Transaction Types Explained

Transactions Types are based on codes, which can be entered by typing in the appropriate code or by using the quick pick to select the code from the various provided categories. 

Payments (start with 'P')

Money that is paid from a patient or insurance company.

Contractual Allowances (start with 'C')

If the amount of the bill cannot be balance-billed to another payer (including the patient), this Transaction Type can be used to zero the balance or reduce it to the contractual or EOB amount; then, the user can send the bill to another payer, including the patient.

Contractual Allowances are often also called a "write-off", "adjustment", or "contractual".

Adjustments (start with 'A')

Revenue Adjustment

The Revenue Adjustment (AR) Transaction allows fees or interest to be posted without affecting the true balance owed. The AR adds (or subtracts) amounts to both the balance and the billed amounts to maintain the original balance.

The AR can be posted with a negative or positive amount, as explained below. A negative amount is created by typing the negative sign (-) with the Amount Field active. 

• With a positive amount, the AR adds the entered amount to the Late Fee balance and the total balance.
• With a negative amount, the AR subtracts the entered amount from the Late Fee Balance, and reduces the balance of the bill by that amount. There cannot be a negative amount in the Late Fee Balance.

Note: Never use the AR transaction code to correct posting mistakes.

Payment Adjustment

The Payment Adjustment (AP) Transaction is used to cancel a Payment Transaction.

Post an AP when a Cash Balance exists. While the AP can be used for any specific payment code, it must only be posted if that amount is showing on the current payer.

Note: Use the Undo Rebill (UR) to move back to the previous payer if the cash is not there. This Adjustment Code should not be used as a negative amount.

Bad Debt Adjustment

The Bad Debt Adjustment (AB) Transaction is used to zero out balances that were written off as bad debt, but then had payments or other transactions posted afterward. The AB cancels out those additional amounts to maintain the proper balance of the Write-Off.

This Adjustment Code should not be used as a negative amount.

Contractual Allowance Adjustment

The Contractual Allowance Adjustment (AC) Transaction cancels a posted Contractual Allowance.

Post an AC when a Cont/Allow Balance exists. While the AC can be used for any payment code, it must only be posted if that amount exists on the current payer.

Note: Use the Undo Rebill to move back to the previous payer, if no Cont/Allow exists. This Adjustment Code should not be used as a negative amount. 

Refunds (start with 'F')

The Refund Transaction removes a payment with the expectation that the money is immediately returned/mailed back to or requested by the appropriate payer. When a payer demands a return payment (called a “take back” with Medicare) the proper transaction to post is a Refund.

Note: A refund actually posts as an AP code on the bill.

When posting a Refund, always make sure the payment and the refund match, or that the refund is the proper amount (if different from the original Payment). Only use a refund when money is returned.

Rejections (start with 'J')

A Rejection Transaction is used to allow editing of the bill or change the current payer after the bill was sent. This transaction greatly aids in situations where a payer refuses to pay the claim or needs additional information, or when the claim was sent to the incorrect payer.

The Rejection Transaction does not require a debit/credit amount, internal processes adjust the balance.

Collections

The Send to Collections (SL) Transaction is used to show that a Collection Agency is working the bill. This places the bill number in Collections Status.

The balance is provided on Collections Reports, but the bill number is removed from Statements, Warning Letters, and Aging. 

Write-Offs

When a payment is not expected to be paid, the Write-Off to Bad Debt Transaction greatly helps. The WB Transaction removes the posted amount from most reports and sets that amount as Bad Debt in A/R Ledgers.

The WB is not a Contractual Allowance. It should not be used to make any corrections.

Technically, the WB Transaction should only be posted when a bill is not expected to be paid, but efforts were made to receive payment. It can be posted for all or some of the balance. Payments or other transactions can be posted to a balance in bad debt, but these need further adjusting.

Other

These transaction types are not specific to a payer or payer type. Each transaction has a unique code. Once any of these transactions are posted, they can change the Bill Status, affect program functionality, and alter the current payer.

Rebill

The Rebill (RB) must be posted after the first (primary) payer pays, if the balance is to be sent to another payer (including the patient).

A Rebill Transaction moves the current payer assignment to the next payer. It can only be used when there is a balance and must be used if that balance needs to be sent to a different payer.

Note: If the next payer does not exist, a payer must be added to the bill before another transaction can be posted. If no payment or contractual allowance exist, a Reject is the proper transaction to change the payer.

Hold Account

The Hold Account (HA) Transaction places the bill in Hold Status, which removes it from most activities that would send information to a payer. Transactions can be posted to a bill in a Hold Status.

When in Hold Status, the bill number is not included in the following activities/functionality: Statements, Warning Letters, Aging, Collection Reports

Note: The HA Transaction does not affect other bills of the account.

Take Off Hold

The Take-Off Hold (TH) Transaction removes the Hold Status from the bill number, which allows the bill number to assume normal activities.

Kill Bill

The Kill Bill (KB) Transaction removes the bill number from the program. It does not remove the balance, so some reports may show this.

This transaction should only be posted if a claim was created in error (usually because it duplicates another bill). This transaction can only be posted if no balances exist on the bill, and only apples to the first payer.

Note: The Kill Bill Transaction is not a way to remove a bill with multiple transactions posted in error, because balances must be zero to post the KB Transaction.

Undo Kill Bill

The Undo Kill Bill (UK) Transaction restores a bill number that was removed by the Kill Bill Transaction and restores the balances. This should only be done if the bill number was killed in error.

Undo Collections

The Undo Collections (UL) Transaction removes the Collections Status and restores functionality for this bill.

Undo Refund

This Undo Refund (UF) Transaction corrects a posted refund. It should always be posted for the same amount as the refund. This transaction actually uses an AP for ledgers.

The UF should always be posted to the payer where the refund was posted.

Undo Rebill

The Undo Rebill (UR) Transaction corrects a Rebill Transaction by moving the responsibility back to the previous payer.

This transaction can only be posted after a Rebill (RB) was posted, and the next Payer exists for the rebill to assign the responsibility. If the UR is unable to be posted, make sure the current payer is indicated, print the current payer to the screen, or try posting the UR again.