Transcript Processing Recoupments in Office Practicum April 23, 2015

2015 User Conference
Processing Recoupments in Office Practicum
April 23, 2015 & April 25, 2015
Presented by:
Melissa Holmes
Training Manager
PM Session
Who has dealt with Payer Takebacks?
2015 Office Practicum User Conference
Objectives
●Identify Retraction, Recoupment, Take Back, Offset
●Reasons Retractions, Recoupments, Take Backs, Offsets
occur
●Process a Retraction, Recoupment, Offset &/or Take Back in
an EOB or in an ERA in Office Practicum
Identify
2015 Office Practicum User Conference
Reason
Process
What is a Recoupment, Retraction, Take-Back?
● A retraction* is a public statement made about an earlier statement
that withdraws, cancels, refutes, diametrically reverses the original
statement or ceases and desists from publishing the original
statement.
● Recoupment* is a common practice within the insurance industry. It
means virtually the same thing as above, but generally occurs when
an insurance company has paid the benefits to a hospital and then
takes back that money when they have determined that those
benefits should not have been given.
● A take-Back** means to seize with authority; confiscate.
● An offset An offset is when a payment you would have received is
used to pay all or a portion of a debt you owe.
* en.wikipedia.org/wiki/Recoupment /**http://www.thefreedictionary.com/take+back
Identify
2015 Office Practicum User Conference
Reason
Process
Why do Retractions, Recoupments &/or Take Backs
occur?
In some cases, insurance companies will take money back on
claims that they have partially or fully paid to a provider, due to:
•Paid in Error
•Benefits were retro-terminated
•Additional information requested
•Overpaid based on contractual allowed amount
Identify
2015 Office Practicum User Conference
Reason
Process
How do Recoupments, Retractions, Take-Backs occur?
Money that is being recovered from a payer can happen two
ways:
•Electronic Remittances
•Explanation of Benefits
Identify
2015 Office Practicum User Conference
Reason
Process
What is the best way to handle Recoupments,
Retractions, Take-Backs?
● Find the account the insurance is taking money from
● If the money is not sitting as an insurance credit on the
account, open the claims tab and delete the corresponding
insurance money
● Move into a patient that is getting paid on the remittance and
add an insurance credit
● Post the credit onto the patient that is getting paid on the
remittance as an insurance (payer) credit to the outstanding
claim
Identify
2015 Office Practicum User Conference
Reason
Process
Recoups, Retractions, Take-Backs, Oh My!
Identify
2015 Office Practicum User Conference
Reason
Process
Recoups, Retractions, Take-Backs, Oh My!
●
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Locate the Patient on EOB where Recoupment is
Open
in OP
Click on
Highlight the Claim money is being Retracted
● If All monies are being recouped, Click on
Identify
2015 Office Practicum User Conference
Reason
Process
Recoups, Retractions, Take-Backs, Oh My!
Identify
2015 Office Practicum User Conference
Reason
Process
Let’s
Try It!
2015 Office Practicum User Conference
Recoups, Retractions, Take-Backs, Oh My!
Identify
2015 Office Practicum User Conference
Reason
Process
Recoups, Retractions, Take-Backs, Oh My!
●
●
●
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●
Locate the Patient on EOB where the Payer is making a payment
Open
in OP
Click on
Click on
Select a Payment Method to be
Use
to Select what OP patient you wish to Debit the
Insurance Credit From
Identify
2015 Office Practicum User Conference
Reason
Process
Recoups, Retractions, Take-Backs, Oh My!
Identify
2015 Office Practicum User Conference
Reason
Process
Recoups, Retractions, Take-Backs, Oh My!
2015 Office Practicum User Conference
Identify
Reason
Process
Recoups, Retractions, Take-Backs, Oh My!
Identify
2015 Office Practicum User Conference
Reason
Process
Recoups, Retractions, Take-Backs, Oh My!
●
●
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●
Click on
Click on
Use the Payment Method
Post Payments as you normally would to each CPT code line
Note: Do not overpost your Insurance Payer Credits in one Transaction
Identify
2015 Office Practicum User Conference
Reason
Process
Road Map Guide
2015 Office Practicum User Conference
What If the Payer Takes Back Only Partial?
2015 Office Practicum User Conference
Take these steps...
2015 Office Practicum User Conference
Recoups, Retractions, Take-Backs, Oh My!
2015 Office Practicum User Conference
What is an E Billing Prov Adj?
2015 Office Practicum User Conference
Remove the E Billing Prov Adj Claim
2015 Office Practicum User Conference
Let’s
Try It!
2015 Office Practicum User Conference
Questions
?
2015 Office Practicum User Conference
We need your feedback!
2015 Office Practicum User Conference