CARRIER RESCINDS FUNDS

Occasionally, you might find yourself in a situation where the carrier “over pays” an account. Not often, assuredly, but it could happen. Or, more commonly, a No Fault or Work Comp payor might decide that the payment previously made to you was incorrect. They then rescind (or take away funds) from one patient and apply them to a different patient. This results in an E.O.B. (Explanation Of Benefits) for one amount, and the actual check for a lesser amount.

You will need to do the same action as the carrier. Use Transfer to move the money from one patient to another. We suggest you do the following steps.

Enter the Payment (amount of the check) and apply it as far as you can. For example if this check covers 4 patients, it is possible that you will be able to fully apply 2 or 3 of the patients. When you run out of check, make a mark on the E.O.B. showing where you have stopped. Now, we will use Transfer to complete the E.O.B. entries.

[ $ ] Payments Icon

Click on this icon, click the “+” to add a new entry.

Choose TRANSFER as the type of payment that has been made. Fill in the correct business. When you select TRANSFER you will note much of this first portion of the payment entry “disappears”. Since this is not a new payment into the system, this data is not needed. There is no need to fill in any other areas of this first section. Now click on [NEXT STEP].

Next click on SELECT PATIENT CLAIM(s) and choose the patient and which contains the amount the carrier rescinded. We are removing funds so place a “-“ and the amount in the Refund/Payment column and hit enter. TPS200 will also place this same “-“ amount in the On Account column. If this amount was actually applied to service lines, click on the APPLY TO SERVICES OF THE CLAIM tab. This screen will show you how much is expected from both the patient and the carrier. It will also show if either the patient or the carrier has paid a portion of all of what is expected for each line of service. If you do not see the service date from which you need to transfer, place a “check” in the All Services box. If the E.O.B. states which service lines are being rescinded, go to these lines. Note the amount in the PREV PAID column for the carrier. In the Carrier Pays column, type in a “-“ and the PREV PAID amount (or the amount shown as rescinded on the E.O.B. which ever is less). When you have removed all of the payments, click back on the Transaction Amount/Summary Tab. This part of the process is complete. Now again click on SELECT PATIENT CLAIM(s) and choose the patient (and/or other claim) to which you are transferring this money. TPS2000 will automatically place the “+” amount in the Refund/Payment column and the On Account column for this patient/claim that matches the “-“ amount above. If you are placing this amount as a CREDIT for this patient/claim, you are done.

If you need to apply these funds to services, click on the APPLY TO SERVICES OF THE CLAIM tab. This screen will show you how much is expected from both the patient and the carrier. It will also show if either the patient or the carrier has paid a portion of all of what is expected for each line of service. If you do not see the service date from which you need to transfer, place a “check” in the All Services box. You have several options of applying payments to the lines of services.

You may arrow to a specific service line and click on APPLY BALANCE FORWARD from current line.

You may arrow to a specific service line and click on APPLY BALANCE BACKWARDS.

You may manually apply the amount to each individual line of service.

When you have completed this action click back on the TRANSACTION AMOUNT / SUMMARY. You will note that TPS 2000 has moved the amount in the On Account column to the Applied to Services column.

After you have entered all of the needed transfers, close the payment/refund entry.