How Payment Posting Transforms Your Revenue

Introduction Do you know U.S. healthcare providers lose $262 billion annually due to denied claims? This huge revenue loss reflects the need to devise the best strategies to ensure a strong revenue system that leads to sustainable growth of healthcare facilities. Most of the time reimbursement rates often fall far below providers’ expectations. One of the crucial steps is payment posting that can have huge financial implications on the overall efficiency of Medical Billing services. It might sound easier to an outsider but payment posting services involve overwhelming complications, requiring an advanced set of technical skills to effectively navigate them. Complexities of reconciling numerous insurance accounts force many healthcare facilities to outsource Payment Posting to ensure a higher reimbursement rate and improved practice operations. To ensure a seamless revenue cycle through efficient payment posting, we share with you some of the time-proven techniques that can elevate your practice to financial excellence. Who Initiates Posting Payments? What is payment posting? Payment posting is the process that starts when a healthcare provider submits a claim to an insurance company for reimbursements for the healthcare services, he provided to an insured patient. This medical bill includes important information such as the patient’s geography, insurance plan, provider details, insurance ID, medical codes of the services provided and procedures performed, patients’ responsibility, and associated costs, etc., This is what the journey of payment posting procedure starts with. Payer Steps in the Payment Posting Process Insurance payers keep a vigilant eye to inspect the medical services healthcare facilities provide to the insured patient. Payers thoroughly investigate all the services provided to patients to ensure that those services fall under medical necessity or not. They evaluate and review the claim to determine the reimbursement amount for healthcare providers. There are certain areas that payers specifically take into immediate consideration including:

1. Patient’s coverage plan
2. Correct coding
3. Medical Necessity
4. Pre- Authorization & Referrals
5. Provider Network Status
6. Aggreged Reimbursement Rates
7. Patient Responsibility

If the medical bill complies with the required conditions, the payer reimburses the provider and informs him through an Explanation of Benefits (EOB) or Electronic Remittance Advice (ERA). On the other hand, if there are some discrepancies, then the claim is denied and details of the rejection reasons are sent to the provider through EOB. EOB and ERA serve as a bridge between the payer, provider, and patient by ensuring effective communication. What Is Patient Responsibility According to the patient’s insurance plan, insurance does not pay for all the healthcare services provided to the insured. In insurance plans such as deductibles, copayments, and out-of-pocket maximum, under such plan, the patient is responsible for paying for a portion of the amount for his healthcare. Healthcare provider keeps constantly in touch with the patients, sending them statements, outlining their financial responsibilities, and requesting them to kindly ensure payment. This communication based on transparency and clarity develops long-lasting collaboration and mutual understanding. Payment Posting One-Time Task? Payment posting is the process of always going on and it requires healthcare providers to always be vigilant to monitor. Since the payment process involves multiple stakeholders such as the provider, patient, and payer, therefore it is mandatory to maintain communication with all of them until the payment post is completed the amount is transferred to the provider, and the reimbursement process is completed. What Leads to the Rejection of Claims? Here, it is important to understand that the bill submitted to the insurance company must comply with certain essential conditions. If the provider neglects or fails to comply with those regulations, payers reject the bill. Here are the certain conditions that healthcare providers must take into consideration when submitting the bill to the payer. The reasons that lead to the rejection of the claim include:

1. Incorrect or incomplete patient information
2. Invalid or missing medical code
3. Lack of prior authorization
4. Duplicate claim submission
5. Provider credentialing issues
6. Incorrect modifiers usage
7. Insurance policy issues
8. Service not covered by insurance

Industry-Best Approach to Prevent Claim Rejections The most viable approach to prevent claim denials is to thoroughly review the claims. The best practice to correct the denied claim is to analyze the denial reason by reviewing the Explanation of Benefits (EOB) or Electronic Remittance Advice (ERA) to find out the causes impacting claims such as missing information, coding errors, late filing, lack of medical necessity. The second step to review the rejection reason is to categorize the denial type such as correctible or resubmittal. Thirdly, correct errors such as correcting the patient’s name, insurance details, coding issues, prior authorization and eligibility, etc. Finally, resubmit the claim after correcting it through EDI (Electronic Data Interchange) or clearinghouse. It is worth recommending to take proactive initiatives to detect and resolve any discrepancy at the early stage that can yield significant time-saving, eliminate inconvenience, and significantly improve the overall operational efficiency of your medical practice. Types Of Payment Posting There are two types of payment posting in Medical Billing. Manual Posting Some healthcare facilities employ an auto-posting strategy to submit claims to the insurance company. This process based on manual and human intervention demands thorough attention to avoid errors. It requires continuous human efforts to ensure that includes the whole details that is necessary to ensure clean and correct claim submission. Auto Posting Compared with manual posting, most healthcare organizations prioritize using auto posting which is fast, efficient, and transparent. Its procedure is devoid of human intervention, more error-resistant, and responsive. In this procedure claim is automatically generated and is less prone to mistakes. Its outcomes are satisfactory both for payers and providers as it ensures seamless communication and collaboration between the two, leading to improved operational efficiency. Manual Or Auto Posting Is the Best for Medical Billing? The use of both varies from organization to organization, depending on certain factors such as the scale of the facility and personal preferences. There are similarities and differences, manual posting ensures greater control, human oversight reduces errors, effectively tackles unique challenges, and is not reliant on software. On the other hand, auto posting is not without advantages such as faster processing, automatic payment posting, minimizing manual data entry errors, improved cash flow, and ensuring easier reconciliation. The strategic decision regarding the selection of the channel of claim posting requires a thorough investigation. Based on our years of experience in this industry, we would like to suggest going for auto posting if your practice is small. It is best for the small practice as it will enable you to minimize errors, have greater control, and timely resolve the unique challenges. On the other hand, if you have a large-scale practice, then the feasible option is to go for auto posting which is quick, efficient, and produces immediate results. A hybrid approach is the most desirable to ensure efficiency and maintain balance. What Are the Major Benefits of Payment Posting in Medical Billing? Here, we explain in detail the major benefits that you avail to improve the services of your healthcare practice through a well-executed payment posting procedure. Ensures Financial Stability A well-organized payment procedure crafted by experts amplifies the financial stability of your healthcare practice. Once a clean and clear claim is submitted to the insurance company, you can devise a business strategy based on revenue forecasting. This is what we can say consistent cash posting that keeps your practice financially stable. Provides Valuable Insights Through Electronic Remittance Advice (ERA) and Explanation of Benefits (EOB), healthcare providers get incredibly productive insights that help them elevate their practice to excellence and perfection. These details provide information on whether the claim has been approved, adjusted, or denied. It also outlines contractual adjustments, patient responsibility, and payer payments. This information is largely productive to improve revenue cycle management and ensure accurate patient billing and financial forecasting. Stops Recurring Denials There is no denying the reality that almost all healthcare facilities experience a huge revenue loss due to recurrent claim denials. Most of the time their reimbursement rate falls short of their expectations. Accurate payment resolves this issue to a greater extent. Apart from posting insurance payments, it covers adjustments and denials. Through Electronic Remittance Advice (ERA), the payer outlines the factors leading to recurring claim denials. This insight proves helpful for providers to proactively identify the causes and resolve them to avoid recurring claim denials. Improves Existing Workflow System Revenue cycle management is one of the strongest pillars of any healthcare facility. In this regard, efficient, accurate, and transparent revenue cycle management services are crucial to ensure a steady stream of revenue for the system. Occasionally, it has been noted that management often neglects or may overlook the existing flaws in the healthcare system which leads to a huge revenue loss for the practice. Once those flaws are identified, it becomes easier for them to take proactive steps to resolve them to make a more responsive and efficient healthcare financial ecosystem. Final Thought Given the numerous benefits both financially and operationally, efficient and accurate payment posting is what creates plenty of potential growth opportunities to ensure strategic growth and sustainable financial stability for your practice. In addition to strong cash flow and improved financial forecasting, payment posting also makes it easier to not only understand the current status of your practice but also get an idea of where your practice is heading. It creates an ideal situation for you to put right what is wrong in your practice and improve further what is already doing good to your practice. FAQS What is payment posting in Medical Billing? Payment posting in medical billing is the process of recording payments from insurance companies and patients into the billing system. It ensures accurate account reconciliation, identifies underpayments or denials, and helps maintain financial transparency for healthcare providers. What does payment posting mean? Payment posting means the process of recording and reconciling payments received from insurance companies, patients, or other payers in a healthcare provider’s billing system. It ensures accurate financial records and helps track outstanding balances. What is payment posting definition? Payment posting is the process of recording and reconciling payments received from insurance companies and patients in a healthcare provider’s billing system. It ensures accurate financial records and helps identify discrepancies, denials, or outstanding balances. How does payment posting improve revenue cycle management? Efficient payment posting streamlines cash flow reduces billing errors, and speeds up claim reconciliation, leading to faster reimbursements and improved financial health for healthcare providers. Why is payment posting important in medical billing? Payment posting is crucial in medical billing as it ensures accurate tracking of reimbursements, identifies claim denials or underpayments, and streamlines revenue cycle management for faster cash flow and reduced billing errors. How does Pro Medical Billing Solutions optimize the payment posting process? Pro Medical Billing Solutions expertly manages payment posting with precision, ensuring error-free transaction recording, quick denial detection, and seamless reconciliation, leading to enhanced revenue, faster reimbursements, and a more efficient operational system.