Partial Insurance Takebacks/Refunds

Use these methods when the insurance takes back only a portion of the money originally paid. This can be in the form of a physical check or a Payment that is automatically deposited in the bank (EFT).

• Manually Posting a Partial Takeback from a Paper Remit.
• ERA Posting a Partial Takeback not contained in the body of the Remit.

Manually Post a Partial Takeback on a Paper Remit

When manually posting an Insurance Payment with a Takeback, always post the Takeback first.

1. From the Receipt, select Post (Expert Mode).

2. Enter the Patient ID number or use the Lookup icon or enter the Encounter number preceded by an E (e1234) and press Tab key.
3. Select the ID.
4. Transaction Code: Enter IRF.
5. Amount: Enter the Amount of the Partial Takeback. Since the IRF Transaction Code negates the amount, enter the Takeback amount as a positive number.
6. Press Tab to display the Transaction in the Window.

• If the Remit defines the adjustments to be reversed, you can enter the adjustments here, such as a CO45 which would be entered as a negative amount. Add any necessary adjustments. However, you may not know which Adjustments to reverse until the Payer takes the full Takeback.

7. Send to Worklist: The Encounter can be sent to a Worklist for follow up.
8. Select Save [F2].

• Continue to Post the remaining Payments on the paper Remit.

If you want to write off the balance before leaving the Post Expert screen, add a WOI (Insurance Write off) for the amount of the Takeback.

Post a Partial Refund sent to the Payer by Check

Scenario: You have received a letter from a Payer for a Partial Refund.

• Most of the time, the Payer will take the refund from a future Remit.
• However, you may need to send the refund by check. (Be careful that the refund is not taken twice: by check and taken from a remit.)

Partial Refund by Check

1. Select the Post Refund link on the Encounter.

2. Refund Type: Select Insurance Refund.
3. Enter the Mailed Date/Check Date.
4. Select the Insurance to be refunded.
5. Enter the Refund Amount (Positive number)
6. Enter the Check Number.
7. Notes: Enter applicable notation.
8. Select Save (not Save/Post).

9. Select the Post Expert Mode button on the Insurance Refund Receipt Dashboard.
10. Transaction Code: Enter IRF.
11. Refund Amount: Enter the amount as a positive number

• Press Tab to display the Transaction in the Window.

12. Applicable Adjustments can be added here also.

13. Send to Worklist: The Encounter can be sent to a Worklist for follow up.
14. Select Save [F2].

ERA Partial Takeback

When there is a Partial Takeback on an ERA, it is usually found at the end of the Remit listed under Provider Level Adjustment Details. There will be a message in red on the ERA File Dashboard that notifies you that there is a Provider Level Adjustment.

1. On the ERA File Dashboard, select Attach New Receipt.

2. Received: Enter as a negative the Amount of the Takeback.
3. Select Save [F2].

4. On the ERA File Dashboard, select the Receipt that was created.

5. Select the Post (Expert Mode) button.

6. Enter the Patient ID number or use the Lookup icon or enter the Encounter number preceded by an e (e1234).
7. Select the ID.

8. Transaction Code: Enter IP
9. Amount: Enter the Amount of the Takeback using a negative number.
10. Press Tab to display the Transaction in the Window.

1. Add any necessary Adjustments. You may not know what the Adjustments are until the Payer takes the full Takeback.

11. Send to Worklist: The Encounter can be sent to a Worklist for follow-up.
12. Select Save [F2].