ERA Recoupments

PracticeSuite adds a major enhancement in the ERA posting workflow by automating the refund/reversal posting. It is possible to refund posted and unposted payments.

The ‘Process Refunds’ Checkbox

The “Process Refunds” checkbox in the ERA screen is highlighted in Image 1. When a user checks the option for posting, this enables automatic processing of refunds by the system.

Image 1

A. For the reversal for a claim specified in the PLB segment- there are two scenarios here- Refund of unposted payments and Refund of posted payments.

Refunding Unposted payments

Unapplied amounts indicated in the PLB segment can be refunded when auto-posting the ERA. The steps to refund unapplied payments are explained below:

a. Unapplied Payments can be selected from the PLB matching pop-up screen. If unapplied money is in the PLB, users can search and select the payment to process the refund. The user merely needs to enter the payment # in the PLB Matching pop-up to search and list both the applied and unapplied payments associated with the entered payment #.

b. In Image 1a, there are two entries corresponding to the payment number. The first entry displays the claim # and patient details indicating an applied payment. However, the second entry is the unapplied balance for the payment and users can select this entry if the unapplied part is to be used for the refund.

Image 1a

Refunding Posted Payments 

The user will have to match the claim before checking the ‘Process Refunds’ check box and clicking on Process button. Follow the below-mentioned steps.

a. Click on ‘Match’ link provided beside the amount field (highlighted in Image 1) in the PLB section to manually match the claim.

b. PLB claim Matching screen pops up (Image 2). Search filters are Claim #, Check# and Payment #. Search and identify the claim where the Paid Amount matches the one given in PLB. Click ‘Match’ Button at the bottom. Once matched, ‘Match’ link in the PLB section will change to ‘Matched’.

Image 2

c. When the ‘Process Refunds’ check box is checked and ‘Process’ button clicked, the ‘Match’ link in the PLB segment changes to tick mark  if the refund works. A cross mark  appears if refund fails-Also the ‘Match’ link will appear as ‘Matched’ which can be used to match it to another claim.

B. For the reversals for a claim in the same ERA with status code 22(Reversal of Prev. Payment)

a. Check the ‘Process Refunds’ Check box and click on Process button.

System will crosscheck whether it can find the exact match of Paid and Adjustment Amount specified in the claim with the paid and adj. amount in claims posted in the system. If found, it will refund the amount from the earlier posted claim to the current ERA. It will show a  mark to show refund is a success and a  mark if refund fails; see highlighted portions in Image 3.

Image 3