ERA Takeback/Refund/Reversal

ERA Takeback/Refund/Reversal

Post as Remitted vs. Takeback

Using Post as Remitted on the ERA completes a Takeback exactly as the Remit dictates in the ERA.
In some cases, the Manual Post button will be used to do the Takeback when the ERA does not calculate correctly.

For example:  

  • You did not post the original claim exactly as Remitted (for example you used Post as a Note).

  • The insurance adjudicates the Takeback differently than the claim was originally paid. 

Post as Remitted Process 

  1. On the ERA Remits Items screen, select the Remit number of the Reversal.

  1. From the Manage Electronic Remittance Item page, select Post as Remitted from the Claim Action dropdown. The auto-generated Receipt is for a negative amount.

  2. View the After Posting balance. The balance should be the original Charge Amount after the Reversal is done. If it is not posting as expected, use the Manual Posting button.

  3. Change Remit Status/Worklist: The Status will change to Posted [P] automatically.

    • To send the ERA Remit to a Worklist, choose Custom Worklist from the dropdown.

    • Choose the Custom Worklist from the dropdown.

  4. Add an applicable Note that will be viewable on the Worklist and Save as a Billing Note for the note to be viewable on the Encounter.

  5. Select Save [F2].


Post an ERA Takeback using the Manual Post Button

When a Takeback will not post correctly or has already posted incorrectly, typically, the Claim Action, Post as Remitted, process fixes the error. However, there are times when the Takeback will need to be posted using the Manual Post button on the Manage Electronic Remittance Item screen. If the Takeback has already been posted incorrectly, Unapply the posted transaction(s) to make it available for re-posting.

  1. On the Manage Electronic Remittance Item screen, select the Manual Post button.

  1. The Patient will auto-populate. Tab out of the Patient field.

  2. Select the Takeback button.

  3. Select the checkbox(es) next to the line item(s) for the Date of Service to Refund.

  4. Select Save [F2].



The ERA Remit is a Zero Dollar Payment

 Payment in the Body/Takeback at bottom 

If the Remit has a Zero Dollar Payment, but it has Payments in the body of the Remit, there are probably Takebacks at the bottom of the Remit.

  • If the Payments in the body of the Remit equals the Takebacks at the bottom, apply the Payments as usual and manually post the Takebacks.

  • When finished posting, the amount posted should be zero because of the offset of the Takebacks.

 

 

Payment and Takeback in the Body of the Remit 

The Remit has a Payment and a Reversal in the Body of the Remit, and the Remit amount is zero.

  • Example:

 



Old System Reversals/Takebacks

In the Body of the ERA Remit

Legacy (Old) PM System Takeback in the body of the Remit with ERA Transactions for the New System by:
  1. Apply the ERA as usual.
  2. The Encounter Number is zero (0).
  3. The Claim Type is Reversal of Previous Payment.
  4. The Status is "O".











Not in the Body of the Remit

This Takeback is listed toward the bottom of the Remit and is not in the Body.
  1. The Identifier is not a System Patient ID/Encounter #.
    1. A System Account Number is the Patient ID# plus an "E" plus the Encounter #. (12345E2589)

  1. Attach a New Receipt
    1. Enter a negative amount for the Received dollar amount listed.
    2. Enter an O in the Disbursed Field.
    3. Enter a Note to Identify the reason for attaching a new receipt (optional).
    4. Select Save [F2].

These Takebacks will need to be posted in your Legacy PM.


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