Patient Refund Policies

 

On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Miscellaneous, click Patient Refund Policies

 

 

To access this page, you must have the Billing Admin: Refund Policies user permission.

 

1. Display the Patient Refund Policies page: On the Main Menu, click Settings > Billing. In the left menu, under Practice Links — Miscellaneous, click Patient Refund Policies.
2. Click Add new.
   Additional fields appear.
3. Refund policy name — Enter a name for the policy.
4. Bank account — Select the TOS (time of service) bank account that the checks will clear against when cashed.
5. Payment method — Select the payment method of the refund. For batch refunds, this is limited to payment methods of type check.
6. Eligible amount min — Enter the minimum amount ($) that qualifies a patient account to be refunded. The default minimum is 0.00.
7. Eligible amount max — Enter the maximum amount ($) that qualifies a patient account to be refunded.
8. Minimum age of balance (in days) — Enter the minimum number of days old a credit balance must be to qualify a patient account to be refunded.
9. Include credits of type — Select "Unapplieds and Prepayments," "Unapplieds Only," or "Prepayments Only."
10. Automate policy — If you select No, the policy is not automated. If you select Yes, you must then select a frequency to run the policy, which automatically approves refunds. (Approved refunds appear on the Refund Checks In Process page.)
11. Frequency — Select either Weekly (every Saturday) or Monthly (on the first Saturday) to determine how often the automated policy runs.
    Note: To ensure that we complete the refunds for the week or month, automated policies may also run on the Sunday after the designated Saturday.
    

Exclude patient accounts with:

12. Missing slips — Click Yes to exclude patients who have missing slips.
13. Outstanding patient charges — Click Yes to exclude patients who have outstanding patient charges.
14. Outstanding primary/secondary charges — Click Yes to exclude patients who have outstanding primary or secondary charges.
15. Voided charges or transactions on an open claim — Click Yes to exclude patients who have voided charges or transactions on an open claim.
16. Charges sent to collections — Click Yes to exclude patients who have charges that have been sent to collections.
17. Charges written off to bad debt — Click Yes to exclude patients who have charges that have been written off to bad debt.

18. Family members with outstanding balances — Click Yes to exclude patients who have family members with outstanding balances.

19. Charges written off for these reasons — Select custom transaction reasons to exclude patients who have charges that have been written off for those specific custom transaction reasons.
20. Upcoming appointments within — Select the desired range of days to exclude patients who have upcoming appointments in that time frame.
21. Click Save.
    
    Note: You can edit an existing policy at any time. You can also delete policies, but you must have at least one active policy to use the Patient Refund Worklist.

 

To manage patient refunds, you can set up policies to identify and refund eligible patient balances automatically using the Patient Refund Policies page. A refund policy specifies the criteria that a patient account must meet in order for your practice to issue a refund to a patient.

 

You can also issue refunds manually on the batch scale using the Patient Refund Worklist if your practice prefers to have an additional approval step in the refund process. To use the Patient Refund Worklist, you must first set up at least one policy on the Patient Refund Policies page.

 

Note: Patients who do not have a primary department listed cannot be refunded. If you set up an automated policy, these patients will not be automatically refunded.

 

athenaOne runs a script nightly to review credits on a patient account and match them to outstanding charges. This is helpful, for example, when a copay is collected prior to claim generation. The script does not apply credits to open charges if the charges are associated with a claim that is in HOLD to patient responsibility.

 

The script makes an exception if the claim is in HOLD because it is included on a patient payment plan; patient payments are applied to charges in this instance. There are no charges if the claim status reflects that a primary or secondary payer is still responsible. When a claim is billed to a payer, athenaOne still matches the copay from the patient to the open charge.

 

You can review claims in HOLD to patient responsibility and clear the HOLD before athenaOne applies funds received from the patient, and you can bill a different payer before the unapplied credit potentially closes the claim.

 

If you have a patient refund policy for your practice, athenaOne may not apply credits to a patient account until you clear the claim in HOLD to patient responsibility. Depending on how long the claim is in HOLD and how frequently you issue patient refunds, you could unnecessarily refund patient payments that should be paid. To reduce the risk of refunding patient payments that will subsequently need to be collected again, consider excluding patient accounts with outstanding patient charges when you create your refund policies.

 

Refund policy name	Enter a name for the policy.
Bank account	Select the TOS bank account that the checks will clear against when cashed.
Payment method	Select the payment method of the refund. For batch refunds, this is limited to payment methods of type check.
Minimum eligible amount	Enter the minimum amount ($) that will qualify a patient account to be refunded.
Maximum eligible amount	Enter the maximum amount ($) that will qualify a patient account to be refunded.
Minimum age of balance (in days)	Enter the minimum number of days old a credit balance must be to qualify a patient account to be refunded.
Include credits of type	Select whether the policy should apply to unapplieds and prepayments, unapplieds only, or prepayments only.
Automate policy	If you select No, the policy is not automated. If you select Yes, you must select a frequency to run the automated policy, which automatically approves refunds. (Approved refunds appear on the Refund Checks In Process page.)
Frequency	Select either Weekly (every Saturday) or Monthly (on the first Saturday) to determine how often the automated policy runs. Note: To ensure that we complete the refunds for the week or month, automated policies may also run on the Sunday after the designated Saturday.
Provider group	(This field appears if your practice is an athenaEnterprise organization.) Select the provider groups to which this policy should apply.
Missing slips	Click Yes to exclude patients who have missing slips.
Outstanding patient charges	Click Yes to exclude patients who have outstanding patient charges.
Outstanding primary/secondary charges	Click Yes to exclude patients who have outstanding primary or secondary charges.
Voided charges or transactions on an open claim	Click Yes to exclude patients who have voided charges or transactions on an open claim.
Charges sent to collections	Click Yes to exclude patients who have charges that are out to collections.
Charges written off to bad debt	Click Yes to exclude patients who have charges that have been written off to bad debt.
Family members with outstanding balances	Click Yes to exclude patients who have family members with outstanding balances.
Charges written off for these reasons	Select custom transaction reasons to exclude patients who have charges that have been written off for those specific custom transaction reasons.
Upcoming appointments within	Select a time frame to exclude patients who have upcoming appointments within that time frame.