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 now be allocated. 

Options for posting additional payments on reprocessed insurance claims

if an insurance claim with an existing payment is reprocessed and an additional payment is issued, there are a couple of options for posting it. 

Option 1

To begin, navigate to the Patient Dashboard. 

Click on the Encounter Number. 

Scroll to the bottom, and click the Chevron. 

Click the Reverse button to reverse this single payment. This action will not impact any other payment linked to the check. 

Type CONFIRM and click Continue. 

After reversing all encounters, go to the insurance payment tab, create the new payment, pull in the relevant patients, and select the correct date of service. The full charge amount will appear as the balance. 

Post the new payment with the latest paid and allowed amount. The system will automatically update the remaining balance CO-45.

Option 2

You can also manually post an insurance chargeback where the payer reclaims money for one line and applies it to another line item under the same date of service. 

Begin by navigating to the insurance payment screen. 

To link the patient, enter the patient's Last Name, First Name, Account/MRN Number, Chart Number, or Claim Number. 

In the Encounters section, click the Link icon for the corresponding date of service. 

Choose the Payer from the dropdown menu. 

From the Payment Code Type dropdown menu, select Insurance Charge Back for the line item from which the money is being reclaimed. 

Enter the amount being reclaimed in the Payment column. This will create a balance on the line item. Then, determine how to handle the balance: bill the patient, select Accept & Rework Denial, or Rework Denial to mark it as a denial, and then rebill the payer or write off the balance in the Write-Off column. 

Enter the payment details for the line item. If a disallowed amount was adjusted in the initial payment, enter the amount in the Disallowed field. 

Enter the payment amount in the Payment field. 

Assigning the chargeback payment amount to another patient

To begin, navigate to the insurance payment screen. 

Search for the patient by entering their Last Name, First Name, Account Number, Chart Number, or Claim Number. 

To link the encounter date of service associated with the chargeback, click the Link icon under the Encounter tab. The encounter date will be found either under the Unlinked or Unlinked & Settled tabs.

Select the Payer from the dropdown menu. 

Select Insurance Charge Back from the Payment Type dropdown menu. 

Enter the chargeback amount in the Payment amount column. The payment amount will be displayed as a negative amount. 

To include additional patients, enter the patient's Last Name, First Name, Account/MRN Number, Chart Number, or Claim Number, then click Search to proceed. 

Link the patient's date of service. 

Select the payer from the Insurance column dropdown menu. 

Select the Insurance Payment in the Payment Type dropdown menu. 

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

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

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