Payment posting in medical billing

Accuracy in payment posting in medical billing is imperative for an optimized revenue cycle. Once payments are posted to patient accounts each denial is addressed separately. Rejected claims, late payments, and untimely patient statement submission can eventually lead to a huge loss for healthcare practices. ABC handles the payment posting in medical billing according to client-specific rules that would indicate the cut-off levels to make adjustments, write-offs, refund rules, etc.

ERA and paper EOB posting

Electronic remittances typically contain a high volume of payment transactions. The processing of ERA batches involves loading the files into the practice management system, processing exceptions from the batch run by making corrections using the functionality available. Payment data from scanned images of the Explanation of Benefit (EOB) document are captured line by line and posted to the respective patient accounts. ABC develops practice/physician specific business rules to ensure accurate payments, adjustments, write-offs, and balance transfers are posted correctly. Here are our salient features

  1. ERAs are posted on the same day it is received
  2. Sequestration and MIPS penalty are posted in separate adjustment code
  3. 835 files are directly downloaded from Payspan, PNC, Zelis, Echo, Redcard, JP Morgan, Optum, etc into PMS for small insurances such as USAA, Aetna continental, etc
  4. EOBs are posted in 8 hours
  5. Paper checks cashing details are verified with providers and Insurances
  6. Downloading paper EOB files from Dropbox, PMS, FTP, Fax, Email, etc
  7. Practice employees are trained to upload paper EOBs and Medical records
  8. ABC does electronic payment posting into the medical billing software and handles the exceptions (fallouts) manually to make sure no payment is missed. Missing ERA’s are traced
  9. ABC certified coders analyze the Medical records for claims which are down coded due to lack of documentation and suggest appropriate codes to the providers
  10. Continuous monitoring of payee address in ERA’s/EOBs
  11. Uncashed checks or checks sent to incorrect addresses are rectified
  12. Every year fee schedules are updated depending upon Medicare, Medicaid, Commercial and Self-pay allowed fee schedule to reduce contractual adjustments
  13. Every week missing paper EOB reminders sent to the providers
  14. Refund letters are analyzed and emailed to the provider to mail the check to the payer
  15. Educating the providers frequently regarding obsolete ICDs, CPTs, Insurance reimbursement policies, etc
  16. Payments deposited in the bank are reconciled for discrepancies 
  17. Weekly charges and payments report are texted to the providers
  18. Monthly payment reports Emailed to the providers
  19. Custom year-end reports send to the practice to inform the practice production, collection, and outstanding account receivable
  20. Payer paid amount is compared with accountable care organizations (ACO) fee schedule to make sure the provider is paid according to the ACO/payer contract
  21. Adjustments and denials are adjudicated properly which helps patients understand their responsibility​