Payment Posting And Its Factors
At this process, the payment records of patients are entered in the billing management software. This also includes attention to be given to claim denials — in identifying the problematic areas and their reasons along with apt actions to be taken on resolving the issues.
After receiving a scanned explanation of benefits (EOBS) and checks, we immediately enter the transactions into the system. Appropriate patient accounts are charged and the process for denied claims is initiated, even if the actual claim falls short of expectation.
We reconcile the accounts on a daily basis. Although we do electronic payment posting, we handle the exceptions manually to ensure that no payment is missed. We aim at accuracy, ensuring that we capture everything. In this exercise, we believe that swift turnaround and keen attention to details are important aspects in order to capture everything and give our customers results within a reasonably short period.
Analysis of Explanation Of Benefits (EOB):
The EOB contains personal details of the patient, services tendered and their respective codes, the amount of insurance which was billed, allowed and adjusted money (EOBs are accompanied with payments from insurance agency) along with denial information, co-pays etc. This information is keyed in, and an analysis is conducted to verify the above, to check if claims were processed suitably, and regular trends recorded for further analysis.
Action On The Analysis/Patient Billing:
If there is money left from the insurer, the rest of the co-pays/deductibles/co-insurance/uncovered insurance bills are then sent to the patient for payments. This information must be passed on to the billing department at the earliest to increase cash flows.
Payments must be entered within one day or less of receiving receipt. EOBs and Electronic Remittance Advise (ERA) must be obtained; 20% of the medical payments are manually entered in the system as some insurance payers do not provide ERA (835/ERA). The claims must be handed over to the A/R team for follow-up. Accuracy increases overall billing competence, and analysis leads to clearing out the causes for low inflows. Automation of processes can increase the chances of timely, appropriate and faster revenues.