Payment Defaults contain options that will automatically be set when posting payments. They can be changed at any time to a new default setting; once changed, the default will only take effect for new payments posted.
Follow the steps below to set your Payment Defaults for a specific office.
Select Customer Setup > Practices.
Use the Show All button to view all practices. Or user the Search field to further drill down your search.
Select the Practice.
Click the Defaults tab from the side panel.
Click on the Payment. tab
Make your selections referencing the Payment (ERA) Default Descriptions below.
Payment (ERA) Default Descriptions
A. Allow automatic patient payment redistribution: This option is selected by default and is used to set whether the patient or the payer gets an account credit due to the over-payment of a charge, regardless of the source of the over-payment. For example:
The patient makes a payment on a $100 charge at the time of service (this could be a patient payment or a patient co-pay).
The claim is submitted to the payer for processing.
When we receive the ERA check from the payer they include an $80 payment and a $20 adjustment.
User auto-applies the check and the following actions take place:
The non-insurance payments are removed from the charge (i.e., patient payment/patient co-pay).
The insurance payments and adjustments are applied to each charge.
The system will verify if there are any outstanding balances on the claim.
If so, the system will apply the payment amount (patient payment) that was removed; to bring the charge to $0 or until all money is used.
If there’s any money left, the system will set this money as an account credit due to the patient (in this case $20).
When Allow automatic patient payment redistribution is not checked, all the steps remain the same, except for #5 which will then be the following:
- If there's any money left, the system will set this money as an account credit due to the payer (in this case $20).
B. Include the sequestration amount (adj code 253) in the allowed amount: Selecting this option will include the sequestration amount (shown under adjustment reason code 253) within the Allowed amount on ERAs received by Medicare.