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Posting an Insurer Payment (Example)

Need to record an EOB in detail? Not sure how to enter what’s displayed on your EOB when posting a payment in Jane?

If so, keep reading!!

Posting an Insurer Underpayment - Example

For our example, let’s say we treat Nathan and bill out two codes:

1) 98941 - with a fee of $75

2) 97140 - with a fee of $50

Additionally, at the time of service, we collect a $20 co-pay.

Let’s fast forward a couple weeks (after we’ve submitted this claim using our EDI feature) and say that we’ve received an EOB for this visit.

The information might look something like this (please keep in mind that your EOB might not look exactly like this and could definitely include some different lingo!):

Code 1: 98941

  • Charge Amount: $75.00
  • Payment Amount (from insurance): $38.75
  • Total Adjusted Amount: $36.25 (Charge Amount - Payment Amount = Adjusted Amount)
  • Patient Responsibility: $20.00

Code 2: 97140

  • Charge Amount: $50.00
  • Payment Amount (from insurance): $15.25
  • Total Adjusted Amount: $34.75 (Charge Amount - Payment Amount = Adjusted Amount)
  • Patient Responsibility: $10.00

In total, insurance paid $54.00 towards both codes, so that’s the amount we’ll need to use when saving our payment. For a refresher on how to create an insurer payment, please checkout the following guide: Receiving an Insurer Payment

After you’ve saved the payment, you can search for the purchase you’d like to apply this payment to and press the Edit button to record/post that payment in detail:

Now, we’ll need to enter what was approved for each code and update the patient responsibility using the information from our EOB.

1) For our 98941 code, we’ll enter in that $58.75 was approved/allowed ($20 patient responsibility + $38.75 insurer payment).

For reference from above:

Code 1: 98941

  • Charge Amount: $75.00
  • Payment Amount (from insurance): $38.75
  • Total Adjusted Amount: $36.25 (Charge Amount - Payment Amount = Adjusted Amount)
  • Patient Responsibility: $20.00

2) For our 97140 code, we’ll enter in that $25.25 was approved/allowed ($10 patient responsibility + $15.25 insurer payment).

For reference from above:

Code 2: 97140

  • Charge Amount: $50.00
  • Payment Amount (from insurance): $15.25
  • Total Adjusted Amount: $34.75 (Charge Amount - Payment Amount = Adjusted Amount)
  • Patient Responsibility: $10.00

We’ll then need to update our patient responsibility (in our case, their co-pay), as we originally charged the patient $20, but our EOB came back saying the total patient responsibility is $30. This will create a $10 private outstanding balance on the patient’s account that you can collect at your convenience!

After you’ve inputted your approved amounts and updated your patient’s responsibility, you can see a breakdown of what was entered in the bottom right hand corner of the screen.

This example leaves us with an uncovered (remaining balance) amount of $41.00 ($16.25 from the first code + $24.75 from the second code). From this screen you can choose to write-off that remaining amount, pass the remaining to the next payer/patient, or leave it as a balance owing.

For this example, I’m never going to collect that $41.00, so I’m going to write it off. To finish up, all I need to do is press that Apply Changes button!

Voila, our payment is recorded and posted!

If you need to reference what was recorded, you can head to your patient’s purchase (Patient Profile > Billing > View), and open up the policy by clicking on the blue text.