When posting an amount with reason “To ded’ble” in EOB invoice, my expectation was the deductible amount will reduce the overall balance. For example, if I have a total of $100, and insurance pay is $50, and insurance adjust is $20, I want to mark the remaining $30 as Due Patient. So I entered $30 in the adjust column and selected “To ded’ble” as reason, but after saving the invoice, the balance remained $30, and just a line got added to the invoice with the comment “Ins1 dedbl $30”. After looking at the code, I noticed we specifically search for “To ded’ble” and “To copay” adjust reasons and ignore the specified dollar amount. This makes absolutely no sense to me. Can someone explain the logic behind this?
I ideally, the balance for a claim may consist of the following and we should be able to support all of them:
1) Due Ins - pay
2) Ins Adjust
3) Due Pt - copay
4) Due Pt - deductible
Rod is more familiar with the inner workings of the EOB posting code. Logically posting any kind of ‘Adjustment’ should change the balance positive or negative depending. The net is always ‘Due from patient’ after all insurances have been run/posted. Using an adjustment to note that the remainder should be applied to deductible seems like it wouldn’t work, but it left the balance due, so maybe there is magic in the system for that?
The initial design was that any adjustments entered would reduce the balance due on the invoice, and you should not enter adjustments that simply shift payment responsibility from the insurance to the patient. I think what happened is someone insisted on being able to record some adjustments like that anyway as “comments”, and “To ded’ble” would be in that category. You don’t want to put in an adjustment that is not a write-off and then never collect the balance.