Issue Insurance Refund

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This page allows you to record (post) an insurance refund and view the patient's open charges that have insurance payments posted against them. Insurance refunds should be processed on a weekly basis.

 

You can also add a refund to the Refund Checks In Process list for processing by your accounting department. (After the accounting department issues the check, you can fill in the check number on the Refund Checks In Process page.)

 

Important: athenaOne cannot issue actual refund checks for you. You must generate the refund check from the relevant practice bank account checkbook or using another refund method that you manage within your practice. If you use athenaMailbox, in most cases, patient refunds issued with a Payment method type of Check can be issued from your local/TOS bank rather than U.S. Bank. A Cut Refund Check Remittance Record will be created for refunds using U.S. Bank.

 

On the Patient Actions Bar, click Billing, and then click Issue Insurance Refund

 

On the Main Menu, click Claims. Under CLAIM MANAGEMENT, click Billing Worklists > Show Overpaid Claims (button) > PATIENTNAME (in Task Bar)

 

On the Main Menu, click Financials. Under REFUNDS, click Approve Insurance Refunds > Generate Worklist (button) > click linked claim in Worklist

 

 

 

 

Before posting an insurance refund to a claim in athenaOne, contact the applicable claim payers to determine the appropriate payee, the amount of the refund, and whether the payer will instead perform a takeback.

Important: athenaOne cannot issue actual refund checks for you. You must generate the refund check from the relevant practice bank account checkbook or using another refund method that you manage within your practice. If you use athenaMailbox, in most cases, patient refunds issued with a Payment method type of Check can be issued from your local/TOS bank rather than U.S. Bank. A Cut Refund Check Remittance Record will be created for refunds using U.S. Bank.

  1. Display the Issue Insurance Refund page: On the Patient Actions Bar, click Billing, and then click Issue Insurance Refund, or display the Issue Insurance Refund page via the Claim Edit page.
    Note: If you display the Issue Insurance Refund page via the Claim Edit page, by default only the paid charges on the claim appear. If you display the page via the Patient Actions Bar, by default only overpaid charges on that patient's claims appear.
  2. If the charge for which you need to issue a refund does not appear, use the filters at the top of the page to find the charge.
  3. Refund Amount — Enter the refund amount to issue for the charge. The refund amount cannot be greater than the amount of the payer's payment.
  4. Payee — You can select a payee for the refund. Begin typing in the Payee field to search existing payee addresses. Select an existing payee or select "Add new payee."
    If you select "Add new payee," a pop-up box appears. Enter the payee name and address. The new payee is added to that payment row and also to your practice's list of payees for future use when refunding that payer.
    Note: In rare cases, payers may request that you refund any excess payments directly to the patient/guarantor. In this case, select Patient as the payee, which populates the guarantor's information with the payee name and address. This refund will still be posted to the claim as an insurance refund transaction: the payee information pertains only to where the refund should be sent.
    If you selected a payee in error, click Change.
  5. Repeat the steps above for each charge to be refunded on the claim. If you're posting a refund to an additional payment for the same payer as one for which you've already entered a refund amount and payee, the payee for that refund is automatically populated.
  6. Notes — Enter any notes. athenaOne automatically posts these notes to the payment batch associated with the refund.
  7. Do one of the following:
    • If you need to post additional refunds, click Post Refund. This option posts the current refunds and refreshes the page so that you can post additional refunds for the patient or find the next patient/claim for which you need to post refunds.
    • If you're finished posting refunds, click Post and Batch Refund. This option posts the current refunds and displays the Batch Refunds tab of the Manage Refunds page, where you can include the refunds in a deposit batch.
    Both options post the refund transactions for the amounts that you specified. Both options also create and then close a payment batch for each refunded payer.
    Note: For reconciliation purposes, you must now batch the payment batches into deposit batches.

 

 

The Date of Service column on the Issue Insurance Refund page refers to the date of service on the claim, not on the charges. If you have multiple instances of the same charge with different dates of service on a claim, you can click Show charge dates to help you determine the correct charge line to refund to the payer.

  1. Display the Issue Insurance Refund page: On the Patient Actions Bar, click Billing, and then click Issue Insurance Refund.
  2. Click Show charge dates.
    The Charge From Date and Charge To Date columns appear.
  3. Click Post Refund or Post and Batch Refund.

Note: If no charge dates were entered (for example, when a claim is created using basic charge entry), the Charge From Date and Charge To Date columns display the same date as the Date of Service column, which displays the date of service on the claim. You can click Hide charge dates to remove these columns from the display.

 

 

  1. Display the Issue Insurance Refund page: On the Patient Actions Bar, click Billing, and then click Issue Insurance Refund.
  2. To locate a closed charge, click "show all insurance charges that have payments." An itemized list of all the patient's charges appears.
  3. Locate the item that you want to refund, then click on the charge (blue area) to display the insurance refund form. (This form is similar to the payment posting form.)
  4. Refund — Select the payment method that you are using to issue the refund.
    (Leave the Check # field blank.)
    Important: athenaOne cannot issue actual refund checks for you. You must generate the refund check from the relevant practice bank account checkbook or using another refund method that you manage within your practice. If you use athenaMailbox, in most cases, patient refunds issued with a Payment method type of Check can be issued from your local/TOS bank rather than U.S. Bank. A Cut Refund Check Remittance Record will be created for refunds using U.S. Bank.
  5. $ — Enter the amount of the refund. The maximum refund amount that you can enter is the amount originally paid by the insurance. This amount appears at the right — (payments = max refund: $$$).
  6. Click Save Refund. The posted refund appears in the list on the Refund Checks In Process page. (After the accounting department issues the check, you can fill in the check number on the Refund Checks In Process page.)

 

 

 

The insurance refund workflow begins when you identify a claim that requires a refund. You can use the Manage Refunds page to generate a list of claims that may need insurance refunds.

 

Use the Issue Insurance Refund page to post the refund. Behind the scenes, athenaOne opens (and closes) your refund payment batches automatically.

 

Reconcile these refund payment batches to deposit batches via the Batch Refunds tab of the Manage Refunds page. athenaOne automatically closes the deposit batches that you create using the Batch Refunds tab of the Manage Refunds page.

 

You can record payee information during the insurance refund posting process so that your practice's check writer or A/P department can easily find the payee to whom the refund check needs to be sent on the Assign Check Numbers tab of the Manage Refunds page.

 

You can also add new payees as follows:

Capturing payee address information is not required to complete the refund posting process. A payee address provides additional information to your practice's A/P department or check writer about where an insurance refund should be sent.

 

Notes:

 

View by
Claim ID The claim ID for the charge.
Payers The insurance package associated with the payment amount for the charge.
Date of Service The date of service of the claim.
Payments table
Claim ID The claim ID for the charge.
Payer The insurance package associated with the payment amount for the charge.
Date of Service The date of service of the claim.
Charge From Date Charge from date. This column appears when you click Show charge dates.
Charge To Date Charge to date. This column appears when you click Show charge dates.
Procedure Code The procedure code for the charge.
Payment Amount The payer's total payments on the charge. Note that the refund amount for a row cannot be greater than its charge amount.
Overpaid Amount The amount by which the charge is overpaid. If the charge is not overpaid, this value is $0.00.
Refund Amount The amount to be refunded for the payer on this charge.
Payee

You can select a payee for the refund. Begin typing in the Payee field to search existing payee addresses. Select an existing payee or select "Add new payee."
If you select "Add new payee," a pop-up box appears. Enter the payee name and address. The new payee is added to that payment row and also to your practice's list of payees for future use when refunding that payer.
Note: In rare cases, payers may request that you refund any excess payments directly to the patient/guarantor. In this case, select Patient as the payee, which populates the guarantor's information with the payee name and address. This refund will still be posted to the claim as an insurance refund transaction: the payee information pertains only to where the refund should be sent.
Notes Notes to be appended to the payment batch.

 

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