Manage Refunds

 

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:

• When you post a refund to a patient claim via the Issue Insurance Refund page.
• When you reconcile payment batches to deposit batches via the Batch Refunds tab of the Manage Refunds page.
• Directly from the Payee Addresses page.

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:

• You must use the Refund Checks In Process page for any "in process" refunds (refunds without check numbers) that you posted prior to Release 14.2; only refunds posted after Release 14.2 appear on the Assign Check Numbers tab of the Manage Refunds page.
• You can post patient refunds manually using the Issue Patient Refund page or in batches using the Patient Refund Policies page and the associated Patient Refund Worklist. However, patient refunds will appear on the Assign Check Numbers tab of the Manage Refunds page.

1. Display the Manage Refunds page: On the Main Menu, click Financials. Under REFUNDS, click Manage Refunds.
   The page opens to the Review Claims tab.
2. Use the filters to limit the claims returned, as necessary. You can also select the initial sort criteria from the Sort by menu.
3. Click Search.
   athenaOne displays the Insurance Refunds worklist in the Task Bar on the left.
4. You can change the sort criteria using the Sort by menu at the top of the Insurance Refunds worklist.
5. To review a claim, click the linked claim ID.
   The Claim Edit page appears, displaying the claim details.

 

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.

 

A deposit batch corresponds to a check that you intend to write to a payer. A deposit batch can include a single payment batch (refund), or it can include multiple payment batches (refunds) posted for the same payer.

1. Display the Manage Refunds page: On the Main Menu, click Financials. Under REFUNDS, click Manage Refunds.
2. Click the Batch Refunds tab.
   The Payment Batches list displays all the refund payment batches that you have not yet reconciled to deposit batches.
   The Batch Refunds tab shows only refund batches or batches that contain transactions of type "REFUND" that have not been tied to a deposit batch.
3. To narrow the list of displayed payment batches, you can use the filters at the top of the page. You can also click any column header to sort the list by that criterion.
4. Select the payment batches to include in the deposit batch. To select all the displayed payment batches, check the box at the top of the column.
   Note: As you add payment batches to the deposit batch, athenaOne updates the deposit batch information in the Deposit Batch box on the left.
5. Deposit date — Defaults to today's date. You can select a different date, if necessary.
6. Bank account — Select the bank account from which the refund check will be issued.
7. Check number — Enter the check number.
   Note: Entering the deposit batch without a check number is not recommended. Although it is possible to enter the check number later, on the Assign Check Numbers tab after you issue the check, this may create confusion if there is more than one deposit batch with the same amount.
8. Deposit location — Select a deposit location, if applicable.
9. Payee — Payee information that you recorded when posting refunds on the Issue Insurance Refunds page appears with the corresponding payment batch in the Payee column.
   If you already selected a payee for the payment batches that you're including in the deposit batch, the Payee field in the deposit batch summary on the left side of the page is automatically populated with that payee. If you have not yet selected a payee for the payment batch, you can select an existing payee or add a new one in the Payee field.
   Note: If you select multiple payment batches and those batches have different payees, a warning indicates that there are multiple payees for the deposit batch. Because a deposit batch represents a single check, it is not possible to have a deposit batch with multiple payees. You can select a new payee for the batch in the Payee field.
10. Notes — Enter any notes.
11. Click Save to create the deposit batch.
    Note: If your deposit batch contains multiple refunds for payers that span more than one insurance category, a warning asks you to confirm that the payment batches you included are intended to be covered by the same check. In this case, click OK to proceed; otherwise, click Cancel to remove incorrect payment batches.
    athenaOne creates the deposit batch and refreshes the Batch Refunds tab, removing the payment batches that you just added to the new deposit batch (because they are now reconciled).

1. Display the Manage Refunds page: On the Main Menu, click Financials. Under REFUNDS, click Manage Refunds.
2. Click the Assign Check Numbers tab.
   This tab displays all refund deposit batches, including batches containing patient refunds, that do not have an associated check number.
3. The payee information that you recorded appears in the Payee(s) column. Payee name and address information also appears in the file that you generate when you click Download to Excel.
   Note: If you do not record payee information while posting or batching the refund, this column continues to display insurance package names and IDs for that refund deposit batch.
4. You can click edit for a deposit batch to make changes to the payment batches included within it.
5. Check Number — Enter the check number for the deposit batch.
6. Click Save.

1. Display the Manage Refunds page: On the Main Menu, click Financials. Under REFUNDS, click Manage Refunds.
2. Click the View Refunds tab.
   This tab displays claim and batch information for posted refunds that meet the selected filter criteria. For example, you can use this page to display claims to which you recently posted refunds, so that you can verify their status.
3. Click links in the Claim ID, Payment Batch, and Deposit Batch columns to review additional information about the posted refunds.

Note: The View Refunds tab shows refunds in process. A voided refund is not considered to be "in process" and, therefore, does not appear on this tab.

 

1. Display the Claim Edit page for the claim.
2. Locate the refund transaction to void.
3. Click Void this transaction.
   The transaction details appear.
   
4. Under the "Void Refund for" heading, do one of the following:
   • If you have not yet reconciled the associated refund payment batches to a deposit batch or issued the refund check, click Void to void the refund. The refund then appears on the Batch Refunds tab of the Manage Refunds page, where you can add it to a deposit batch. You should include the original refund payment batch and the void payment batch in the same deposit batch.
   • If the original refund has already been reconciled to a deposit batch, click Void and Manage Deposit Batch to void the transaction and display the Manage TOS Deposit Batch page for the original refund deposit batch. You can reopen the deposit batch to include the void batch to ensure an accurate deposit total for the batch.