Insurance Overpayment
- Dylan Nigh
In MacPractice, every insurance payment is assigned to a claim, and can only be applied to charges associated with that claim. This document explains how to apply an insurance overpayment to other charges on the patient's ledger.
If you're looking to handle Insurance Takebacks instead, please review this linked article.
Creating an Insurance Overpayment Adjustment Type
Before you begin, you should create an "Insurance Overpayment" adjustment type, if you do not have one already. Click here for instructions on creating an adjustment type.
This Adjustment Type will be used when creating a Negative Adjustment so you can easily identify which Negative Adjustment is the Insurance Overpayment.
Once you've created the new Adjustment Type or confirmed you already have it, you can then proceed to the next step.
Refunding the Remaining Amount
Go to the patient's account, and select the payment you wish to apply that is larger than the charge associated with it. You'll first need to apply the amount of the payment that should be applied to the charges this payment is for. When in doubt, consult the EOB to confirm.
After you've applied the rest of the payment amount, the payment should have an unapplied amount and be displayed in red on the patient's ledger.
Select that payment in the ledger, go to the Other menu and select "Refund". The Refund window will open.
In order to apply the overpayment remainder of the insurance payment, you will need to check "Refund Credit to Patient". An adjustment drop-down window will appear, as shown in the above screenshot. You can now select the Insurance Overpayment Adjustment Type we had you create earlier.
Click OK when you are finished.Â
Applying the Negative Adjustment
You will now see one or two new line items on the ledger:
Ins. Credit to Patient
Negative Adj.
The description of the "Ins Credit to Patient" Refund line will read "Refund for Patient Credit Overpayment". and will be the amount you chose to refund the patient by.
The Negative Adjustment will display the "Insurance Overpayment" adjustment type in the description. This is the Overpayment amount you can now apply to other charges as you wish by double clicking the negative adjustment and applying it to other eligible charges in the patient's ledger. You can also leave the adjustment unapplied for future charges.
In the case of Secondary Insurance Overpayments
If you are working with a patient with a Primary and Secondary Insurance, and you encounter an overpayment on the Secondary Insurance, the same process will apply. However, you will need to ensure that the Insurance Payment is posted on the patient's account, even if there is nothing to apply it to.
When you enter the payment amount, and you notice the Save button is greyed out, simply click into the Payment Window table anywhere. This should cause the Save button to highlight.
Once the payment is posted, you can then use the Refund option to credit it to the patient in the steps described above.