An insurance chargeback occurs when an insurance company reclaims a payment it had previously made to a patient. This usually occurs due to reasons such as policy cancellations or billing mistakes. When the insurer issues a chargeback, it will specify the patient and the date of service to which the funds must no be allocated. 

Creating a chargeback

To begin, click the Insurance Payment tab in the top navigation bar. 

Click, New Payment.

Search for the payer by typing directly in the Payer field. Selecting a payer is optional. 

Choose the Payment Method

If the payment method is a check or electronic fund transfer, enter the Check Number or Electronic Fund Transfer Number

Enter zero in the Payment Amount field. 

Enter the date specified on the Chargeback in the Payment Date field. 

Click Create Payment

Enter the patient's Last Name, First Name, Account/MRN Number, Chart Number, or Claim Number, then click Search to proceed. 

If the details entered match multiple patients, select the correct patient from the search results below. 

Insurance payment screen

The Payment Amount, Payment Method, and Check/EFT number will populate if applicable. Payer and Payment Date will be automatically populated based on the details provided on the previous screen. The Posted Date defaults to the current date, but can be changed. 

The grid on the top-left corner will display the patient's details, including their name, chart number, and total charge amount. If you're creating a chargeback from the primary or secondary payer and the patient has a tertiary payer, the "Requeue" checkbox will be automatically selected. If you prefer not to re-submit the payment information, uncheck the requeue option. 

The grid in the top-middle section will display all of the patient's encounters with an outstanding balance, and the "Show unrelated encounters" checkbox will be preselected by default. To include encounters with a zero balance, make sure to select the checkbox for "Included $0 balance." Then, click on the appropriate Date of Service. 

The grid in the top-right corner will show the CPT codes and payer. Select "Insurance Charge Back" in the Payment Code dropdown menu. 

Input the insurance chargeback amount into the Payment Amount column within the line item. 

Adding the chargeback payment amount to another patient

To include additional patients, click the blue plus sign (+) to search for the patient. 

Enter the patient's Last Name, First Name, Account/MRN Number, Chart Number, or Claim Number, then click Search to proceed. 

If the details entered match multiple patients, select the correct patient from the search results below. 

To view all patients added, click the Refresh button. 

Click on the patient name in the top left grid. 

Click the patient's service date in the top middle grid. 

Select the payer from the Insurance column dropdown menu. 

Select "Insurance Payment" in the Payment Code drop-down menu. 

Input the insurance chargeback payment amount into the Payment Amount column on the line item. 

Click Save and Post to post the chargeback or click Save to save the chargeback without posting it.

 

Additional information

The chargeback amount will be displayed at the top of the screen as the Charge Back Balance. Both the Payment Applied and Payment Balance will show a zero balance. 

 

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