2015 User Conference Processing Recoupments in Office Practicum April 23, 2015 & April 25, 2015 Presented by: Melissa Holmes Training Manager PM Session

2015 Office Practicum User Conference Who has dealt with Payer Takebacks?

2015 Office Practicum User Conference Objectives ●Identify Retraction, Recoupment, Take Back, Offset ●Reasons Retractions, Recoupments, Take Backs, Offsets occur ●Process a Retraction, Recoupment, Offset &/or Take Back in an EOB or in an ERA in Office Practicum Identify Reason Process

2015 Office Practicum User Conference What is a Recoupment, Retraction, Take-Back? ●A retraction* is a public statement made about an earlier statement that withdraws, cancels, refutes, diametrically reverses the original statement or ceases and desists from publishing the original statement. ●Recoupment* is a common practice within the insurance industry. It means virtually the same thing as above, but generally occurs when an insurance company has paid the benefits to a hospital and then takes back that money when they have determined that those benefits should not have been given. ●A take-Back** means to seize with authority; confiscate. ●An offset An offset is when a payment you would have received is used to pay all or a portion of a debt you owe. * en.wikipedia.org/wiki/Recoupment /** Identify Reason Process

2015 Office Practicum User Conference Why do Retractions, Recoupments &/or Take Backs occur? In some cases, insurance companies will take money back on claims that they have partially or fully paid to a provider, due to: Paid in Error Benefits were retro-terminated Additional information requested Overpaid based on contractual allowed amount Identify Reason Process

2015 Office Practicum User Conference How do Recoupments, Retractions, Take-Backs occur? Money that is being recovered from a payer can happen two ways: Electronic Remittances Explanation of Benefits Identify Reason Process

2015 Office Practicum User Conference What is the best way to handle Recoupments, Retractions, Take-Backs? ●Find the account the insurance is taking money from ●If the money is not sitting as an insurance credit on the account, open the claims tab and delete the corresponding insurance money ●Move into a patient that is getting paid on the remittance and add an insurance credit ●Post the credit onto the patient that is getting paid on the remittance as an insurance (payer) credit to the outstanding claim Identify Reason Process

2015 Office Practicum User Conference Recoups, Retractions, Take-Backs, Oh My! Identify Reason Process

2015 Office Practicum User Conference Recoups, Retractions, Take-Backs, Oh My! ●Locate the Patient on EOB where Recoupment is ●Open in OP ●Click on ●Highlight the Claim money is being Retracted ●If All monies are being recouped, Click on Identify Reason Process

2015 Office Practicum User Conference Recoups, Retractions, Take-Backs, Oh My! Identify Reason Process

2015 Office Practicum User Conference Let’s Try It!

2015 Office Practicum User Conference Recoups, Retractions, Take-Backs, Oh My! Identify Reason Process

2015 Office Practicum User Conference Recoups, Retractions, Take-Backs, Oh My! ●Locate the Patient on EOB where the Payer is making a payment ●Open in OP ●Click on ●Select a Payment Method to be ●Use to Select what OP patient you wish to Debit the Insurance Credit From Identify Reason Process

2015 Office Practicum User Conference Recoups, Retractions, Take-Backs, Oh My! Identify Reason Process

2015 Office Practicum User Conference Recoups, Retractions, Take-Backs, Oh My! Identify Reason Process

2015 Office Practicum User Conference Recoups, Retractions, Take-Backs, Oh My! Identify Reason Process

2015 Office Practicum User Conference Recoups, Retractions, Take-Backs, Oh My! ●Click on ●Use the Payment Method ●Post Payments as you normally would to each CPT code line Note: Do not overpost your Insurance Payer Credits in one Transaction Identify Reason Process

2015 Office Practicum User Conference Road Map Guide

2015 Office Practicum User Conference What If the Payer Takes Back Only Partial?

2015 Office Practicum User Conference Take these steps...

2015 Office Practicum User Conference Recoups, Retractions, Take-Backs, Oh My!

2015 Office Practicum User Conference What is an E Billing Prov Adj?

2015 Office Practicum User Conference Remove the E Billing Prov Adj Claim

2015 Office Practicum User Conference Let’s Try It!

2015 Office Practicum User Conference Questions ?

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