Posting Payments > Posting Insurance Payments

Posting PPO Payments with Write-Offs

You can post PPO insurance payments in the Insurance Payments window. Write-offs are automatically posted with the claim payment.

To post a PPO payment with a write-off:

1. Select Insurance > Insurance Payments > Bulk Insurance Payments. The Insurance Check Info window is displayed in EDIT mode.

2. Select the insurance company, insurance plan, and transaction code from the drop-down lists.

3. If the payment includes a DMO/capitation plan service fee, enter the plan, plan fee, and plan doctor information to display the plan fee in the correct plan Transactions window. The plan fee is subtracted from the check amount. You can distribute any remaining amount to the patients with outstanding claims.

3. Type the amount of the insurance payment, the check number, and the bank number in the appropriate fields. Ensure the correct date is selected from the Date drop-down list.

4. Select the billing and plan doctors from the drop-down lists.

5. To submit completed claims covered by a secondary plan to the insurance batch file, select Print Secondary Claims.

6. Click OK. The Insurance Payments window is displayed. The insurance check information is displayed at the top of the window.

7. Select Load Claims from the Options section of the Express bar or Options menu.

8. Edit and remove claims as necessary. For a detailed list of Insurance Payments window options, see Using Insurance Payments Window Options.

The write-off amount posted is the difference between the plan’s allowed amount and your fee schedule 0 amount for the code. The reserved code 50.90 is posted as the transaction write-off.

9. If the payment amounts and estimates in the Payment column are not the same, select Write-Off Mode from the Options section of the Express bar or Options menu to post the write-off. The Payment column replaces the Dr. Amt. column, the Write-off column replaces the Total column, and the Risk Woff column replaces the Payment column.

10. Select Edit Write Off for Trans from the Options section of the Express bar or Options menu. The Claim Line Item Adjustment window is displayed for the transaction.

The amount that must be written off is displayed in the Adjustments field. The patient portion (claim total minus insurance payment plus adjustments) is displayed in the Remaining field.

11. Click Edit. The Write Off field is highlighted. Enter the appropriate write-off amount, based on the amount displayed in the Remaining field.

12. The Adjustments field and the entered write-off amount should be the same.

12. Click OK.

13. To change the write-off amount for another claim, select Next from the Options section of the Express bar or Options menu. The claim is displayed. Click Edit to change the write-off amount for the first transaction. You can press the down arrow key to move to the next transaction in the list. Click OK.

14. Click Close. The Insurance Payments window is displayed. Some PPO plans require an additional risk and development write-off, and it may be necessary to type it in the Risk Woff column. When you post the insurance payment from this window, the risk write-off amount is automatically calculated. This amount is the risk write-off percentage multiplied by the claim’s estimated insurance payment. The write-off amount is subtracted from the insurance payment amount.

Example:If the claim’s estimated insurance portion is $63 and there is a three percent risk write-off, $61.11 is displayed in the e Payment column. When you click Options and select Write-Off Mode, $1.89 ($63 x.03 = $1.89; $63 - $1.89 = $61.11) is displayed in the Risk Woff column. Code 50.91 is displayed in the patient Transactions window as the risk write-off adjustment. This adjustment is displayed in the Write-Off report and in any reports where adjustment totals are displayed.

15. When you have edited all distribution and write-off amounts, click Post.

16. You are prompted to update the bluebook. Leave the default value of 1 to update the bluebook for each claim. If you do not want to update the bluebook, enter 0 and click OK in the Bluebook Update Method window.

17. You are prompted to print the batched billing statements. Click Yes to print the statements; click No to print the batch file later.

18. Click Close to exit the Insurance Payments window. You are prompted to confirm the exit. Click Yes.