Adjusting Balances and Recoupments in Payment Center

Adjusting Balances and Recoupments in Payment Center

There are a several instances in which you may need to adjust, write-off or change the balance for a payer in Aloha.  Please find different examples below as well as best practices to complete your adjustments.

Adjusting total payment because some services were billed outside of Aloha


Sometimes, especially when you are switching into a new practice management system, some checks will cover claims billed both inside and outside of Aloha.  In this case, Aloha cannot apply the entire amount of the check because there are not chargelines/claims in Aloha to apply to.

1.  Post the payment as normal (i.e., manually or automatically) as seen in the Knowledge Base article, How do I add and manage my payments?.  All claims that were billed in Aloha will begin with P000 on the ERA.  
2.  There will be a small balance left in the "unapplied" section.  
3.  Edit check amount to reflect only what was billed in Aloha.  Use the  to the left of the check in the payment center to open the check.
4.  Edit the amount of the check to reflect the applied amount.



4.  In the note section, explain what you did (i.e., "Original check for $5643.92, adjusted check amount due to charges billed outside of Aloha).
5.  Click Save.


A payer paid interest on top of what was owed due to a late payment

1.  Edit payment amount using the  to the left of the check in the payment center (for an interest of 22.09 we would change 3200 to 3222.09.

2.  Click Save

3.  Go back into the payment and select Interest under Action


4.  Write the amount of interest in the box labeled Amount.  In our example, it would be 22.09.

5.  Click Save

A payer charged a fee that was subtracted from the total of a check

The issue in this example is that the check does not cover the total amount of the claims even though everything is showing as paid.  .  

1.  Post the payment as normal (i.e., manually or automatically) as seen in the Knowledge Base article, How do I add and manage my payments? 
2.  There will be a small balance left in the unapplied section.  
3.  Refer to the ERA as to which chargelines were not posted.  
4.  Double click on the check to enter the Payment Center
5.  Search for the Client and Month of Service in the top of the payment center.  Click Add.



6.  Find the chargeline that was not reconciled.  Write the remaining balance of the check in the Paid box.  Write any contractual adjustments or client responsibility referring to the ERA.  The status should show as an underpayment with a remaining "Payer balance".
7.  In the Action box, select Adjustment and under Adjustment Code select Other.  Write the remaining payer balance in the Amount.  In the Note you can write "adjusted to cover payer filing fees" or whatever will help you remember what you did.


8.  Click Save.

A payer/client balance needs to be written off.

Examples may include writing off co-pays, deductibles, or coinsurance.  Please always check on the legality of this with your legal council.

1.  Go to the specific chargeline.  A chargeline (or session) can be found by searching for the client and month of service in the top of the payment center and then clicking Add



2.  In the bottom left corner under Payment Details, under action, select "adjustment" and write the amount of the balance you would like to remove in the Amount box.



3.  Select the adjustment code that best applies.  This will most often be write-off.

4.  Write a note (e.g. "client discontinued services and not paying co-pays") if desired explaining what you did.  

5.  Click Save.


Recoupments

A recoupment is the insurance company taking back money for a claim that was previously paid in error. 
The first step of a recoupment is always to fight it.  Call the payer and find out why money is being recouped and see what can be done.  However, if the recoupment is legit, use the following steps to reconcile your checks in Aloha.
Recoupments are really complicated.  The first time you do one, it is best to schedule a meeting with your Customer Success Manager for extra support!

A payer recouped a previous payment (services were billed in Aloha)

1.  Post the payment as normal (i.e., manually or automatically) as seen in the Knowledge Base article, How do I add and manage my payments?.  There will be chargelines that do not get posted due to the fact that the check is a lower amount than you are owed due to the recoupment.
2.  Go to previous check in which the payment was recouped from.  For example, if the original payment is from check number 543, and the recoupment occurs in check 623, you should use the search bar at the top to search for check #543.  Always make sure to clear the filters.



3.  Double click on the check and search for the client and month of service that is being recouped.
4.  Delete all the payment details (paid, contractual obligation) for the recouped chargeline.
5.  An "unapplied" amount in the amount of the recoupment will now appear.  Use this unapplied amount to reconcile the chargelines from the new check that you were not able to reconcile due to the recoupment.
6.  Go to AR Manager and find the recouped claim (i.e., the claim you deleted the payment from).  Select it and go to More.
7.  Settle the claim.  

A payer recouped a previous payment (services were billed outside of Aloha)

1.  Post the payment as normal (i.e., manually or automatically) as seen in the Knowledge Base article, How do I add and manage my payments?.  There will be chargelines that do not get posted due to the fact that the check is a lower amount than you are owed due to the recoupment.
2.  Create a new "payment" or "check" for the amount of the recoupment.  
3.  Apply the check to the chargelines that were not posted.  
4.  Make sure to note that this check was created to cover for a recoupment and reconcile your books from your previous system.

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