v17 RM automatically adjusts electronic remit postings to $0

prosete · Post by **prosete** » Sun May 22, 2011 12:50 pm

My Medisoft v17 Revenue Management uses an adjustment definition I've had thru many previous versions of MS to auto-adjust all Medicare payment postings, so that the 835 Electronic Remittance Posting downloads from Medicare automatically bring the balance down to $0 even for the 20% co-payment expected to be paid by co-insurance. All versions of MS I had prior to v17 left these balances open, to be entered and posted manually when co-payments were received.

What do I need to change to allow these co-payments to remain open so I can go back and manually post them as the secondary carriers issue their 20% Medicare co-insurance?

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Post by **Gavin Walker** » Mon May 23, 2011 8:28 am

Let me put my disclaimer here: YOU CAN GET IN TROUBLE WITH MEDICARE IF THEY FIND OUT YOU ARE NOT BILLING PATIENTS FOR THEIR COINSURANCE AMOUNT!

1. In Revenue Management go to Configure -> Preferences. Uncheck Use Insurance Posting Codes.
2. Uncheck Never Write Off Patient Responsible (PR)
3. Go to Assign Posting Codes Tab and for each ERA Code that you want written off, select an Insurance Adjustment code. I suggest setting up a separate Insurance Adjustment Code for these so you can quickly look these up in case you ever get audited.

prosete · Post by **prosete** » Mon May 23, 2011 9:29 am

I guess I wasn't clear...I'm not looking to write anything off. The $0 balances that I refer to and which are automatically set by the 835 Electronic Remittance Postings are all coming from Medicare's ERAs. These $0 balances are the 20% co-payments that in MS v16 and before would reflect whatever the $$ amount set by the 20% co-payment. In the previous versions to v17, these amounts were the 'balance due' that secondary insurers were to pay (and did eventually). These balances were then manually posted by me for each secondary insurance EOB that I received (with payment)> Right now, when the 835's come from Medicare, the adjustment to $0 is done automatically by the remit downloads, thus, reflecting a $0 balance for the patient, even though Medicare correctly processed the secondary crossover to the co-insurer, except that the 20% due is now being reflected as $0.

I understand your suggestion on how to fix it. Does it still remain the same given that I'm not looking to write off any balances but leave the 20% co-pay figure correctly left open as 'balance due' until I manually enter the amount after receiving the EOB from the secondary carriers?

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Post by **Gavin Walker** » Mon May 23, 2011 9:56 am

Basicially you would do as I suggest above, except you check Never Write Off Patient Responsible (PR) and you select a Deductible code or (DED) instead of an Insurance Adjustment.

prosete · Post by **prosete** » Tue May 24, 2011 10:16 pm

Thanks! This last suggestion worked great and did what I was looking for!

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