Recording Insurance Chargebacks

Insurance audit procedures can result in a patient “chargeback” to collect a previous insurance overpayment or lab fee, or pay an amount higher than a patient’s open balance.

The patient’s insurance must have been billed through the Fee Slip window before you post a chargeback to the patient’s account. An overpayment or underpayment chargeback can be recorded for patients with or without open balances. For more information on recording fee slips, see Recording Fee Slips and Printing Receipts.

  1. Open the Receipts & Adjustments window. For more information on opening the Receipts & Adjustments window, see Opening a Patient’s Receipts and Adjustments.
  2. Click the Apply to Insurance tab.
  3. Select an insurance company from the Insurance drop-down menu.
  4. Type or select dates in the Date Range boxes if you want to view patients that are reflected on date-specific EOBs.
  5. Click Display Charges and select Display Detail View.
  6. Select one of the following payment Method radio buttons:
    • Check
    • Credit Card
    • EFT

      • If you selected check or EFT as the payment method, select the check or EFT date from the Check/EFT Date calendar.

  7. Type the payment amount in the Amount Paid text box.
  8. Apply the payment amount using one of the following methods:
    • If you are applying a check or EFT payment, type the check or EFT number for your deposit ticket in the Check # or EFT # text box.
    • If you are applying a credit card payment, select the card type from the Type drop-down menu.
  9. If you want to record a payment for the amount in the Amount Paid text box while you are recording the chargeback, click in an item’s Payment text box and type the payment amount. For more information on applying insurance payments to open balances, see Applying Insurance Payments to Any Open Balances.
  10. Locate a patient’s line item and select the insurance_chargeback check box.

    The selected patient must be assigned to the same insurance company that you selected in step 3, above. For more information on assigning insurance companies to patients, see Recording Patient Information.

  11. Click the Adj button.

    The Fee Slip Item Adjustment window appears. It lists the fee slips associated with the patient.

  1. Make a selection from the Adj. Type drop-down menu.

  2. Select a Balance Effect button (either Increase or Decrease Balance).
  3. If the amount is different that the total that auto-populates in the Amount box, type the correct amount.
  4. Type relevant details in the Reason box.
  5. Select the person recording the transaction from the Recorded By drop-down menu, if this field is not locked.
  6. Click Record.

    A chargeback is posted and displayed as a line item in the Receipts & Adjustments and Fee Slip windows.

  7. Click in the Payment text boxes and apply all or part of the amount in the To Apply box to patients’ open balances.
  8. Click Print if you want to print the list of patient insurance receivables.
  9. Click Record in the Receipts & Adjustments window.

    If you try to record a payment on a line item in the detailed view that is higher than the open charges, the Insurance Overpayment window opens. Choose to adjust the open charges to match the overpayment amount, transfer the overpayment to the patient’s credit, or not make the overpayment.

    • If you adjust the open charges to match the overpayment amount, OfficeMate automatically increases the balance to match the overpayment. The amount in the Patient’s Ledger will display “(ADJ)” next to it.
    • If you transfer the overpayment to the patient’s credit, the correct amount is credited to the line item and the overpayment is transferred to the patient.
    • If you do not make an overpayment, the payment will automatically be corrected to be the same amount as the open charges.

    After you record a payment, the payment is assigned a receipt number. To view and change payments, click History. For more information on viewing and changing payments, see Modifying Payments by Using the Receipt History Window.