Negative Adjustment Posted
You’ll receive this error when there is a negative adjustment on the electronic EOB. It is important to review the accounts associated with these errors to ensure an incorrect balance wasn’t created on the charge line. You’ll also need to confirm that the amount isn’t open to the incorrect responsible party. Verify the electronic EOB balances to paid check amounts and add a refund or reprocess the claim, if needed.
Important: This is a soft error meaning the payment did post to the patient’s account. Corrections may be required, with the procedure depending on the scenario.
- Entire Payment on One Charge Line: Some payers will post the entire payment for a Date of Service on one CPT code and will use negative adjustments to apply any remaining balance to the next available payer or patient. For this scenario, no action is needed.
- Recoupments: Medicare and a few other payers will take recoupments (taking money back) in the form of negative adjustments. This scenario is a bit tricky because, often, they’ll add the recoupment in the payment detail of one EOB, and then they’ll actually take that money back (negative adjustments) on a later EOB (usually within 30 days). It’s key to review the following items:
- Confirm the negative adjustment didn’t create an incorrect balance out to the patient.
- Determine if the recoupment is part of the check you’re posting. Your check total should balance to the paid amount. If it does not, you’ll need to delete the recoupment for that check to balance, and the actual recoupment will come over in another EOB later.
- Tip: Review the Provider Adjustment Amount field on the 835 file (located on the last page). If the Provider Adjustment Amount is in parentheses, the payer is not taking recoupment on this EOB. If the amount is not in parenthesis, the recoupment is occurring on this check. In this instance, the EOB will typically list the patients and dates of service they are taking the recoupment from. The refund detail will not appear in the 835 file, so you’ll need to post these recoupments manually on the Batch Payments page.
- In this screenshot, we can see that the PROV ADJ-AMT is in parentheses, indicating the recoupment is not occurring on this check. We’d need to delete the payments associated with the recoupment, as shown in the Medicare Recoupment Example below.
- Reversal of Denied Date of Service: When the original Date of Service is denied by the insurance, and this denial is shown by adjusting off the entire DOS, rebilling the claim can result in a negative adjustment. Because we didn’t post the denial, the original adjustment amount for the charges won’t be in the system. When the DOS is rebilled and paid, the EOB can show the reversal of the original adjustment amount from the denial as a negative adjustment. This leaves a false balance due by the patient. Tip: These types of payments will all show the same check number.
- To resolve, simply delete the negative adjustment from each charge in Error Corrections.
It’s important to resolve these errors before you close your month. That way, if an adjustment is incorrect, you can simply delete the line in error corrections. If the month is already closed, you’ll need to post a reversal on the batch payments or batch adjustments page.
Medicare Recoupment Example
- Navigate to the Payments menu and select Error Corrections.
Enter the Date of Service and/or Charge ID you’re researching. Check the Show Inactives box, then click Search.
- We can see that for the Blue Cross Payment lines, they took back the payments. We can also see the negative adjustment on the Blue Cross Adjustment lines.
- We can also see there is a balance for the charge amount.
- Next, review the total paid amount to the associated check number. Confirm your payments’ balance against the total paid amount with the recoupment posted. Note: If the check does not balance, this indicates that the insurance is not taking the recoupment amount from this check. You’ll need to delete the negative payment amount and negative adjustment amount lines and wait for the payer to take the money back.
Since we’ve identified that the recoupment is not occurring on this check, the negative payment and adjustment amount will need to be deleted. Click on the Charge ID to open up the Transaction Edits.
Select the checkboxes to delete the Insurance negative payment and adjustment lines and the checkbox to delete the patient responsibility. Click Save.
- Repeat for all impacted charges and dates of service.
- Then, confirm the total paid amount and the payment posted amount for the check balances. Note: We recommend adding a note to the patient's account indicating the date of service and check number. That way you can pull that check to see how to post it for each line item when the recoupment is actually taken.
Reversal of Original Adjustment Example
- Navigate to the Payments menu and select Error Corrections.
- Enter the Date of Service and/or Charge ID you’re researching. Check the Show Inactives box, then click Search.
- We can see there is an open balance on the patient’s account from the negative adjustment.
- Because these are all one check number, this typically indicates that at some point previously, the payer sent a denial saying they weren’t paying this Date of Service and adjusted it off. Because we didn’t post the denial, the original adjustment amount will not be in the system. This Date of Service was rebilled and now on this EOB, they are showing the reversal of the original adjustment amount as a negative adjustment. This leaves a false balance open to the patient. To resolve:
- Click on the Charge ID.
Remove the Negative Adjustment, enter $0.00 and click Save.
Confirm that Transfer Amount and Transfer Detail Amount is at $0.00.
- Lastly, confirm the remaining balance is assigned to the correct responsible party. If the charge line is showing due by Insurance when it’s actually due by the Patient, you’ll need to change the Transfer Ins Code drop-down to the insurance, save, re-open the charge line, and then select Patient from the Xfer Ins Code and Save. This puts the balance back to the patient.