reflect the total contract value and treatment schedule.

Patient CoPayment Column

• Represents the patient's financial responsibility.
• Includes the initial fee and scheduled copayment charges.
• Is used to calculate the expected insurance portion based on the total contract value shown in the Amount column.

Step 3: Review the Initial Fee Amount

The initial fee is often the most important factor to consider when correcting an activated contract.

• The initial fee activates the contract and cannot be voided from the Financial Day Sheet after it has been charged. Because of this, it is important to review the contract carefully before making any corrections.
• The Initial Fee, for both columns of the spreadsheet, also determines the how much of the contract or patient's responsibility is remaining to allocate in monthly charges.

Step 4: Click your Scenario or Guidance for Next Steps

Scenario 1: When the Patient Copayment column is incorrect

Scenario 2: When the Amount column is incorrect

Scenario 3: When BOTH columns are incorrect

Important Guidelines for Editing the Contract Worksheet

When it May be Best To Create a New Contract

Scenario 1 : When the patient copayment column is incorrect

Use the following correction methods when:

• The Amount column is correct.
• The contract total is correct in the Amount column.
• The monthly charges in the Amount column are correct.
• The error is limited to the Patient Copayment column, such as:
  • An incorrect initial fee.
  • Incorrect copayment monthly charges.

Important

Do not make changes to the Amount column

If you need to add a new row to correct the patient's copayment schedule:

• Enter the correction amount in the Patient Copayment column.
• Enter $0.00 in the Amount column for that same row.

This ensures the contract value remains unchanged while allowing you to correct the patient's financial responsibility.

Pro Tip: Take a screenshot of the contract worksheet before you begin working on adjusting the amounts.

Example: The patient made a down payment of $1250, but the contract was activated with an initial fee of $1200. The patient also agreed to make monthly payments of $325, but the contract was created with monthly copayment charges of $316.66. Insurance is expected to pay $1000.

Error: The initial fee should have been $1250 but $1200 was charged as the initial fee.  In addition, the monthly copayment charges should have been  $325 but $316.66 was recorded. Because the initial fee has already charged out, the $1200 cannot be voided from the Financial Day Sheet.

Steps

1. In the contract worksheet, click the button, Add Charge at End.
2. Change the date on the newly added charge to reflect tomorrow's date.
3. Enter a $0 value in the Amount column.
4. Enter a $50 value in the Patient CoPayment column.

5. Update each scheduled monthly copayment charge to $325 in the Patient Copayment column.
6. Do not make any changes to the Amount column.

7. Verify that:
   • The Initial Fee,
   • The Scheduled Patient Copayment Total, and
   • The Calculated Insurance Portion

combine to equal the contract total reflected in the Amount column.

Also verify that the Contract Total in the Amount column is the correct contract value.

If the Amount Column total is incorrect, you have accidentally changed a value in the Amount column. Click the Revert button and try again.

8. Click Record Contract

In this example:

Patient Copayment column  - Initial Fee ($1200)+Scheduled Patient Copayment Totals ($3800)+Calculated Insurance ($1000) = $6000.

Amount column - Initial Fee ($1500) + 12 Scheduled monthly charges ($4500) = $6000.  The initial fee represents 25-30% of the contract value.  12 scheduled monthly charges represent 12 months of treatment.

Result

The additional $50 charge will automatically post to the patient's ledger during rollover.

By making the correction in the Patient Copayment Column only:

• The contract value remains $6,000.
• The Amount column continues to accurately reflect the treatment fee schedule.
• Insurance calculations remain accurate.
• The patient's payment schedule matches the agreed-upon financial arrangement.

Scenario 2: When the Amount Column Is Incorrect

There are situations where the error exists in the Amount column, not the Patient Copayment column.

Examples include:

• The number of monthly charges does not match the number of treatment months.
• Monthly treatment fees were distributed incorrectly.
• The treatment fee schedule does not accurately reflect the intended contract structure.

In these situations, adjustments to the Amount column may be necessary. Because the Amount column is used to determine treatment fee allocation and insurance claim calculations, review the treatment schedule carefully before making any changes.

Scenario 3: When both columns are incorrect

If both the Amount column and the Patient Copayment column contain errors, use the guidance provided in Scenario 1 and Scenario 2 to correct each column.

Keep the following in mind:

• The Amount column represents the treatment fee distribution and the total contract value.
• The Patient Copayment column  represents the patient’s financial responsibility and is used to calculate the expected insurance portion.
• While the monthly dates and amounts in each column may differ, the Patient Copayment column is calculated against the Amount column, which represents the contract total.

Before Recording the Contract

Verify that:

• The Amount column accurately reflects the treatment schedule and total contract value.
• The Patient Copayment column accurately reflects the patient’s payment schedule.
• The Calculated Insurance displayed in the upper-left corner of the contract worksheet matches the expected insurance amount.
• All scheduled charge dates are correct.

Once these items have been verified, click Record Contract.  

Important: Guidelines for Editing the Contract Worksheet

The following guidelines apply to all contract corrections.

Adding or Removing Rows

If you need to modify the contract worksheet:

• Click Add Charge at End to add a new row.
• Select one or more rows and click Delete Selected Charges to remove scheduled charges.

Review Both Columns Carefully

When adding, deleting, or editing rows, always review both the Amount column and the Patient Copayment column.

A change made to one column does not necessarily mean the other column should also be made to the other.

• If you are correcting the Amount column, only adjust the Patient Copayment column when the patient’s payment schedule also needs to change.
• If you are correcting the Patient Copayment column, avoid making unnecessary changes to the Amount column, as it represents the treatment fee allocation and contract value.

Verify Before Recording

Before clicking Record Contract, confirm that:

• The Amount column reflects the intended treatment fee schedule and contract value.
• The Patient Copayment column reflects the intended patient payment schedule.
• The scheduled charge dates are correct.
• The calculated insurance amount matches the expected insurance amount.
• Any added or deleted rows have been reviewed to ensure both columns remain accurate.

When it May be Best to Create a New Contract

While many contract errors can be corrected, there are times when making multiple adjustments becomes more complicated than creating a new contract.

If the contract has numerous errors, the treatment fee distribution is significantly incorrect, or you are no longer confident that the contract accurately reflects the intended financial arrangement, it may be best to deactivate the contract and create a new one.

For instructions on deactivating a contract, reference the articles listed at the bottom of this page.

After the contract has been deactivated:

1. Create a negative (-) Account Adjustment for the full contract amount.
2. Navigate to the Clinical tab of the patient's chart.
3. From the Treatment Plan drop-down in the upper-left corner of the chart, create a new treatment plan.

4. Update the new treatment plan so it is an exact duplicate of the original treatment plan.

   Pro Tip: To make comparing the two treatment plans easier, enable the split view in the Clinical tab. Select the new treatment plan in the top pane and the original treatment plan in the bottom pane. This allows you to compare the plans side by side and verify that all treatment details match before creating the new contract.

5. Make the new treatment plan the active treatment plan.
6. Create a new contract using the corrected treatment plan.

Taking the time to create a new contract can often be the cleanest solution when extensive corrections are needed. It helps ensure that the treatment plan, contract structure, patient payment schedule, and insurance calculations are all accurate from the start.