Fax Coversheet

CLEANING UP LEDGER PROBLEMS

When cleaning up ledger mistakes (i.e. services entered that were not truly delivered, payments for incorrect amounts, etc.), if these entries were made during a period for which you have not yet run a closing (end of day process), then you may DELETE these items and completely remove them. However, if these entries were made in the past and a closing has been performed, you will may still “cleanup” the ledger, but you must leave a full paper trail of the actions. What I mean is, we can no longer DELETE any of these lines, we need to use other actions to clean these up.

Cleaning Up Items AFTER A Close

Service Needs to be REMOVED

1)No Payment Applied to Service Line

To handle a service that was not delivered, open the Patient’s Claim area and select this patient. Click on the Ledger Tab to load the ledger for this claim. Arrow to the date of service that needs to be removed. Make the Carrier Amount 0.00, make the Patient Amount 0.00 and hit enter. The full amount of the service (i.e. 50.00) will automatically be placed in the Adjust Off column. Now go to the Adj. Comment column and put in the reason for this adjust off (i.e. Undelivered Service). A service that has been adjusted off 100% prior to billing, will not appear in any billing run. WARNING: If the service is being adjusted off FULLY, and was originally part of the deductible, please remember to edit the deductible field in the ledger as well, otherwise, this service will be billed on a HCFA form.

NOTE: You may not reduce either the Pat Amount or the Car Amount to LESS than the amount listed in the Prev. Pmt column next to it. If the service you wish to remove has had a payment applied toward it, you will need to do an additional step.

2) Payment Applied to Service Line

To handle a service that was not delivered and a payment has been applied to either the patient or carrier portion, open the [$] Payments/Refund area. Click on the “+” to add a new entry. Choose Transfer as the entry type. Click on [Next Step]. Click on [Select Patient/Claim] and find this patient. No need to fill in any amounts on this screen. Click on Apply to Services of the Claim. Put a checkmark in the All Services box. Arrow to the date of service that needs to be removed. If there is an amount in the Previous Payment column for the Patient, place this amount with the “-“ in front in the Patient Pays column (i.e. “-12.50”). If needed, do the same for the Carrier Pays column if there is an amount in the Previous Payment column for the Carrier. Next make the Carrier Amount 0.00, make the Patient Amount 0.00 and hit enter. The full amount of the service (i.e. 50.00) will automatically be placed in the Adjust Off column. Now go to the Adj. Comment column and put in the reason for this adjust off (i.e. Undelivered Service). A service that has been adjusted off 100% prior to billing, will not appear in any billing run. WARNING: If the service is being adjusted off FULLY, and was originally part of the deductible, please remember to edit the deductible field in the ledger as well, otherwise, this service will be billed on a HCFA form.

Click on the Transaction Tab. You will see the amount you placed in the “Pays” column in the On Account column and an equal amount with a “-“ in the Applied to Services Column. Close this screen. This shows that we moved or transferred money into the On Account Credit area (or holding tank) of this account. This money is available to redistribute if necessary.

Payment needs to be REDISTRIBUTED

1) Payment Applied to Incorrect Service Line

To handle a situation where payment was applied to the incorrect service line (i.e. usually carrier payment in this case but can be used for patient amounts as well), you will need to use the Transfer process. Click on the [$] Payments/Refund area. Click on the “+” to add a new entry. Choose Transfer as the entry type. Click on [Next Step]. Click on [Select Patient/Claim] and find this patient. Since we are simply “moving” the money around on the same claim, there is no need to fill in any amounts on this screen. Click on Apply to Services of the Claim. Put a checkmark in the All Services box. Arrow to the date of service that needs to be removed. If there is an amount in the Previous Payment column for the Carrier, place this amount with the “-“ in front in the Carrier Pays column (i.e. “-12.50”). Now arrow to the service line that should have been paid with this amount, in the Carrier Pays column, type in the amount of the payment (i.e. 12.50).

Click on the Transaction Tab. You will see the amount you placed in the “Pays” column in the On Account column and an equal amount with a “-“ in the Applied to Services Column. Close this screen. This screen will still not have any numbers on it as we took it off and put it on in the same action.

2) Payment Applied to Incorrect Patient or Claim

To handle a situation where payment was applied to the incorrect patient or claim, you will need to use the Transfer process. Click on the [$] Payments/Refund area. Click on the “+” to add a new entry. Choose Transfer as the entry type. Click on [Next Step]. Click on [Select Patient/Claim] and find the patient to whom the payment was originally applied Since we are moving money OUT of this claim and putting into another claim, you will need to place the amount we are transferring with a “-“ in the amount column.

Amount to be transferred is showing as a Credit

If the amount to be transferred has not been applied to any lines of service (shows as an On Account Credit for this patient) you are done with the first step. Click on [Select Patient/Claim] and find the patient to whom you are now giving this money. TPS2000 will fill in the amount with a “+” automatically. If you are placing this money in the On Account Credit for this patient, you are done, if you need to apply this money to services, click on Apply to Services of the Claim. Use the standard payment methods (Apply Forward, Apply Backward, or manually enter the amount) to apply this transfer.Click on the Transaction Tab. Close this screen.

Amount to be transferred has been applied to services.

If the amount to be transferred has been applied to line of services, you need to click on Apply to Services of the Claim. For each line of service that has money to be removed, type in the amount (showing in the Previous Payment column) with a “-“ (to show that is being removed from this line), i.e. “–12.50”. Continue until each line of service that was inappropriately paid has been corrected (or until the amount in the lower left hand box reads $0.00). Click on the Transaction Tab.

Click on [Select Patient/Claim] and find the patient to whom you are now giving this money. TPS2000 will fill in the amount with a “+” automatically. If you are placing this money in the On Account Credit for this patient, you are done, if you need to apply this money to services, click on Apply to Services of the Claim. Use the standard payment methods (Apply Forward, Apply Backward, or manually enter the amount) to apply this transfer.Click on the Transaction Tab. Close this screen.

Handling a Negative Balances

When you see a negative numbers in the Patient Balance, Carrier Balance or the On Account Credit field, we have a problem that needs to be addressed. Occasionally, you will take money off of account that doesn’t truly exist. It could also be that money was originally applied either the Patient or the Carrier, then an adjust off was done WITHOUT transferring the amount paid. To clean this up, you need to find where the amount is negative and whether it is from the carrier or from the patient. Start by reviewing the patient’s ledger.

Negative Patient/Carrier Balance

When you have a negative patient or carrier balance on a patient ledger, you may see "where" it went negative by going down each line in the ledger and checking that amount of “Patient Responsibility” compared to the amount shown as “Patient Paid”. (For negative Carrier amounts you would check the “Carrier Responsibility” compared to the amount shown as “Carrier Paid”). When you find a line that shows more paid than owed, this is where it happened.

Click on the [$] Payments/Refund area. Click on the “+” to add a new entry. Choose Transfer as the entry type. Click on [Next Step]. Click on [Select Patient/Claim] and find this patient. Since we are simply “moving” the money around on the same claim, there is no need to fill in any amounts on this screen. Click on Apply to Services of the Claim. Put a checkmark in the All Services box. Arrow to the date of service that needs to be removed. If there is an amount in the Previous Payment column for the Carrier, place this amount with the “-“ in front in the Carrier Pays column (i.e. “-12.50”). Now arrow to the service line that should have been paid with this amount, in the Carrier Pays column, type in the amount of the payment (i.e. 12.50).

Negative On Account Credit

When you have a negative amount in the On Account Credit Field it will be the result of using more credit than the patient had available. You may see where this happened by review the On Account column in the patient’s ledger. If you start at the top of the ledger and go down the On Account column, you will see positive (+) and negative (-) numbers. The positive numbers show where money was placed into the On Account credit and the negative numbers show when and how much was used. If you add and subtract with the column, and you come up with a negative balance, this is when the credit was exhausted and more used than existed.

Amount was REFUNDED out of the system

If the amount that went negative was actually removed from the system via a refund (whether this was real or just on paper trying to balance an account), there is only 1 solution to correct this situation. Since this amount was actually REMOVED from the ledger via a refund, the only way to reverse it, is to put a “fake” payment back in to off set this refund. If this refund was Real, but should have been from services, I will need more data to help you handle this.

Please remember, if you put in a “fake” payment to bring this account back to what is real, make a note in the Cash Drawer as the closing will be off by this amount tonight.

Amount was used to pay service lines.

If the amount that went negative was used to apply toward service lines, this amount may be TRANSFERRED back into the On Account Credit correcting this entry. Please remember, if we remove the amount applied toward the service line, that amount will again become DUE by either the patient or the carrier.

Co-Pay Policy not working as desired

Start by going to the 1^st Responsible screen from the claims. Note the EXACT Carrier and Policy names. Now, go to the Open File Folder Icon and select Carrier Information. Click on the “Show List of Records” icon and find this EXACT carrier. Once this carrier information is on the screen, click on the [Carrier Policies…]. Again, click on the “Show List of Records” icon and find this EXACT policy name that exists in this patient file. Now, we need to check how this policy has been setup. We are assuming that this is a basic co-pay policy. By this we mean that after the co-pay ($5, $10, whatever) the carrier picks up at 100% of allowed. If this is correct, the “Default Policy Service Percent” should be set to 100%. Now, check the Carrier Percent column by each of the services. For all services EXCEPT the Adjustment codes (or the code most commonly delivered, the Carrier Percent should be 100. For the Adjustment codes (98940, 98941 and 98942) or the exceptions, the Carrier Percent column should be BLANK. On these same lines, you should also see 10.00 (or the co-pay amount) in the Patient Pays column and the balance of the service amount in the Carrier Pays column. If this is not what appears, the policy has not been setup to accommodate a co-pay situation.