Payment

Accuracy in payment posting is imperative for an optimized revenue cycle. Once payments are posted to patient accounts each denials are addressed separately. Rejected claims, late payments and untimely patient statement submission can eventually lead to huge losses for a healthcare practice.  ABC LLC handle the payment posting according to client-specific rules that would indicate the cut-off levels to take 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 revenue cycle system, processing exceptions from the batch run by making corrections using the functionality available on the revenue cycle system. Payment data from scanned images of Explanation of Benefit (EOB) document are captured line by line and posted to the respective patient accounts. We develop practice/physician specific business rules to ensure accurate payments, adjustments, write-offs and balance transfers are posted correctly.

  • All ERAs are posted on the same day.
  • Sequestration and MIPS penalty are posted in separate adjustment code.
  • 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.
  • All EOBs are posted within 8 hours
  • Paper checks cashing details are verified with providers and Insurances.
  • Downloading paper EOB files through Dropbox, PMS, FTP, Fax, Email etc.
  • Practice employees are trained to upload paper EOBs and Medical records in PMS
  • ABC LLC does electronic payment posting in to the medical billing software and handles the exceptions (fallouts) manually to make sure no payment is missed. Missing ERA’s from clearing house are traced every week by calling them.
  • 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.
  • Continuous monitoring of payee address in ERA’s/EOBs.
  • Uncashed checks or checks sent to incorrect address are rectified.
  • Every year charge fee schedules are updated depending upon the changes in Medicare, Medicaid, Commercial and Self-pay fee schedule to reduce contractual adjustments.
  • Every week missing paper EOB reminders sent to the providers
  • Refund letters are analyzed and emailed to the provider to send the check to the payer on time
  • Educating the providers frequently regarding obsolete ICD, CPTs, Insurance reimbursement policies etc
  • Payments received in the bank are reconciled every month.
  • Weekly charges and payments report are texted to the providers
  • Monthly payment reports Emailed to the providers
  • Year-end reports Emailed to the practice to understand the practice production, collection and outstanding account receivable.
  • Payer paid amount is compared with ACO’s fee schedule to make sure the provider is paid according to the ACO/payer contract.
  • Adjustments and denials are adjudicated properly which helps patients understand their responsibility.​

Payment comparison with others

Payment ABC LLC Others

Downloading paper EOB files through Dropbox,
PMS, FTP, Fax and Email

Training practice employees to upload paper
EOBs and Medical records in PMS

Payments are posted the same day the money hits
the bank

Missing ERA's from clearing house are traced every week
by calling them

835 files are directly downloaded from Payspan, PNC, Zelis,
Echo, Redcard, JP Morgan, Optum etc to PMS for small insurances
such as USAA, Aetna continental

Sequestration and MIPS penalty are posted with the
separate adjustment code to identify the total deductions

Monitoring the CPT downcoding from insurance and
suggesting the correct CPT by analyzing the
Medical records to the providers

May be

Continuous monitoring of payee address in ERA's/EOBs

May be

Verifying paper checks cashing detail with providers and insurance

Uncashed checks or checks sent to incorrect payee
address are rectified by calling the insurances

Updating the charge fee schedule every year depending
upon the changes in Medicare, Medicaid, Commercial and
Self-pay fee schedule to reduce contractual adjustments

Sending Missing paper EOB reminder to the providers

Paper EOB files are posted within 16 hours

Check refund letters are analyzed and emailed
to the provider to send the check

May be

Educating the providers regarding obsolete ICD, CPTs,
insurance reimbursement policies etc

Reconciliation is done every month by comparing
the bank statement and ERA's/EOBs

May be

Weekly charges and payments report texted
to the providers

Monthly payment reports emailed to the providers

May be

Year-end reports Emailed to the practice to
understand the practice production, collection
and outstanding AR.

May be

Comparing ACO's fee schedule with the paid
fee schedule for each insurance to make sure
the provider got the contracted fee schedule