Revenue Cycle Time Line:  Payment Posting

This article has links to allow easy access time line content from Scheduling to Bad Debt Recovery.  Use this information as a starting point for planning, SWAT Analysis, or to review policies and procedures for gaps.  Create a time line for your facility to assure all participants share the same expectations.

Goals

· Prompt, accurate, and efficient posting of payments to patient accounts

· Daily reconciliation of AR Transactions and GL Transactions

Activities and Considerations

Traditional remittance processing required staff to review remittance pages, enter payments and adjustments, and reconcile batches to the daily transaction detail. 

Pressure to improve efficiency between payers and providers led to the development of various electronic remittance formats.  Early formats did not include all information needed. 

The HIPAA law, and hard work by WEDI, brought an update to the ANSI standard format to include information needed.  Both Payer and Provider technology systems, however, have been slow to adapt to the additional fields available leaving the information “available, but not used”.

With increasing numbers of payers making ANSI 835 format files available, providers may be able to post 80% or more of payer remittance transactions electronically, saving significant labor. 

Because some patients seek care with out-of-area coverage, some transactions must always be posted manually.

A comprehensive posting system must assure the following needs are met:

· Posting electronic remittance of various formats

· Posting paper remittance advices

· Posting patient payments

· Capturing data from remittance transactions for decision support system(s)

· Capturing patient-specific and batch-specific documents for archive, audit, credit balance processing, secondary billing, and patient inquiry support.

Electronic Remittance Advice Posting

Because of format variation, electronic remittance processing is not as easy as envisioned in the 1990s.  ANSI 835 formatting allows payers flexibility to customize fields.  This requires time and planning in the setup of remittance processing routines.  The planning effort is time well-spent, especially for high volume payers.  The planning effort should include:

· Handling of claim/account numbers that have no match in the host system

· Comparing data to assure elements of the transaction match expected values (e.g. total charges on the remit is equal total charges from the claim file

· Automating the correction of contractual adjustments (when estimated contractual amounts are posted at the time of billing)

· Matching patient liability on residual account balance with amounts shown by payers on the remittance advice

· Loading human-readable remittance advice information automatically in the electronic document storage system (by patient account number and batch number)

· Creating efficient manual repair processes for errors detected during the processing cycle

· Defining rules to process claim and line-item denials detected during remittance processing

· Integrating internal controls defined in the ANSI 835 specification with posting systems rules

Paper-based Remittance Processing

Document Imaging and Workflow tools have made processing of paper-based remittance more efficient.  While some technology providers have configured the use of OCR tools to capture and input data, the long-term efficiency has not out-performed a well planned manual system that simultaneously captures posting and indexing information from a single set of key-strokes.  Dual-screen technology makes this an effective, efficient, and economical solution.

· Paper-based remittance advices are scanned first, posted and indexed simultaneously (as a by-product of posting)

· Single transaction insurance payments are scanned first, posted and indexed simultaneously (as a by-product of posting)

· Posting screens allow the posting operator to review and correct adjustments while posting payments

· Denials and Correspondence items are processed “like cash”.  Transactions trigger the activity for line item and claim level denial follow up.

Patient Payment Processing

Patient payment processing has improved in recent years as well.  Payments may be received through web payments (electronic transactions), through bank lock boxes, or from traditional mail receipt. 

Web payment procedures require specific processing rules.  Depending on the service, these transactions can be applied electronically from data feeds from the systems that generate these reports.

Traditional payments from patients can be automated using data feeds from bank lock-box services or by scanning and creating data set internally, reducing (or eliminating) the cost of lock-box services.

Regardless of method, the checks and payment stubs received should be scanned and associated with the patient’s account for various research and archival requirements.

Management Reporting

Reconciliation of Cash Clearing, Bank Records and GL should be recorded and reviewed on a daily basis storing bank records and cash posting journals confirmed by Accounting with deposit and posting journals confirmed by the Cashiering Supervisor.

Adjustment transactions should be saved at the “detail” level.  Software systems should support the sorting and filtering of transactions by CDM code, operator, account number, date, and dollar amount.