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Navigating the Payment Reconciliation Process

Medical billing professionals are typically responsible for hundreds of patient accounts on any given business day. While the exact amount of daily submitted claims and self-pay bills depend on the size of your practice but a daily reconciling of payments is essential for a healthy revenue cycle for practices of all sizes.

This reconciliation of payments from third-party insurers and patient payments of deductibles, co-pays and full charges ensures that all payments are posted appropriately to patient accounts in your billing software system and then reconciled against bank deposits.

However, payment reconciliation is quite complex for the following reasons:

  • Patients may have more than one health plan

  • Claims and payments are processed at different stages of treatment

  • Payer mix has shifted to the patient, with its own collection, tracking and deposit process.

  • Reconciliation involves multiple steps across different departments or team members.

  • There are different claim processes among third-party insurers.

When reconciliation issues arise, they usually result in unposted payments that challenges a clear picture of cash flow and revenue for your practice. This places financial reporting and projections and an accurate understanding of its financial health at risk. So understanding best practices in the processes and workflows of payment reconciliation will lead to a more efficient system —and likely a faster revenue cycle.

Technology Can’t Do It All for Payment Reconciliation

Technology is crucial to capturing charges and payment reconciliation through electronic fund transmittal (EFT) and electronic remittance advice (ERA) systems. Once the Operating Rules for the Affordable Care Act took effect January 1, 2014, which created policy for EFT and ERA, faster and broader development of software systems for healthcare payments and reconciliation followed.

Through its consulting with healthcare practices, Clinic-ology knows that choosing the software systems that work best for your practice is crucial. We can help break down your payment reconciliation processes and needs to help find the right match. But whichever system is used, the accuracy and efficient posting by your billing team comes first.

The basics of payment reconciliation appear simple:

  1. Third-party payment is posted to the patient account.

  2. Patient’s financial responsibility is determined.

  3. Patient is billed for that amount.

  4. Patient payment is posted to the patient account.

Medical billing professionals know the level of expertise this requires in medical coding, claim submission, handling claim denials, and patient self-pay collections is high.

Clinic-ology finds that for an effective revenue cycle management, clear policies and procedures are essential and recommends these best practices in payment reconciliation:

  • Conduct a daily reconciliation.

  • Maintain patient records in a consistent and easy-to-find format, such as consistent color codes and information tabs.

  • Eliminate paper as much as possible.

  • Develop clear practices for managing accounts, including for flagged transactions, denied claims, self-pay collections, and so on.

  • Have a designated account manager review patient accounts on a weekly basis.

  • Train team members in account management expectations.

  • Allow appropriate time for claims adjustments and resubmissions.

  • Be ready and willing to adjust processes for better practices and new approaches.

In the complex and changing world of medical billing, Clinic-ology works with healthcare clinics to implement technology and best practices into the payment reconciliation process and then train billing teams in these practices for better revenue cycle management and a faster cash flow for your practice.

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