Setting up a robust payment posting reconciliation process is not just about keeping your books tidy. It’s crucial for cash flow, avoiding denials, and maintaining trust with patients and payers. Errors in payment posting can snowball into bigger issues—think overpayments, underpayments, or unrecognized revenue. Implementing both daily and monthly reconciliation processes can make a world of difference.
Daily Reconciliation: The Backbone of Accuracy
Why Daily?
Daily reconciliation might seem tedious, but it’s essential for catching errors early. Every day, payments and adjustments come in through various channels—ERA, EFT, even snail mail checks. Daily checks ensure nothing slips through unnoticed.
Setting Up Your Daily Process
Gather Your Tools: Start with your EHR and billing software open, along with payer portals for quick access. If you're still relying on spreadsheets, it might be time to reconsider—manual entry is a breeding ground for errors.
Match Payments to Remittance Advice: Begin by matching payments received to the remittance advice provided by payers. This means verifying every payment line item, not just totals. Automated ERA posting can handle much of this, but it’s not foolproof.
Address Discrepancies: Any mismatch should be flagged immediately. Is there a missing payment? A duplication? Get on the phone with the payer support line—expect hold times— to sort it out while details are fresh.
Note Adjustments and Write-offs: Ensure all adjustments and write-offs are accurately recorded. Arbitrary write-offs to "make it balance" will bite back during audits.
Daily Reports: Run end-of-day reports comparing payments received to payments posted. It’s a simple check but essential for validation.
Monthly Reconciliation: Taking a Step Back
The Importance of a Monthly Review
While daily reconciliation keeps the ship sailing smoothly, monthly reviews help you steer it. These are your chance to catch broader trends or systemic issues that aren't visible in daily reconciliations.
Monthly Process Setup
Prepare for Month-End Review: Block out time with your billing team. Have everyone gather any unresolved issues or discrepancies flagged over the month.
Run Comprehensive Reports: Include total charges, payments, adjustments, and any outstanding balances. Look for patterns—like a spike in certain denial codes—that could indicate deeper issues.
Payer-Specific Reports: Analyze payer-specific data. Payer quirks can cause consistent headaches—some might consistently underpay or delay responses. Use data to back up conversations with reps.
Bank Statement Reconciliation: Match your system's total deposits with bank statements. Discrepancies here can signal missed postings or fraudulent activity.
Reconcile Patient Balances: Ensure patient payments are correctly applied. Misapplied payments can lead to frustrated patients and a hit to practice reputation.
Audit Adjustments: Review all adjustments for the month. Are there patterns of non-standard adjustments that could indicate training issues or systemic problems?
Common Pitfalls and How to Avoid Them
Overreliance on Automation
Automation can speed up processes, but it’s not infallible. ERA auto-posting can miss nuances, leading to incorrect payment applications. Regular human checks are necessary.
Ignoring Small Discrepancies
A few cents here and there might not seem like a big deal—but they add up. Consistent small discrepancies can indicate larger procedural issues.
Lack of Communication
Sometimes billers work in silos, handling their own set of payers or types of claims. Monthly reconciliation should be a team activity—it’s a chance to share insights and learn from collective experience.
A Forward-Looking Approach
Reconciliation isn’t a one-time fix; it’s an ongoing process that evolves with your practice. Regular training, updating your reconciliation procedure, and staying informed about payer policies are essential. By embedding reconciliation into your daily and monthly routine, you're not just ensuring accuracy—you're securing your practice's financial health.
Avoid complacency and keep questioning processes. The right question can uncover savings or point to inefficiencies. It’s these details, often overlooked, that pave the way for truly effective reconciliation.
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