Don’t assume that payers are going to post payments as you expect. Download our free eBook, 10 Deadly Sins of AR and How to Fix Them, to empower your billing department to know the status of payments as soon as there’s a change. You’ll also learn how to avoid nine other common AR sins.
Many billing offices do not post all the remits they receive, but this issue cannot be accurately described as simple negligence on the part of your team. All of the remits your AR department receives may not come to the same place – they may go to specific payer websites or intermediary clearinghouses, for example.
Your legacy software systems may also be causing issues. Your billing department could be attempting to post 835 files that never get fully posted because your software is not able to account for nuances in the payment information, creating accounting and balancing issues.
In the claim payment process, an act of “posting” can refer to any instance in which the payer generates a payment information.
Payers can perform these actions electronically or by mailing a paper copy, making it all the more difficult to keep track of the many payment updates that your office does (or does not) receive. Regardless of the method, these actions would ideally be performed as soon as possible so your medical business would know the activity and the outcome of the claims.
But even if payers do technically post activity on a claim, your AR team may not be aware.
For instance, a payer may post a zero dollar payment. If your billing department relies exclusively on bank account deposits as the trigger to post payment files, that “payment” may as well be invisible. That in itself may irritate you, but that could only be the beginning of your frustrations.
For our purposes, let’s assume that that payment contained five remits representing five claims. The payer covered two of those claims and refused to pay for the other three. Could be worse, you may be thinking. At least you got some of the money you were owed.
But, unbeknownst to you and your AR department, that payer may have also initiated a recoupment at the same time. In this situation, the payer retroactively decides to refuse coverage of a service they’ve already paid you for. To recoup that money, they deduct from the current payment they’re making.
That payment where the payer only paid two of the five claims? It’s back to a zero dollar balance that never shows up in your bank account, so your billing department remains unaware they can and should follow-up.
Meanwhile, months of valuable follow-up time go by. The payer may have denied coverage in January and your team may not become aware until June, if they find out at all. Because the remit was never posted, that claim may sit in your AR with no action being taken until it eventually times out, leaving your medical business short on money you’re owed.
Solution: Know When Payments Are Posted
The difficulty of tracking payments from receipt to posting to reconciliation often creates major workflow issues
Many billing offices attempt to save money by getting their electronic remits from:
- The payer website directly
- The payer’s intermediary clearing house
- Their own clearing house
There are multiple problems with this approach. When electronic remittances are not consolidated to a single location, they can easily get lost and not posted into the practice management system. More labor can result as well in the form of reconciliation workflow that starts with looking at what was deposited into the bank and then finding the associated electronic remittance advice in whichever location it is stored.
Additionally, if you receive zero dollar payments, they may not have an associated bank deposit and therefore may never get posted.
All of these problems can be resolved by consolidating the receipts of 100% of all remits to your main clearinghouse and ensuring that you’re posting them. You can even digitize paper payment information you receive from certain payers.
Your reconciliation process can be managed in a different, more productive way where all 835 payments are posted first and then reconciled after they’ve already been added to the practice management system. This can be done by different staff members or at different times so you won’t have to delay the flow of information into the accounts receivable area for accounts that have been delivered, are unpaid, or underpaid.
Learn how to better inform your team about the status of payments and enable them to follow-up on claims when necessary by downloading our free eBook 10 Deadly Sins of AR and How to Fix Them. You can learn even more by booking a consultation with the RCM Brain ninjas by calling us at 1-855-RCM-BETH or taking a moment to book online.