If a service is being added to a patient's ledger, and it is always defaulting to fully patient responsibility and you do not want it to, there are a number of areas that you would need to check. If ANY of these are true - then it would cause a service to default to patient responsibility.
Any service that is set to patient responsibility will not be eligible for billing, and it will not appear in your billing queue as the designation is indicating the patient is fully responsible for this amount as it is a service that should not be billed to insurance even though it is on an insurance case.
1. Service Settings
Navigate to your System Dashboard > System Settings > Services > click on the service > Default Responsibility set to Patient.
This setting means that no matter what case type is being used, if this service is added onto a ledger, it will always default to patient responsibility.
2. Fee Schedule
Navigate to the Patient Profile > Cases Tab > Defaults/Patient Rates/Recurring Charges > under the Fee Schedule field, see if there is a fee schedule attached.
If no, then this is not the reason.
If yes, move forward in looking at that specific fee schedule.
To look at the Fee Schedule Settings, navigate to your Live Location > Insurance > Settings > Fee Schedules > click on the Fee Schedule Name > find the service and look under Default Responsibility field
If it says Patient, that means that if this service is added onto a ledger, it will always default to patient responsibility.
3. Max visits have been reached on the policy
Navigate to the Patient Profile > Cases Tab > Insurance/Coverage Tab > click Edit on the current policy > scroll to the max visits field.
If the patient has already reached their max visits in this case, the system will see that and assume that since they no longer have any visits - everything is patient responsibility from this point moving forward.
If you do not want the system to assume this action, either update or remove the max visits field.
If you leave it blank, the system will think the patient has endless visits.Notification of Max Visits:
A message will appear on the Provider's SOAP Notes screen that the max visits have been reached.
Recommendation: We suggest that you also set up a charge count alert that matches the max visits so that the front desk is notified of the max visits being reached.
4. Copay Visit or Max Visit set to zero
If the Copay Visit field or Max Visit field is set to 0 with a copay amount entered, this means the insurance allows 0 visits at the specified copay amount (e.g., 0 visits at $30), which results in the full amount being assigned to the patient.
To prevent this, you can either leave the Copay and/or Max Visits field blank or enter a valid number of visits—just avoid entering 0 in this field.
Manually Change a Single Transaction
Please note, these are reasons as to why a service would default every time to be patient responsibility.
To change the responsibility on a single transaction, that can be done mulitiple ways:
When inputting the Service the first time, on the Transaction Modal, use the drop-down menu under Payer and select Patient.
If the service is already entered onto the patient's ledger, you can edit by clicking on the far left edit button.
This will bring up the transaction modal screen. Please refer to option 1 on how to make the desired change.
If the service is already entered onto the patient's ledger, you can also go to the Billed Column < click on the green criss-cross arrows.
Click Yes on the warning message.
