Free Medisoft Tech Help- Medisoft V26, Medisoft Clinical EHR & More- Courtesy Support Resource

I am having the following issue. If I post a withold by the primary insurance, that amount is not showing up on the electronic secondary claim, so my claim gets rejected because it doesn't balance (all payments, adjustments, etc. do not add up to the charge amount).

Do you submit claims and post remittances with Revenue Management?

I do submit all of my electronic claims with RM. I only post some remits with it. Many have to be manually posted.

All line items on the claim must be paid by the primary payer - even if it is a $0 pay. The line items on the secondary claim must match what was sent on the primary claim.

They are being paid by the primary payer, but Medisoft is not accounting for any amount applied as a withold by the primary payer. For example:

The charge for a line is $10. The primary carrier allows $8 (so there's an adjustment of $2) pays $5 and withholds $2. The patient's balance is $1.

Medisoft only shows the payment, and the adjustment. It does not show the withold, so my claim is rejected by thesecondary carrier because it's out of balace by $2.

I am still having this problem. Do you know of any solution to it?

That sounds correct. By withholding $2 that means the insurance intends to pay that $2 probably at the end of the year and the patient owes $1.

I am posting (as are most of the billers that I've consulted) the Medicare sequestration 2% reduction as a withhold. This 2% amount does not show up as an adjustment when I submit the secondary claim, which causes my claims to rejected since they don't "balance".

Yeah, I think it should be setup as an Insurance Adjustment because Medicare is expecting the doctor to take the hit on this one. Interestingly, if the doctor does not participate with Medicare, then the patient takes the 2% hit.

I know this is an old post, but I just started submitting secondary claims. When I submit with the MIPS reduction (similar to the sequestration), it doesn't show up on the clearinghouse end. The CO-45 shows up with the correct amount, but the CO-237 does not show up and I have to put it in manually on the clearinghouse website. Is there a way to set up revenue management to pick this up? I submit all my claims through revenue management, but post remits manually in medisoft.
Thanks in advance!

Hi, you can just post these as an Insurance Adjustment. The doctor is being penalized for not participating with an electronic health record for MIPS/MACRA.

That's what I'm doing, but the clearinghouse (emdeon) is only picking up the first insurance adjustment and labeling it CO-45, which is the regular reduction, it's not picking up the additional adjustment, which should be CO-237 for the MIPS adjustment. Is there another way to classify it so that it gets picked up also. I do enter the payments manually, so, it doesn't come through on an ERA or anything.
Thanks

The clearinghouse should be sending both adjustments in the EOB, but you may have to setup CO-237 as an adjustment code in Revenue Management or it won't post it for you.

No withhold codes/amounts are sent on the secondary claim even if it's posted correctly by RM or manually. I use Office Ally and have to go in and manually add those adjustments after the claim rejects for not balancing.

There is the option in Revenue Management to post adjustments from secondary payers. It doesn't happen very often, so I normally leave that option turned off.