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.
The service set up
At the system level > 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.
Fee Schedule
First click into the patient's case > 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.
For Insurance V2, log into the location > Insurance > Settings > Fee Schedules > click on the name of the fee schedule that was attached in the patient's case > find the service and look under Responsible Party field - if it says Patient, that means that if this service is added onto a ledger, it will always default to patient responsibility.
Max visits have been reached on the policy
Go to the patient's case > Insurance/Coverage > 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.
We always recommend that you also set up a charge count alert that matches the max visits so that the front desk is notified of this point since that system does not have an automatic message for this setting for the front desk. A message will appear on the Provider's SOAP Notes screen, but not anywhere else.
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 one of two ways:
On the transaction modal when inputting the services
Use the drop-down menu under Payer and select Patient
On the ledger via the green criss-cross arrows
If the service is already entered onto the patient's ledger, you and edit it by click on the edit button. This will bring up the transaction modal - then please refer to option 1 on how to make the desired change. Or you can click on the green criss-cross arrows under the billed column and this will also switch the responsibility of a service > click Yes on the warning message.
