Post Medicare Advantage Co Pay / Co Insurance Payment

This article will go through the steps on how to post RAP and EOE payments for Medicare Advantage Plans and then post the correct adjustment amount and transfer the patient responsibility over as a self-pay. You may need to create new Payment/Adjustment codes - see article link Setup a Payment / Adjustment Code. 

Overall, what you’ll be doing is creating the RAP and EOE payment and updating the PPS Tracking. You’ll need to modify the adjustment code and amount so that the correct amount is transferred over to the patient as self-pay (the amount they are responsible for paying out of pocket). You’ll be able to print a statement that shows the Medicare Advantage Plan’s payment history, including what is being transferred over the patient. 

After the insurance has paid the RAP and EOE, you can enter the accounts receivable to reflect. The instructions below are for a patient that has already had a RAP payment entered, and we are entering an entry for the RAP take back and the EOE payment. 

• Go to the Accounts Receivable > Post Payments > Post Paper R/A screen. 
• Enter the patient’s chart number. 
• Select the Amount Billed line for the episode period of the payment. 
• Enter the Transaction Date (bank date for the EOE payment). 
• Enter the RAP take back on the line for $ Amount #1. Enter the RAP payment code on the Code #1 line. 
• Enter the EOE payment, total payment for this episode (you may need to add the RAP and EOE together)on the line for $ Amount #2. Enter the EOE payment code on the Code #2 line. 
• Click on Save. 

• Click on View Details and Print, as needed. If everything looks good then Approve Totals and Post Entries. 
• Click on Post Payments > Update PPS Tracking From Payments. Click on Update PPS Tracking THEN Create A/R Adjustments THEN Post to A/R… printing the reports as needed. 
• Click on the Inquiry > A/R Inquiry screen (still within the Accounts Receivable screen). 
• Select the adjustment that was just created for the episode with payment. 

• Change the Payment/Adjustment Code to a code that has been setup for the insurance contract adjustment. Modify the $ Amount to reflect the actual adjustment amount (this will be the current adjustment amount minus what the patient’s responsibility is). 
• Click on Save. 

• Click on Reports > 05.37 Balance Forward Statements (still within the Accounts Receivable screen). 
• Enter the patients Chart#, Program and Payer of the Medicare Advantage Plan, and the billing month. Click on Print. 

• This will print a statement that shows the original amount billed, RAP and EOE payment and the adjustment amount from the insurance agency.

• Go back to Post Payments > Post Paper R/A and enter the patient’s chart number. 
• Select the Amount Billed line on the episode you are working on. 
• Change the transaction date to the same as the EOE date. 
• Check the box Transfer the Balance to another payer. 
• Enter the Transfer Code you would like to use for the Pay/Adj code to transfer to self-pay. 
• Enter the balance remaining, which should be the patient’s Co Pay / Co Insurance. 
• Enter the program and payer codes for the Self Payment codes. 
• Click on Save.

• Go to Reports > 05.37 Balance Forward Statements. 
• Enter the patient’s chart number, the self-pay program and payer codes, and the billing month you have been working on. Click on Print. 

• This will print a statement that shows only the Transfer to Self Pay amount.

**Note: If you need to reprint the statement that shows the RAP and EOE payment with the contract adjustment (first statement above), use field Transfer P/A Code to Ignore. Enter the adjustment code that transfers the patient’s responsibility amount to self-pay. This will show a balance that belongs to the patient. The A/R screen will look like this when finished: