Why Did My Adjustment Reporting Numbers Change

Note: Archy's reports do not lock, and currently, they don't close out each day, allowing changes to be made.

Insurance Adjustment

• The Insurance Adjustment may be different from the UCR fee minus the negotiated rate if:
  • The total patient responsibility plus the insurance payment is greater than or less than the negotiated rate.
• To avoid changes to the insurance adjustment amount:
  • Keep fee schedules up to date
  • Don’t record a patient's responsibility and insurance payment on a claim that does not equal the negotiated rate.
• An example of when the insurance adjustment is not the difference between the UCR and the Negotiated Rate
  • The office UCR for a procedure is $500. The negotiated rate is $350. The estimated insurance writeoff (adjustment) is $150.
  • When the claim is processed, the employee records an insurance payment of $300 and a patient responsibility of $25, which totals $325.
  • This updates the insurance adjustment to $175 rather than the original $150. 

Collections Adjustment 

• Collections Adjustments can change over time if:
  • A patient account adjustment is backdated when it is entered into the ledger
  • A patient account adjustment is edited to a different amount or date.
• How to avoid changes to Adjustments:
  • Don’t backdate adjustments
  • Don’t edit adjustment amounts
  • Don’t edit adjustment dates
• An example of when a collection adjustment changes due to a date change:
  • An employee adds a patient account adjustment for a Patient Referral on August 1st, crediting the patient with $25.
  • You view the adjustment report for August 1st and see the Collection Adjustment of -$25.
  • The employee then edits the adjustment date to July 28th.
  • You now view the adjustment report for August 1st and see a $0 Collection Adjustment, because this adjustment has been moved to July 28th.
• An example of when a collection adjustment changes due to a change in the amount of the adjustment:
  • An employee adds a patient account adjustment for a Patient Referral on August 1st, crediting the patient with $25.
  • You view the adjustment report for August 1st and see the Collection Adjustment of -$25.
  • The employee then edits the adjustment because it was supposed to be a $50 patient referral credit.
  • You now view the adjustment report for August 1st and see a -$50 Collection Adjustment.