Author Topic: Applied payments deleted. Why?  (Read 2946 times)

deebbecke

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Applied payments deleted. Why?
« on: July 02, 2019, 08:09:18 AM »
I'm curious as to the reason(s) why payments applied to a patient account may be deleted by a in-house biller? 

I am the owner of a small private practice outpatient physical therapy clinic and collect weekly summary stats for the office.  Over the weekend (closed for business at this time) I generated a report titled "Collections by Rendering Facility" for the week and was provided with a $ figure.  I re-ran the report on Monday of the following week,  prior to start of business, and the figure was ~ $700 less than what it was originally.  Further investigation into the system log revealed that the biller deleted a batch of applied payments over the weekend which explained the discrepancy according to a rep from our EHR company that I spoke with.  He was however unable to provide me with an answer as to why such an action would ever be carried out.

PMRNC

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Re: Applied payments deleted. Why?
« Reply #1 on: July 02, 2019, 10:15:53 AM »
Quote
I am the owner of a small private practice outpatient physical therapy clinic and collect weekly summary stats for the office.  Over the weekend (closed for business at this time) I generated a report titled "Collections by Rendering Facility" for the week and was provided with a $ figure.  I re-ran the report on Monday of the following week,  prior to start of business, and the figure was ~ $700 less than what it was originally.  Further investigation into the system log revealed that the biller deleted a batch of applied payments over the weekend which explained the discrepancy according to a rep from our EHR company that I spoke with.  He was however unable to provide me with an answer as to why such an action would ever be carried out.

There would be no good reason for deleting them I'm afraid. I'm assuming all those with access have their own secure login and that your PM System has a full audit trail? If so then you can see where they were deleted and see if any notes were attached.  I would also try to match them up with your deposits in the date range of the original posting.   I hate to imply anything bad but I am sure you are thinking the same thing and it sounds like you would be right.
« Last Edit: July 02, 2019, 10:17:31 AM by PMRNC »
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kristin

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Re: Applied payments deleted. Why?
« Reply #2 on: July 02, 2019, 12:44:48 PM »
Over the years, I have had numerous times/reasons when I have had to delete either insurance or patient payments from accounts, but the difference is that I always reapplied them to the same accounts...which it doesn't appear was done here, but that also doesn't mean that it won't be done at some point.

One example where I have had to delete and reapply a payment would be a patient putting a deposit down on something, and then once insurance pays, I would have to take the patient deposit out of the account, and reapply it so that the line items balanced. You don't say what types of payments these are...patient checks/cash, insurance (ERA or paper EOB's with checks)? Do the majority of your payers do EFT directly into your bank account? If not, they should be. While embezzlement is always a concern, this could simply be a situation where what the biller did was completely above board, and with a good reason. Have you spoken to the biller?

PMRNC

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Re: Applied payments deleted. Why?
« Reply #3 on: July 03, 2019, 03:46:55 PM »
For legal reasons, audit trails are in place for a reason. Nothing should ever be "deleted" A payment can be reversed, voided or adjusted. Deleting even if you are replacing it in same account is not sufficient to pass audit. But you bring up good point.. maybe the money was reapplied elsewhere.. that is why, however you don't use the delete key for anything.

Easy to figure out though, just pull the audit trail and look for similar amounts/login of users, etc.
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Christy

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Re: Applied payments deleted. Why?
« Reply #4 on: July 03, 2019, 04:01:06 PM »
the fact that an in house biller logged in over the weekend on their day off and did this is very suspicious.

if it was an outside billing company, would be less suspicious as we do work nights, weekends etc, and do not directly handle payments.

Michele

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Re: Applied payments deleted. Why?
« Reply #5 on: July 03, 2019, 11:01:55 PM »
Yes that is very suspicious.  How did she have access on the weekend?  Is it a cloud software?  Does anyone else have her login?  Definitely needs to be investigated further.
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Eyore

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Re: Applied payments deleted. Why?
« Reply #6 on: September 10, 2019, 05:21:20 PM »
I am a medical biller and when insurance does not pay I bill the patient. I apply the patient's payment while continuing to collect from the insurance company. If the insurance finally pays, I apply the insurance payment and delete that same amount from the Patient Payment to balance the books. The Patient Ledger then has a Credit.

PMRNC

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Re: Applied payments deleted. Why?
« Reply #7 on: September 10, 2019, 07:02:47 PM »
Do not delete...PM Systems if HIPAA compliant contain an "audit" trail which logs EVERY keystroke. If something is deleted and there is an audit, it could be red flag.. never "delete"..always void or adjust.
Linda Walker
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Michele

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Re: Applied payments deleted. Why?
« Reply #8 on: September 13, 2019, 11:26:51 AM »
I agree, we always adjust and note that refund was sent to the patient, or apply credit to another visit.  It shouldn't be adjusted until the money is either returned to the patient or credited to another visit.
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Re: Applied payments deleted. Why?
« Reply #8 on: September 13, 2019, 11:26:51 AM »