Reverse an Encounter Overview

Reverse an Encounter Overview

Things to Consider Before Doing a Reversal

  • Insurance Transactions have been posted, and you expect the insurance to do a Takeback
    • Do not Reverse for Modification and wait for the takeback.
    • Or, Reverse for Modification: Change the old charge to $0.00 fee and make it not billable; make the changes to the Encounter and rebill. The old charge with the posted money will still exist to do the Takeback.
  • Insurance Transactions have been posted, but the Encounter was a mistake.
    • Do not Reverse for Deletion because there will not be an Encounter to apply the Takeback to.

Types of Reversals

If you need to make changes that will affect the fees (such as CPT® code or Units), and the charge is in a closed period, there are two possible situations:

Reverse for Deletion

Example: An Encounter was entered twice by mistake in January, but you caught it today. January is closed and has already been reported, so you cannot change January numbers. You would use Reverse for Deletion for the duplicate charge. If there are payments on this Encounter, move the payments to another Encounter before Reversing for Deletion. If there are insurance payments on the encounter, you should not Reverse for Deletion because there will likely be a recoupment by the Insurance.

This accomplishes three things:

  • Flags the original Encounter as Reversed (a header message is added).
  • Creates a Reversal Encounter in the current accounting period, negative mirror image of the original.
  • If payments or adjustments exist on the Encounter, the transactions will be undone (Undo Posting) and put in Escrow.
  • For this example, Encounter from January, Procedure XYZ was billed for 10 units at $1,000. In March. A Reverse for Deletion was done, creating an Encounter with Procedure XYZ with -10 Units and a fee of -$1,000. The January numbers will not change. The March numbers will reflect the Reversal. For yearly reports, the charges on this encounter will balance to zero.

Reverse for Modification

Example: An Encounter was entered for an incorrect amount in January, but you caught it today. You could Reverse for Modification to change the Encounter without deleting it.

Using this example, Procedure XYZ was billed in January for 10 units at $1,000.00. In March, we Reverse for Modification, retaining the Encounter with Procedure XYZ. The original Encounter is retained with the posted transactions, and you can Modify Charge Lines when there are payments and adjustments, since the Encounter is in the current open period.

You may not need to Undo the line items on an Encounter prior to Reversing for Modification. You can choose to undo all transactions when reversing the Encounter. The following figure shows the Undo Transactions checkbox.

 




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