Payment posting is not the most glamorous job, and conceptually it’s not rocket science. However, it is critical that it is done right. The skills and processes needed to ensure accurate payment posting have become more complex over the years with new technology and the advent of the electronic remittance advice.

Here are three practices that will ensure that your PM system is accurately tracking remittances received from payors:

We have seen many situations in which some ERA files were not processed by the PM system because either the file was never retrieved, was misplaced, deleted, or overlooked and not posted. The first three scenarios (not retrieved, misplaced or deleted) are self-explanatory, so we will elaborate on the “overlooked and not posted” category.

In the era of electronic remittances, payors often send files known as 'non-checks' or 'zero dollar checks.' When the month-end rush is in full swing, these files are often seen as unimportant; posting these ‘non/zero-dollar checks’ into the system is sometimes overlooked or forgotten entirely. However, these 'non/zero dollar checks' are just as important as the files associated with 'real' checks because they impact accounts with outstanding balances. They are usually associated with ‘provider level adjustments’ (PLBs), where payors will offset all payments or take-backs associated at the account-level with an organizational-level adjustment. These 'non/zero dollar checks' can also be overlooked when payors, such as the local Blues plan, send hundreds at once. When PM systems were splitting ERA files by checks, a few were overlooked. 

Make sure there is a process in place to account for all ERA files, especially if you have a process to split out the electronic file-by-check, (often a file will encompass several checks). Also, make sure that they all get processed and posted in your PM system. Your staff responsible for retrieving the ERA files should know the schedule of when and how many files your organization should receive, so that any variances (i.e., missing files) are caught early and researched/resolved.

This seems like a given, but you would be surprised that many do not have a process to reconcile their PM batches to the check (including zero-checks and non-checks). In some cases, it is an ownership issue. One department might be responsible for retrieving and processing the file, but the batch is passed to the payment poster to reconcile. If the payment poster didn't work the edits associated with the file (or work them correctly), the batch would not reconcile to the check. In other cases, the payment posters have the ability to set their own controls for the batch, so they could change the control totals to fit what they posted in order for the batch to post.

Reconciliation issues are avoidable with a process control in place (i.e., a control worksheet) where management can quickly review all batches reconciled to the check amounts. This is an even larger issue and risk when multiple systems are in place such as during a billing system migration.

Does your Patient Accounting (PA) department speak the same language as your Finance department? Reconciling what is posted in your PM system with what is in the bank may be tricky when your two worlds have different yard sticks. Finance will recognize funds when in the bank, whereas PA typically recognizes funds only when posted in the PM system. These two are usually not on the same day, which can cause issues when reconciling. Finding a good way to recognize, account (no pun intended) for, and 'bridge' the variance is key.

Make sure that both departments understand how this bridge is formed. Make sure that there is someone on your staff who can be an “interpreter” between the two departments. For example, PLBs may be a term that finance may not know, but when they are educated on this, it is may help account for some of the month-to-month variance in cash.