Imagine that you have a charge entry for patient account Jeff Dunn, and the fee of $75 has been allocated entirely to the patient. That is, the payers on the account are Jeff and Aetna insurance, but the splits show $75 as Jeff’s responsibility, and $0 as the Aetna responsibility. The service rendered is insurance billable and a claim has been submitted.
Happily, a couple of weeks later, a $65 payment for this service is received from Aetna and you proceed to enter the payment and apply it to this service. Remember that the Aetna charge split was zero, so when we apply Aetna’s $65, we see that it will result in a negative balance of $65 for the Aetna split, which is not permitted. (An amount in parentheses is negative.) In spite of the apparent violation, SOS allows you to apply the payment and save the Credit entry.
If we go back to the original charge, we see that SOS automatically changed the original splits, moving $65 from Jeff’s chargesplit to Aetna’s chargesplit, and applied the payment to the new Aetna chargesplit balance after adjusting the payers’ responsibilities. As a result, there is no longer a negative balance for Aetna! This result represents SOS G5’s Auto-Transfer capability, and you are welcome to use it routinely, if you wish. You could, for example, configure every patient’s primary non-insurance payer as 100% responsible for all fees, and just let SOS do automatic transfers to move responsibility to insurance when insurance payments arrive, as with our example above. Be mindful, however, that the patient will receive bills for the full fee up until insurance payments arrive. Once insurance payments are applied, the patient responsibility will automatically diminish, even if no patient payment has been made.
There are certain conditions in which Auto-Transfer will not be able to help. For example, you cannot apply a payment that exceeds the entire fee of a charge entry, nor can Auto-Transfer make it possible to apply a payment if there is not enough transferable responsibility to increase the current payer’s responsibility to match the incoming payment. Transferable responsibility includes:
- Any remaining payer balance (chargesplit balance) on the charge.
- Any previous payments by other non-insurance payers.
- Any non-system adjustments applied to other payers.
Auto-Transfer will convert responsibility from other payers in the order shown above. For example, if other payers have remaining charge split balances, Auto-Transfer will first move those balances to the payer from whom we are processing the new payment. If Auto-Transfer still doesn’t have enough responsiblity to match the payment, it will next un-apply other non-insurance payers’ payments, and finally reduce other payers’ non-system adjustments if necessary. If none of these actions match the needed responsibility, Auto-Transfer fails and you won’t be able to save the credit. If feasible, you can try again, applying a lower payment. Ultimately, it may be necessary to cancel the credit entry, go back to the patient’s ledger, and manually manipulate the charge’s splits and previous credits until you have enough responsibility on the right payer to allow you to apply the new payment.
Note that system adjustments are NOT considered transferable responsibility. System adjustments include adjustments resulting from Insurance Plan Exception settings (Insurance Carriers > Insurance Plans tab > Plan details screen > Plan Exceptions tab) and from Patient Discount and Sliding Scale settings (Patient details screen > Care Episodes tab > Care Episodes detail screen – Service Discounts panel).
