Medical billing may seem like a simple process to an outsider: submit the claim, and the provider gets paid. Unfortunately, it is not that simple. Many steps are involved in the revenue cycle management process. Posting payments and reconciling accounts is necessary to ensure that a provider is receiving all payments to which they are entitled.
After claims are submitted to the insurance payer, they are processed and adjudicated and then, either paid or denied. An Explanation of Benefits (EOB) or Explanation of Payment (EOP), or a similar document, is sent to the provider and the member. Some providers may deposit the check and move on. However, an experienced revenue cycle expert knows that payment posting and account reconciliation is a critical step in the process for the following reasons:
- Patient Balances- Many claims have assigned patient responsibility. The account must be reconciled correctly, and balance must be billed to the patient promptly.
- Reviewing Denials– Accurate posting of remittance or EOBs is necessary for the Accounts Receivable staff to work denied claims. It also helps identify problems with payers that may impact multiple patients.
- Identifying Internal Issues– Reviewing payment and denial information will reveal internal process issues such as prior authorization issues or coding issues, so those issues can be prevented in the future and possibly remediated for past claims.
- Reviewing Write-offs and Adjustments- Checking write-offs and adjustments against fee schedules and policies may also disclose errors in payments.
- Secondary Claims- Many patients have multiple payers. Quick turn around of EOBs from the primary payer to secondary or even tertiary payer will result in faster complete payment of the claim.
- Data Analysis- Compiling payment and denial information is a tool for companies to analyze their overall business operations. It can help with revenue forecasting and business strategy and use the information to improve overall operations.
- Reconcile payments with ERAs/EOBs- Reconciling the incoming checks, credit card payments, and electronic funds transfer with the statements from payers is imperative to safeguard that all funds have been received. Funds could have been misrouted or checks lost.
Do posting payments and managing those details seem like too much work for your practice? Missing Piece Billing and Consulting specializes in helping ABA therapy and behavioral health provider with the complete revenue cycle management process. We have an entire department focused on posting payments. They post payments promptly, so the Accounts Receivable team can work the outstanding claims, or the Patient Statement department can bill the patient for the balance due in a timely manner. This ensures that your practice is paid more quickly and more accurately.
To learn more, set up your free Revenue Cycle Analysis review today with one of our consultants by calling
765-628-7400 or by emailing firstname.lastname@example.org.