Electronic Billing - Charge Adjustments
How can I adjust claim or invoice charge amounts?
Administrators, Billing
The Charge Adjustment feature allows providers to reconcile differences between the original billed amount and the amount paid by a funder without modifying the original charge. In situations where payments do not match the billed amount, where a funder overpaid or underpaid on a claim and it was expected or unavoidable, this feature enables providers to record an adjustment that brings the net claim balance to zero. This allows for custom aging reporting to filter out these adjusted claims while still preserving the integrity of the original billing data.
Terminology can be modified within SETWorks to better fit the needs of your organization. If the terminology in our articles are not the same on your site, talk to your local administrator to assist in translation.
How to enable the Charge Adjustment feature:
First enable the feature:
Settings > Provider Build tab > Maintain Privileges
Enable the Manage Charge Adjustments feature, available from the Global Action Menu.
How to create a Charge Adjustment:
Open the Global Action Menu (" Select: Add..." dropdown).
Select: "Billing: Manage Charge Adjustments"
Adjust the filters to show the claim(s) you want to add an adjustment to, (1) and then click "Add Adjustment" (2):
Once the Charge Adjustment window loads, you can input an adjustment amount (1). Positive values will increase the charge, and negative values will decrease the charge. The projected amount (2) will show what the net charge will be after the adjustment is applied. The "Reason" dropdown (3) can be configured in the "Charge Adjustment Reason" utility (Settings > Provider Build tab > Utilities dropdown > Charge Adjustment Reason utility) and an optional memo can be added (4):
Once a charge adjustment has been created, you will see it in the "Pending Adjustments" grid:
Custom Reporting on Charge Adjustments:
Charge Adjustment data is available in the Advanced Report Builder. There is a "Charge Adjustment" data model that holds details about specific charge adjustments, and then several columns on the "Billing" data model that can be added to billing/aging reports (Total Adjustments and Net Monetary Amount).
We recommend reaching out to us at ebilling@setworks.com if you need to add Charge Adjustment data to your custom aging report.
Integration with Accounts Receivable feature:
The Charge Adjustments feature does not require the use of Accounts Receivable, but if your organization is using Accounts Receivable, there is communication between them.
Charge adjustments will be listed in the "Pending Adjustments" grid until the current accounting period is closed. When the accounting service is applying payments to accounts, it will also apply charge adjustments, at which point the adjustments are no longer considered "pending" and will leave the "Pending Adjustments" grid.
If a charge adjustment no longer matches an account, for example if the corresponding activity record was deleted or the service or date changed, it will not be applied to an account and instead remain in the "pending adjustments" grid with the status "ORPHANED." This may indicate that a new adjustment needs to be created and the existing one removed, or it could flag an accidental/unintentional change on the original record that needs correction.
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