How Andre Takes from One Claims for Another (“Recoup”) in Eaglesoft
There are times when an Insurance Carrier will “recoup” a previously paid claim from a totally different Patient. On the Explanation Of Benefits (EOB) it shows that they are paying for a service but then show a $0 payment because they are taking money, previously paid, from this EOB. Typically, you’ll see a message like: “A reduction has taken place due to an overpayment on a prior claim”.
Scenario:
Dan had a Prophy done 3 months ago. The Fee was $100 and United Accordion paid $100. Dan’s Account now has a $0 balance.
Phil has a Prophy done 2 weeks ago. The Fee was $100 and United Accordion was estimated to pay $100.
An EOB is received for Phil that states that “A reduction has taken place due to an overpayment on a prior claim” this is because Dan’s policy was retroactively canceled, and he is responsible for the $100 fee himself. But United Accordion is taking the $100 that they paid for Dan from the $100 they were supposed to pay for Phil. Phil has a $100 Account Balance, and the total of the Check and EOB is $0.
Here is what I suggest:
Create a new Adjustment Type (List>general Setup>Adjustments) called “Overpayment Recovery” that impacts Collections.
Create a new Payment Type called “Insurance Recoupment”; Payment Prompt “number”; Currency Type “Check” and include on Primary Deposit.
If you receive Electronic Funds Transfers (EFTs), you may need to create a Payment Type for EFTs also.
There is an Insurance “Payment” of $100 that should be reflected in Phil’s Account, but we received $0. Let’s start there.
Open Phil’s Account; Open the Insurance Payment Tab; Post a Payment using the new Insurance Recoupment Payment Type for $100. This is really nothing different in this process from a traditional Insurance Payment other than the Payment Type. The Deposit report will have a unique Payment that your Bookkeeper can reconcile.
Because the actual check from United Accordion was $0 I have to reconcile the $100 payment made in Phil’s Account and I have to Show that the $100 was taken from Dan.
Phil’s Account will be correct and reflect that a $100 was done; a claim was submitted; the claim was paid in full; an Insurance Payment was made on the claim; the only difference is that the Check Type was an Insurance Recoupment check.
Open Dan’s Account. We have to show the $100 was “recovered” in Phil’s payment. Open the Adjustment tab. Select a Debit (increase balance) Adjustment. Use the Adjustment Type drop down to select the Overpayment Recovery Adjustment type you created earlier. Enter $100 into the Current ageing category. The impact of this Adjustment will be changed to Collections. That means that when you save this Adjustment, it will offset the $100 payment made on Phil’s Account. In the Notes field, add a note about this account information with the corresponding offset. I use the Account Number of the other Patient. NEVER USE THE PATIENT’S NAME! An Account Note should be added describing the disputed payment. I recommend using the same language used on the EOB.
Dan’s Account balance has now increased by $100 (essentially removing the original payment that was “taken back”). This will also decrease $100 on the Collection reports removing it from the Provider who was initially paid for this service. The Insurance Recoupment payment will be distributed to the Provider who treated Phil. Of course these might be the same Providers and there will be no impact to Provider Collections.
Dan now has a $100 balance due and should be sent a Statement.
Dan’s Account will be correct and reflect that $100 Services were done; a claim was submitted; the claim was paid; an Insurance Payment was made on the claim; then there was an Overpayment Recovery Adjustment done of $100. An Account Note was added describing the disputed payment.
DISCLAIMER:
This is a resource guide and all decisions on each dental office setup should remain the sole decision of the dentist/owner of the practice. Eaglesoft is a registered trademark of Patterson Dental Company. All other software or products mentioned are the property of their respective owners. Although Andre Shirdan was an employee of Patterson Dental, he is not associated with Eaglesoft or Patterson Dental Company or endorsed by Patterson or any other Company Mentioned in this blog
