EOBs and Payment Posting – Important Part of Medical Billing Process

If you had to make a list of all the elements that are pivotal to running a successful healthcare organization, revenue cycle management would unquestionably be at the top. 

Yes, it’s true that nothing is more important than the quality of the experience you offer to patients. In order to both remain competitive and secure the best possible outcome, you must not only meet their needs but exceed their expectations to the point where they’re as engaged as they can possibly be with the process itself. 

It’s hard to do any of that if your practice isn’t profitable, however, which is a large part of what revenue cycle management is all about. This requires an almost intense level of attention to detail. 

This is also a big part of the reason why concepts like payment posting are paramount. But what exactly is payment posting, why does it matter, and how does it relate back to larger concepts like EOBs? The answers to questions like those require you to keep a few key things in mind. 

What is Payment Posting in Medical Billing?

Payment posting process
Vital Part of Medical Billing Process - Payment Posting

At its core, payment posting is the process of generating as much visibility as possible into your practice’s revenue cycle management. It means that you have taken meaningful steps to: 

  • Track and account for all services that are being provided to patients. 
  • Accurately submit associated claims to insurance providers. 
  • Review all the information that you’re getting back from insurers regarding those claims. 
  • Coordinate claim payment posting and reconciliation with the actual payments that patients are making. 
  • Do all of the above on a timely basis. 

If one of your main goals is to run the most profitable healthcare practice you can, payment posting becomes a way to break that down into a series of smaller and more manageable steps. The more efficient these processes are, and the more accurate they are, the faster you get money coming in the door after services are performed. 

That means a stronger cash flow, which is only possible if you’re getting A) the maximum amount of reimbursement, in B) the minimum amount of time. 

The Key Features of Payment Posting in Medical Billing: Breaking Things Down

While payment posting as a concept brings with it many different benefits, it is also often a time-consuming and complicated process – especially when done manually. 

If multiple payers have their own unique, non-standard EOB formats, each one is an invitation for human error. It’s been estimated that more than half of all insurance denials are due to mistakes made with medical billing codes. All this doesn’t just lead to lost revenue in the short-term in that you’re literally not getting paid for work you’ve already performed as quickly as you should. When you consider the sheer volume of hours it might take to find and correct the error, that’s another labor-related cost on top of it all. 

That’s why medical billing solutions like PrognoCIS have been such a benefit to smaller practices in particular. They include a plethora of different features designed to mitigate risk from human error and streamline the payment posting process. Batch EOB posting, electronic claims submissions, and automated patient statements are core components of that. 

Some of the other key features of payment posting in medical billing include but are not limited to ones like: 

  • A solution (like PrognoCIS for just one example) can automatically match EOB data against payments as they’re being received. 
  • EOB and ERA posting, and reconciliation happen accurately and timely. 
  • These tools can help automate the processing of adjustments and write-offs, especially as they pertain to contractual agreements. 
  • Any issues that need to be corrected are identified based on their category. Non-covered services, denials, collection issues, and more are flagged so they can be routed to the right person as quickly as ever. 
  • A patient copay is automatically applied, and the remaining outstanding balance is moved to the appropriate account for processing. 
  • PrognoCIS includes native support for patient payment plans, collection agencies, and more

The Payment Posting Process

While the actual payment posting process will vary slightly depending on the organization you’re talking about, in general it encompasses these important steps: 

  • Your practice will submit a claim to an insurance company for services rendered. This information will be provided to others as well, like the patient. It will include information about the services that were provided, associated costs, and more. 
  • At that point, the insurance company will review everything you’ve submitted and decide how much they’ll pay based on a patient’s insurance coverage. Based on this decision, the insurance company will send the patient  an Explanation of Benefits (EOB) or Remittance Advice (ERA) giving them more information. Patients get an EOB in medical billing to better understand what their insurance will pay versus what they have to pay. 
  • You will receive payments from the patient based on what they learned from the  EOB or ERA. Payments will include the amount you’re getting from the insurance provider, or patient payments like a copay or a deductible. 
  • Payment posting. All the above information will be accurately (in theory) recorded in your billing system. You’ll note the payment amount, the day of the payment, who paid, and additional details. 
  • Everything will be reconciled to verify that it is accurate. You’ll want to make sure that every dollar you receive is accurately credited to your practice’s bank account. 
  • If there are any discrepancies, they will be investigated immediately so they can be corrected. Some insurance claims are denied due to coding errors, for example. If you have identified this as an issue, you can then file an appeal or correct. 

There are other important parts of this process – like balancing accounts and reporting on trends – but these are the core steps that must be followed. 

Why Payment Posting Matters: The Importance of Accuracy

This may sound dramatic, but it really isn’t: an accurate payment posting process, which includes reconciliation, is literally critical to the continued existence of your practice. 

If you don’t have a strong, healthy cash flow, you can’t continue to scale as-needed. You won’t be able to bring on new employees, and it will be harder to retain the ones you already have. As the overall quality of the patient experience suffers, so will your competitive advantage. 

Also, consider that the longer it takes to get paid for services you’ve already performed, the more likely you are to introduce errors into the process - thus potentially leaving money on the table. 

Accurate payment posting and a strong cash flow also makes it easier to not only understand where your practice is from a financial perspective, but where it’s headed. That way, you can make decisions based on your future cash needs and create the most intelligent budget possible to help you achieve your goals. 

Payment Posting

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Benefits of payment posting in medical billing include: 

  • Matching EOB data against payments received
  • Accurate and timely EOB and ERA posting and reconciliation
  • Processing adjustments and write-offs against contractual agreements
  • Identifying non-covered service, denial, prior authorization, and collection issues to be rectified.
  • Claim denial management to quickly identify denials, rework claims, and resubmit
  • Applying patient Copay and move remaining outstanding balances to the patient’s account for processing
  • Supporting Patient Payment Plans and Collection Agency workflows
  • Improving revenue cycle management

Evaluating Your Payment Posting Process

In terms of actually evaluating your existing payment posting process to help make sure it is right for you, the number one thing you’ll want to look at are staff-related skills. If you want the payment posting process to be as accurate as possible, your staff members need to understand what that looks like and why it’s so important. 

This is another one of the reasons why choosing a partner like PrognoCIS is crucial to your success. We provide training, ongoing support, and other educational resources to help make sure the skills are in place for the most successful payment posting experience possible. 

You’ll also want to make sure your own process has as much oversight as possible – not just to prevent unchecked human error, but to mitigate the possibility of issues like fraud as well. At a bare minimum, the people who do billing should not also be in charge of receipts and collections. A series of checks and balances must be in place. 

Finally, always keep an eye on the amount of revenue your practice is losing through write-offs alone. Write-offs should be based on contractual agreements. They shouldn’t occur due to staff-related issues. 

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Key Takeways

  • Payment posting is all about making sure that you’re getting paid the most amount of money for the services you’re offering to patients in the shortest amount of time. 
  • It’s an approach that helps you optimize all components of revenue cycle management, including submitting claims to insurance providers, coordinating payment posting and reconciliation, and more. 
  • The more efficient your payment posting process is, the stronger your practice’s cash flow is. 
  • Solutions like PrognoCIS with robust revenue cycle management functionality are designed to help make this all as straightforward as possible, freeing up your time to focus less on payment posting so you can devote all your attention to improving the patient experience. 
EHR Integration with Online Credit Card Processing

PrognoCIS: The Payment Posting Partner You've Been Waiting For

At Bizmatics, we pride ourselves on our ability to be so much more than just another software vendor. We’re a partner in every sense of the term – one that understands what it takes to run a successful healthcare practice every bit as much as you do. That’s why solutions like PrognoCIS are built specifically with your needs, your wants, and your challenges in mind. Payment posting is just one of the many items on that list. 

Our robust revenue cycle management offerings, for example, are designed to help you optimize your returns and shorten your revenue cycle across the board. Everything from eligibility checking to denials and appeals management to claims processing and more can all be effectively handled under one proverbial roof. 

For payment posting in particular, this means that you can also integrate with all the software you need to take control over your practice’s medical billing, complete with the customizable workflow you deserve that was built with your unique practice in mind. 

All this, and you also get to enjoy all the advantages of payment posting as outlined above, including matching EOB data against payments received, accurate and timely EOB and ERA posting, and more. 

So if you’d like to find out more information about why payment posting and functions like EOBs are such a critical part of the medical billing process, or if you’re interested in learning more about what an innovative platform like PrognoCIS can do for your practice that you can’t do on your own, please don’t hesitate to contact us.

Speaker

FAQs

EOB is generated by the Insurance Company (payor) when the provider submits a claim for the services provided by him to the patients.

Two to three weeks after claims submission, the medical practitioner receives a reply from the payor in the form of EOB. This is to inform them about their decision as to whether the claim will be paid or denied. The provider receives the EOB via traditional mail.  

If there is a payment associated with the EOB, it will be sent as a check via traditional mail by the Insurance to the service provider (Clinic).

If the EOB states that the claim was denied, the clinic billers are required to take further action like resubmission of information to the Insurance company.  

An ERA stands for Electronic Remittance Advice. It is the electronic version of the EOB.

Clinics must first register with the Insurance carriers to receive ERA. Even though the ERA is received electronically, the payment for the claim can be received by the clinic through various modes like Check, Credit Card or EFT i.e., Electronic Fund Transfer directly to the clinic’s bank account depending on how the clinic has registered with each Insurance company for receiving payment.

The advantages of ERA over EOB are that ERAs eliminate the paperwork overload, they are received on the same day and being electronic, eliminate manual data entry and further automates the payment process. 

An EOB or an ERA is important for healthcare providers and patients as it tracks medical claims and spells out payment responsibilities and denial details. It provides an accurate listing of services provided and their associated fees. EOB/ERA information typically explains the amounts, such as deductibles, co-insurance, and co-payments, that the patient is responsible for paying out of pocket.  

EOB includes the following information: 

  • Patient name 
  • Provider name 
  • Insurance provider/policy number 
  • Claim number 
  • Date of service 
  • Description of service/insurer’s service code  
  • Initial provider fees 
  • The amount allowed by insurance under its contractual fee schedule
  • Applicable co-pays and deductibles
  • Notification of potential patient financial responsibility 
  • Notice of claim denial and appeal process, if applicable 

If the patient has secondary Insurance, the outstanding amount may then be submitted to this secondary insurance, which could further reduce the patient’s responsibility.

After insurer payments are received, the medical office can proceed to collect any remaining amount from the patient. 

 

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