You’ve done the service, sent the claim, now time to post the incoming payment. This is not a step in the revenue cycle to be taken lightly or overlooked. There are a few keys to optimizing payment posting:
- Utilizing electronic remittance advice (ERA) to post directly to the electronic practice management (EPM) system. This removes a degree of human error in regards to data entry. Whenever possible administrators should look to combine electronic funds transfer (EFT) with ERA submissions. This allows clinics to see quicker payments. Staff will still need to verify EFT matches ERA and reconcile each payment. When looking to collect payments via EFT, administrators should be aware of any additional fees payers may add on for this feature.
- If manually posting payments to EPM assure high attention to detail and reconciliation. Staff should be trained on how to read the explanation of benefits (EOB) and remittance advice for any payments not in full.
- Despite manual or automated payment posting, clinics must assure payments match the expected amount to be collected. Whether the amount is equal to the clinic’s fee schedule or the contract agreed amount. According to a 2017 MGMA poll, only 20% of respondents compared reimbursement to contracted rates on a daily basis. Almost 30% were unsure or were unclear on if they compared incoming payments to contracted rates. Administrators and managers should perform due diligence to guarantee they are being paid in full for their services.
- Review adjustment reasons and prepare for denial management and appeals. Administrators should train staff to not accept incoming payments or denials as is without assuring all avenues for full collection have been sought. Best practice is for adjustments to be made during the payment posting process, not before.
- Allocate payments by line item incoming from payers. This helps with tracking, reconciliation, and
To confirm that payments are being posted in timely and responsible manner, administrators and managers can look to report on some of the following indicators:
- Days from claim submission to payment received – this shows delays in claim processes. The clinic’s billing team should be aware on average how long payers take to process a claim. If claims are taking longer than expected, the billing staff should be contacting the payer to determine the reason for the delay.
- Days from payment received to payment posted – this shows if there are any problems in the clinic workflow. Payments should be posted almost immediately upon receipt.
- Claim amount vs payment/contract amount – as discussed earlier, due diligence is required to assure clinics are in receipt of all money
- Number of denied claims, amount of those claims – administrators must be aware of the amount of money not being denied the clinic
- Number of submitted claims vs number of paid claims vs number of non-paid-in-full/denied claims – the percentage of paid vs non-paid claims is important for determining the health of the revenue cycle of the clinic.
- Charges vs Receipts vs Adjustments – the percentages of these three in comparison allows administrators and managers determine revenue cycle health and billing team workflow.
- Adjustment amounts and types – adjustment types like appointment types should be limited and their use monitored for correct use. The amount of adjustments (contractual, modifier based, etc.) should not be of surprise to administrators or managers.
- Top payer by charges, receipts, and adjustments – another report that should hold no surprises but should be run regularly so as to assure there are none.
- Days in A/R by payer – while overall days in A/R may seem low it will hide problems for individual payers.
Though payment posting seems the easiest part of the revenue cycle process, it is one step that can show the true fiscal health of a clinic. Administrators and managers should work to guarantee that this step is not overlooked or skipped. Payments, receipts, adjustments, ERA, EOB, EFT, and days in A/R are only the beginning of the hardest work in the billing team. The last few steps in our revenue cycle take tenacity, initiative, and those that love a good mystery.
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This is Part 9 of a 12 part blogging series on How to Optimize The Revenue Cycle For Your Practice. Be sure to subscribe for email alerts to never miss an article. If you missed anything, check it out here: