Payment posting in RCM has day to day challenges just like any other billing processes. Mere concentration is ultimately required to acquire successful revenue payment with accurate payment posting. Predominantly, billing process is incomplete without payment posting in RCM. That’s the reason why healthcare professionals recognize it as an important component of the revenue cycle management process. In this article, let’s learn some important aspects of payment posting.

What Is Payment Posting?

  • Payment posting in RCM allows viewing of payments and also provides a clear picture of the healthcare practice’s financial structure, making it very flexible to identify the issues and fix them immediately.
  • Soon after the claims are processed for payments from the insurance companies, a check will be issued or EFT (Electronic Fund Transfer) will be done to the provider from the payer along with the EOB.
  • Claims will be reimbursed to the healthcare professionals only if the patient has signed the assignment of benefits (AOB) documents. If the patient has not signed the AOB, then the payment will go to the patient and not the provider.

Why is accurate payment posting essential?

  • In case the payment posting team had inaccurately posted the payments to an incorrect account, the AR team will work closely for the outstanding balance of the claims from aging reports.
  • Because of an incorrect payment posting from the team, the balance of the paid account will still be reflecting.
  • In such a situation, both the time and efforts of the AR team on reimbursing the claims will be wasted as they follow up on paid claims instead of following unpaid claims.
  • Simultaneously, it also reflects the accuracy of claims submissions to secondary and tertiary payers. It becomes more when the primary insurance payment is not posted correctly, and it is possible for the secondary and tertiary payers to get billed out incorrectly.

What is Explanation of Benefits?

  • It’s also called as Explanation of Review (EOR) or Electronic Remittance Advice (ERA), which is issued by the insurance companies for healthcare providers to communicate the decision taken after the determination of the claim.

What is the information that EOB contains?

  • Payer Name
  • Payer Address
  • Name of the patient
  • Provider Name and address
  • Member ID#: It is also known as the policy identification number
  • Claim received Date: It is the date the claim was received by the payer from the provider (Billing office).
  • Payment or denial date: It is the date the claim is processed or denied by the payer.
  • DOS – Date of Service: It is provided from healthcare provider to patient.
  • CPT Code – Procedure code
  • Billed Amount – It is also called as charge amount for each service performed by healthcare providers.
  • Claim Number – It is also called a Document control number or Transaction Control Number, which will be assigned by the payer for each claim as soon as they receive it in their system.

If the claims are paid, what reasons do they hold on to?

  • Allowed Amount: It is an amount payer deems fair for a specific service or procedure. AA = PA+ PR.
  • Paid amount: Paid Amount = Allowed Amount – Patient responsibility.
  • Patient Responsibility: This is the balance percentage of reimbursement that the patient or the secondary insurance has to pay according to the policy with the insurance company.
  • Write off Amount: It is an amount that is waived off by the provider. Write off Amount = Billed Amount – Allowed Amount.
  • Check date
  • Electronic Fund Transfer
  • EFT date

 

Explain the Benefits of Payment Posting in RCM:

  • Easy to Analyze Revenue Cycle Management: When the payment posting is performed accurately, it presents a perfect instance to analyze the medical billing and maximize the account receivables.
  • Denial Resolution: As already known, the intelligent way of resolving the claim denials is to prevent them in the first place. There can be prevention tactics and measures to control and monitor instructions from the insurance companies by maintaining up-to-date files and other records that provide information on new medical billing and coding regulations.

How does payment posting fit in revenue cycle?

  • Payment posting remain as an integral part of revenue cycle system, regardless of whether you bill in-house or outsource your medical billing services.
  • An exquisite payment posting process can aid in identifying opportunities to increase revenue by watching for daily trends within the healthcare practice.
  • Beyond that, payment posting has very good potential to increase profits and relax the whole billing process.
  • EOB and ERA posting and reconcilement – Ensure that the data from both EOB’s and ERA’s match payments.
  • Handling denials – Report and reroute denied claims to the appropriate coding and denial management team for rework and re-submission to payers in a timely manner.
  • Patient responsibility – Identify and move balances to the patient’s responsibility to ensure faster patient billing.
  • Write-offs and adjustments – Process write-offs and adjustments and report any unusual contractual adjustments while processing payment.
  • In person collection issues – Provide inputs on trends in denials, non-covered services, prior authorizations, and deductibles or co-payment collection issues at the point of service.

How to evaluate the payment posting process?

Start with your staff:

  • Any evaluation of your payment posting process should begin with your employees. Healthcare professionals will need enough staff and the rightly trained staff. The staff levels should be based on volume, not merely the number of practitioners who happen to be working at the practice.
  • In addition to having enough staff, it pays to have the right staff. Accuracy and productivity are essential in the billing process given the volume of payments handled by most practices. So, always take time to check references when hiring posters, and use your instincts when interviewing candidates.

Keep your eyes peeled:

  • Hiding unprocessed checks may be a sign of overworked staff. But stealing from providers is a serious crime. Yet it happens at some practices. Without any oversight, few can get very creative.
  • So, in order to avoid this wrongdoing, you should separate duties wherever staffing distributions allow it, look over the daily billing and collection records, and use your intuition about suspicious activities. Also, be prudent about granting authority to give discounts or write-off money.

Time really is money:

  • There is a saying that goes “It’s better to have a dollar today than a dollar tomorrow”, so get your payments posted and deposited as soon as possible. If you don’t post the payment quickly, it means that the billing system may automatically send a statement, even though the patient has been already paid. Healthcare professionals will either create a refund or receive an angry call from a patient. Either way, it costs them money and tarnishes the level of service a bit.
  • One way to increase promptness is to take advantage of available technology. Many insurance carriers offer electronic payment remittance and funds transfer. Electronic remittance means payments are posted directly to your billing system; electronic funds transfer means they are posted directly to your bank account.

Better ways to increase reimbursements is to outsource payment posting services to medical billing companies. For more healthcare related articles, please subscribe to our blog. In case of any query or suggestion, do let us know in the comment section below. For regular updates, follow us on all social media handles.