Payment posting involves posting and deposit functions and reconciling posting activities with deposits. Although it seems simple enough, this is an extremely fundamental feature of the revenue cycle. The payment posting process effects many other functions of the medical office and can have a major impact on patient satisfaction, efficiency, and overall financial performance.
1. Analyze Your Revenue Cycle
Once payments are posted to patient accounts, this presents an opportunity to analyze your medical office revenue cycle for opportunities for improvement. An effective analysis should assist you in maximizing your revenue cycle by increasing profitability as well as improve accounts receivable days.
Accounts receivables, also known as patient accounts, refers to revenues generated but not yet collected. To ensure cash flow is sufficient for effective management, the medical office has the responsibility to maximize its revenue potential.
2. Resolve Recurring Problems
Many problems may exist within the revenue cycle that can be resolved with accurate payment posting. Payment posting not only consists of posting payments but also involves posting adjustments and denials.
Certain payers may deny an entire claim or deny by individual line on the claim. For example, when the payment is posted, it is important that a denied line not be included with the adjustment or part of the patient responsibility. If this happens, it is almost impossible to catch. Identifying line denials is important in resolving the reason for the denial to prevent future claims for denying for this same reason.
Line denials can occur for medical necessity, noncovered service, service not authorized or frequency limits. The ability to identify the reasons for line denials can help prevent them from recurring as well as assist the medical office in indentify ways to improve your current billing and coding processes.
3. Enhance Current Processes
The revenue cycle processes directly impact the efficiency of the medical office staff. Sometimes management can be blind to the fact that their processes may be preventing the revenue cycle from functioning at maximum performance.
Once problems have been identified, it is necessary to determine whether a process could be added, improved or removed to current processes in order to enhance the effectiveness of the revenue cycle. The most accurate way to identify what processes need improvement is to perform a medical office assessment.
Usually managers and administrators only consider performing an assessment when the medical office is in financial trouble, however, an assessment can be done any time to evaluate your overall performance. When performing an assessment, keep in mind the specific problems that are recurring and analyze ways to prevent them in the future.
4. Speedup Denial Resolution Time
Of course, the most effective method for resolving denials is preventing them. The number one prevention tactic is monitoring instructions from insurance payers by keeping up-to-date on bulletins and other correspondence from the payers that provide information on new billing or coding rules. Prevention, however, is not the only way to resolve denials because some claims will slip through with information that may be incorrect or outdated.
The faster you can get those denied claims corrected and back out to the insurance payers the better. Each day your denials go unresolved contributes to your overall accounts receivable days. The ability to quickly identify denials, correct and refile them is the difference between have an excellent AR record of 38 days or less or 60 days or more which can be problematic to cash flow and possibly timely filing submissions to secondary and tertiary payers.
5. Accurate Claims Submissions to Secondary and Tertiary Payers
Accurate payment posting also effects the accuracy of claims submissions to secondary and tertiary payers. If the primary payment is not posted correctly, it is possible for the secondary and tertiary payers to get billed out incorrectly.
Most billing systems have the capability of submitting secondary claims and some tertiary claims electronically. Unless there are edits within your system or billing scrubber to stop these claims for review it is possible that some of your claims may go out with mistakes if the primary payment has not posted accurately.
The medical office should always look for ways to improve each area of the revenue cycle by continuously monitoring processes not only to maximize reimbursement but to stay in compliance with proper billing practices.