Optimizing The Revenue Cycle 9 of 12: Payment Posting

Posted by Crystal L. Miner, MBA-HSA, FACMPE on Feb 6, 2019 6:45:00 AM

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
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Topics: Medical Coding Services, revenue cycle management, Medical Practice Improvement, payment posting

2019 Proposed Fee Schedule Changes - Input From Peers

Posted by David Blanchard on Sep 17, 2018 3:35:10 PM

A few weeks ago The AAFP released its initial summary(2 page PDF) of the proposed 2019 Medicare physician fee schedule which, for the first time, also includes recommended changes that would affect CMS' Quality Payment Program in 2019.  Is this good or bad for you? Let me share some quotes from the AAFP website that can be found here: https://www.aafp.org/news/government-medicine/20180724mpfssumm.html

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Topics: Medical Coding Services, medical audits, ICD-10, medical coding, payment posting, Medical Coding Compliance

"SMART" Year End Revenue Cycle Goals

Posted by Ben Castleberry on Aug 3, 2018 10:06:00 AM

2018 is more than halfway over. "Finishing Strong" will start to be a common message through out organizations all over the country. Goals will be set, measured, and some will be met, some will be exceeded and most will fail. What makes a good goal. What goals should you be setting for your revenue cycle and your medical coding? 

2018 is more than halfway over. "Finish Strong" will start to be a common message throughout organizations all over the country. Goals will be set, measured, and some will be met, some will be exceeded...Most will fail. What makes a good goal? What goals should you be setting for your revenue cycle? 

Before we get into specific goals, lets quickly what sets apart the structure of a good goal versus the structure of a poorly set goal. We call them "SMART" Goals. Specific, Measurable, Attainable, Relevant, and Time-Bound. 

Specific - In terms of revenue cycle and medical coding, you should choose the particular metric you want to improve, like coding related denials, Days in AR, or Overall Medical Coding reimbursement revenue. You should also identify the team members working towards the goal, the resources they’ll have, and their plan of action.

Measurable - If you want to gauge your team’s progress, you need to quantify your goals, like achieving an X percentage increase in Denials, AR, or Reimbursement.

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Topics: Medical Coding Services, medical audits, ICD-10, medical coding, payment posting, Medical Coding Compliance

Changes to Medicare Payments

Posted by David Blanchard on Jul 31, 2018 2:01:42 PM

This proposed rule would revise the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for CY 2019 to implement changes arising from our continuing experience with these systems. In this proposed rule, we describe the proposed changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment system. In addition, this proposed rule would update and refine the requirements for the Hospital Outpatient Quality Reporting (OQR) Program and the ASC Quality Reporting (ASCQR) Program. The proposed rule also includes requests for information on promoting interoperability and electronic health care information exchange, improving beneficiary access to provider and supplier charge information, and leveraging the authority for the Competitive Acquisition Program (CAP) for Part B drugs and biologicals for a potential CMS Innovation Center model. In addition, we are proposing to modify the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey measure under the Hospital Inpatient Quality Reporting (IQR) Program by removing the Communication about Pain questions.

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Topics: Medical Coding Services, medical audits, ICD-10, medical coding, payment posting, Medical Coding Compliance