Payment Posting – Key to Revenue Cycle Management

Payment posting is one of the most important steps that can assist in improving a physician’s revenue if done efficiently. Although payment posting is becoming electronic and automated there is still the need for checking for accuracy and errors in the posting. There are numerous ways in which physicians can benefit from accurate and efficient payment posting and its analysis.


Explanation of Benefits (EOB)


The ability to carefully read and comprehend the EOB is one of the crucial aspects of medical payment posting. Avoiding errors in EOB or correcting the errors made by an insurance payer can lead to avoidance of long term financial loss. Studying and minutely examining the EOB for correct information such as the claim number, provider, type of service, the not covered amount, and insured ID number can drastically reduce mistakes and ensure that you are properly remunerated.


Electronic Remittance Advice (ERA)


ERA is provided by most insurance providers and is an electronic form of EOB or explanation of benefits. This helps in increasing your productivity and streamlining your workflow and can be integrated to your PMS. However, facts about underpayments, denials, multiple adjustments, cross-overs, reversals, and secondary remittance have to be analyzed in order to ensure correct reimbursement in a timely manner.


Insurance Follow up


Correct payment posting also supports insurance follow up which ensures optimal revenues for physicians. Insurance companies can deny claims based on any type of error and it is important for billers and coders to keep in touch with such providers in order to ensure that the issue is being addressed. Therefore accurate payment posting can eliminate such delay in denied claims by avoiding errors. Payment posting sets the stage for effective Account Receivables follow up.


Reduce costs and tool to measure efficiency


The cost of billing can be reduced along with an increase in revenue due to better payment posting processes. The reduction in cost is also due to the time saved by electronically done payment posting which is verified by experienced billers and coders. Moreover Payment Posting is a key tool to measure the efficiency of Medical Billers and Coders as it stands testimony to clean claims and error free billing.


Quantitative advantages


The recent health reform is going to ensure more doctor-patient encounters and the sheer volume of EOB and the amount of posting would become staggering. This is where attention to detail while reading EOBs and familiarity and experience in advanced electronic remittance scenarios is important. Balancing receivables by accurate and timely Payment Posting, makes performance reports more clear and concise to draw financial decisions.


EOB or ERA, the human intervention in the analysis is inevitable; the best computing system can not drive efficiency in collection all by themselves. Expert medical billers are required to scrutinize those customized reports. Medical Billing specialists at medicalbillersandcoders.com are experienced in such scenarios and keep updated about payment posting processes and also all other adjustment clauses in the reimbursement policy.


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Payment Posting – Key to revenue cycle management

Increased inaccuracy in claims payments by health insurers

Commercial health insurance has registered an increase of 2% over the existing average claims processing error rate of 19.3%. This 2% translates to an extra 3.6 million in erroneous claim payments, and costs an additional estimated $1.5 billion in highly avoidable administrative costs to the health system.


AMA (American Medical Association) has released its Fourth Annual National Health Insurer Report Card which underscores the 2% increase in inaccurate claim payments since last year among the leading commercial health insurers. Claims-processing errors by health insurance companies squander billions of hard-earned dollars, frustrating general public as well as physicians in the process. The AMA estimates that eliminating health insurer claim payment errors would save $ 17 Billion.


The key findings of this report are as follows:


Performance: United Healthcare emerged as the only commercial health insurers with an accuracy rating of 90.23% while Anthem Blue Cross Blue shield scored the worst with an accuracy rating of 61.05% according to the report.


Denials: A noticeable reduction in denial rates has occurred since last year at Aetna, Health Care Service Corporation and United Healthcare, which reduced its denial rate by half to 1.05%. CIGNA maintained its industry low denial rate of 0.68%. The common reason for denials continues to be the absence of patient eligibility for medical services.


Non-payment from Insurers: Nearly 23% of claims submitted by physicians in 2010 received no payment at all from the commercial health insurers. One of the most frequent reasons cited by insurers was deductible requirements that shift payment responsibility to patients until a dollar limit is exceeded.


Administrative requirements: The report has also mentioned how frequently claims included information on insurers requiring physicians to ask permission before performing a treatment or service. A recent AMA survey of physicians indicated that insurers’ requirements to preauthorize care delayed or interrupted medical services, consumed significant amounts of time and complicated medical decisions.


Analyzing the various facts highlighted in the report, it appears likely that physicians would continue to experience roadblocks in reimbursement for their payments. In order to streamline the process of reimbursement, they would have to rely on experts who are well versed and experienced enough to pre-empt the loopholes and grey areas in the payer system and avoid falling prey to those. Physicians and healthcare organizations facing obstinate rates of non-payment and/or denials do not have to take it lying down; they can take the help of qualified professionals from medicalbillersandcoders.com to experience error-free claims filing to ensure a healthy reimbursement rate.


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Increased inaccuracy in claims payments by health insurers