Write-offs vs adjustments

Outcome

You can tell the difference between an adjustment (the platform reduces the balance per a contract or rule) and a write-off (you decide to stop collecting), pick the right one, and apply it with a clean audit trail.

Prerequisites

Scope	What it lets you do
billing.payment.write	Apply write-offs
billing.adjustment.write	Apply manual adjustments

The taxonomy

Adjustment

An adjustment reflects the true allowed amount per contract or rule. It is mechanical: the contract says $80 instead of $100, so $20 is an adjustment. The platform writes most adjustments automatically from the 835 (CARC CO-45 etc.).

Write-off

A write-off is a discretionary decision to stop collecting. It is human: "the patient can't pay; we'll write off $50." The platform requires a reason on every write-off.

Common write-off reasons (patient side)

Reason	When
small-balance	Under tenant's threshold (e.g. $5).
patient-uncollectable	Sent to collections; returned.
charity	Tenant-approved hardship.
bad-debt	Aged past collection cycle.
dispute-resolved	Patient disputed; resolution favored them.

Common adjustment reasons

Most adjustments come from the 835 automatically. Manual adjustments are rare but valid:

Reason	When
contracted-rate-correction	Fee schedule was wrong; correct retroactively.
dual-eligible-coverage-correction	Member had Medicaid as secondary and the primary 835 lacked it.
payer-error-corrected	Payer error documented; pre-emptive correction.

Steps — patient-side write-off

1. Open the member's AR tab. Find the line(s) to write off.

2. Click Write off (the bulk action when several at once).

3. Pick a reason + amount + (for other) free-text.

4. Save. The platform writes a payment_application of type WRITEOFF against the line(s). Member AR balance reduces.

Steps — manual adjustment

1. Open the claim or member. Click Apply adjustment.

2. Pick category (the platform has a tenant-defined picklist) + reason + amount.

3. Save. The adjustment writes to the claim's remittance_adjustment ledger with a synthetic CARC chosen by the tenant policy (commonly OA* for non-standard).

Reversing

Both write-offs and adjustments support reverse:

What	How
Reverse a write-off	Member AR → write-off row → Reverse with reason.
Reverse an adjustment	Same shape on claim's adjustments list.

Reverses write paired audit rows (the original + the reversal).

Validation

Check	Expected
Write-off requires a reason	Yes.
Adjustment requires a reason	Yes.
Both leave audit rows	Yes.
Both can be reversed	Yes.
Reporting tracks each separately	Yes; separate widgets.

Troubleshooting

Symptom	Cause	Fix
Write off greyed	Lack of billing.payment.write or claim is in a state that blocks	Ask admin or check status.
Reverse doesn't restore the prior balance	Concurrent activity changed the state	Audit log → walk it back; ping support if confused.
Adjustment posts but doesn't reduce balance	Wrong category (some categories are informational)	Check the picklist; pick the right category.
Bulk write-off skipped some rows	Some rows are protected	Summary tells you N/M.

Where to next

• 5.6 — Write off with reason — the denial-side companion.
• 9.1 — Glossary — adjustment / write-off precise definitions.