# Adjustment

Adjustments are used to create additional charges or reduce charges on a patient account.

In the [Account Module](/content/manual/account.html), in the toolbar, click **Adjustment**.

Alternatively:
- In the Account Module, double-click a [Procedure](/content/manual/procedureedit.html), and click **Add New Adj**.
- In the Account Module, right-click a procedure, and click **Add Adjustment**.
- In a [Claim](/content/manual/claimedit.html), right-click a procedure, and click **Add Adjustment**. _Allow procedure adjustments from Edit Claim window_ must be enabled in [Preferences](/content/manual/preferences.html).

Adjustments affect production (see [Production and Income](/content/manual/productionincome.html)). They are also used by the [Billing/Finance Charges](/content/manual/financecharges.html), [Late Charges](/content/manual/latecharges.html), [Broken Appointments Automation](/content/manual/apptbreak.html), [Discount Plans](/content/manual/discountplans.html), and [Sales Tax](/content/manual/salestax.html) tools. Adjustments can be attached to a procedure but are always attached to a single patient and assigned to a provider and can be assigned to a clinic.

To view a list of adjustments added in a date range, run the [Daily Adjustments Report](/content/manual/reportdailyadj.html).

## Adjustment Details

Enter the adjustment amount, type, etc. at the top of the window.

**Entry Date**: Read only. The date the adjustment was created.

**Adjustment Date**: Typically the same as the entry date. This is the date that appears on the account and most reports. Modifying this date could potentially change historical data.

**(procedure date)**: The date of the procedure associated with the adjustment. Read only when a procedure is attached to the adjustment.

**Amount**: The amount of the adjustment.

**Provider**: Defaults to the patient's primary provider. Click the dropdown or \[...\] to select a different provider or attach a procedure to inherit the procedure's provider.

- If using clinics, only providers with access to all clinics or restricted to the selected clinic are available.

**Clinic**: Defaults to the patient's assigned clinic. Click the dropdown to select a different clinic or attach a procedure to inherit the procedure's clinic.

- If the user is restricted to specific clinics in [User Edit](/content/manual/securityusers.html), only these clinics are available.
- Creating new adjustments through the [Procedure Edit](/content/manual/procedureedit.html) window automatically updates the clinic and provider on the adjustment to match that of the procedure.
- Linking existing adjustments to a procedure through the Procedure Edit window does not automatically update the clinic and provider assignment. Either choose an adjustment with a matching clinic and provider or edit the adjustment to match the procedure.

**Additions**: List of adjustment types that add the adjustment amount to the patient's account balance.

**Subtractions**: List of adjustment types that subtract the adjustment amount from the patient's account balance (issues a credit of production).

**Only show TSI excluded adjustment types**: Only available when [TSI Collections](/content/manual/tsicollections.html) is enabled and the selected patient has a [Billing Type](/content/manual/definitionsbillingtypes.html) marked as _C_ (Collections). Determine which Adjustment Types are listed:

- Checked: Default. Only the _Exclude Negative Adj Type_ and _Exclude Positive Adj Type_ Adjustment Types defined in [TSI Setup](/content/manual/tsisetup.html) are listed.
- Unchecked: All non-hidden Adjustment Types are listed.

Note:
- To customize the list of adjustment types, see [Definitions: Adj Types](/content/manual/definitionsadjtypes.html).
- Additions and Subtractions only display types the user has access to. To edit available adjustment types for a user, edit the _Adjustment Type Deny_ security permission. See Security section below.

## Procedure

Attach or detach this adjustment from a procedure. To set whether users are required to allocate an adjustment to a procedure, see Adjustments in [Allocations Setup](/content/manual/allocationssetup.html).

The clinic and provider of the adjustment must match the attached procedure. If the provider and clinic do not match, the procedure value is not updated and the adjustment is considered a separate charge when a payment is applied.

**Attach**: Select a completed procedure from the [Select Procedure](/content/manual/selectprocedure.html) window. _Subtraction_ adjustments reduce the procedure fee and _Addition_ adjustments increase the fee.

Note: Procedures cannot be attached to adjustments that are attached to a patient payment or [Payment Plan](/content/manual/paymentplandynamic.html).

**Detach**: Remove the attached procedure from the adjustment.

**Edit Anyway**: Button is only visible if the adjustment is attached to a procedure and the Adjustment setting in Allocations Setup is set to _Rigorous_. Click to change the provider or clinic. Users must have the _Setup_ security permission.

## Note and Buttons

Add notes regarding the adjustment, save changes, or delete the adjustment at the bottom of the window.

**Delete**: Remove the adjustment from the patient's account. Adjustments attached to a payment or payment plan cannot be deleted.

**Note**: Enter any notes about the adjustment. These notes can be included on statements when the _Show notes for adjustments_ preference is enabled. This text box supports [Right-Click Options](/content/manual/rightclicktextboxes.html).

Click **Save** to exit the window and add a new adjustment or keep changes. If a warning appears, see Negative Adjustments section below for additional information.

## Add Multiple Adjustments

To create multiple adjustments attached to multiple procedures at once, see [Add Multiple Adjustments](/content/manual/adjustmentsmultiwindow.html).

## Negative Adjustments

The _Negative Adjustments_ preference determines if users are able to create subtraction adjustments that exceed the estimated patient portion remaining. When the preference is set to _Block_, there is a warning that the adjustment cannot be created.

Click **OK** on this message to return to the Edit Adjustment window and edit the adjustment as to not exceed the estimated patient portion remaining.

If the _Negative Adjustment_ preference is set to _Warn_ and the adjustment exceeds the estimated patient portion remaining, there is an _Overpaid Procedure Warning_ instead. Users can choose to **Cancel** the adjustment or click **OK** to proceed with creating the adjustment.

## Security

The following [Permissions](/content/manual/permissions.html) affect access to adjustments:

- _Adjustment Create_: Users must have this permission to create new adjustments. Users without this permission can create $0 adjustments.
- _Adjustment Edit_: Users must have this permission to edit existing adjustments.
- _Adjustment Edit Zero Amount_: Allow users without _Adjustment Edit_ to edit $0 adjustments with today's date.
- _Adjustment Type Deny_: Permission denies access to certain Adjustment Types. See below.

**Adjustment Type Deny**

In the User Groups tab of the Security window, select a user group to deny access to specific Adjustment Types (e.g., finance charge, professional discount, etc.) If there are existing denied Adjustment Types for the user group, the permission box is filled. If the user group has no denied Adjustment Types, the box appears blank.

1. Click the box for the _Adjustment Type Deny_ permission. The Definition Picker opens automatically.
2. Highlight the Adjustment Types to deny for the user group.
3. Click **OK** to close the Definition Picker and save changes.

Users in the selected user group do not have access to the selected Adjustment Types. When creating a new adjustment (or editing an existing adjustment), denied Adjustment Types are hidden in the Adjustment Type lists.

If a user is assigned to multiple User Groups, they are only denied access to specific Adjustment Types when all assigned User Groups are denied access.