Cash Posting

Cash / Payment Posting

It is the section where payments are getting posted or recording of denials for each and every account.

Sources of Payments for a Provider:

                                                          1. Patient
                                                          2. Insurance

Modes of Payment for a Provider:

Insurance Payment = Check, Electronic Fund Transfer (EFT), Credit Card

Patient Payment = Check, EFT, Credit Card, Money Order

Payment Methodology:

Fee Schedule: It is a list of all the procedures with their corresponding billed and allowed amount.

Fee Schedule: 

It is a list of Complete Chart shows the maximum payble amount for the treament or procedure.

*** Fee Schedule is given Only to the Participating Providers.

Case Rate Payment: Is a single fee paid for the complete course of treatment.

Capitation: Is a dollar amount paid to the provider by the insurance every month regardless of the number of patients he treats that month.

Billed Amount: Is the amount for a procedure code with the insurance company for payment.

Allowed Amount: Is the amount for a procedure code by the insurance company.

Paid Amount: Is the amount paid to the provider after deducting the patient's responsibilities.

Offset/Takeback: Is an adjustment made towards an overpayment to the provider in the past.

Withhold / Retention: Withhold of payments happen in case of missing / invalid Tax ID or billing address information and needs to be corrected by the provider only through a W9 form.

Interest: Insurance pays more than the normal amount since they take more time/extra time for provider's money.

Late Filing Charges/Penalty: Provider sends the claim late to the Insurance (i,e) takes more than the filing period. The insurance has 2 options:

                                1. Deny the claim for timely filing

                                2. Might consider with penalty. 

Patient Responsibilities / Out of pocket Expenses:

Deductible (PR 1): Is an insurance prefixed amount which the patient needs to satisfy before the insurance company starts paying the medical bills. Deductible is a cost containment phenomenon.

Co-insurance (PR 2): Is a percentage of the allowed amount which the patient or the secondary insurance pays. Co-insurance is a cost sharing phenomenon.

Copay (PR 3): Is a fixed amount by the insurance which the patient needs to pay at the front dest of the provider. Copay is a cost containment phenomenon.

*** PR is Known as Patient Responsibility and numeric portion shows what type of responsibility. 

Formulas:

1. Contractual Adjustment = Billed Amount - Allowed Amount in Case of participating provider

2. Balance Billing = Billed Amount - Allowed Amount in Case of Non Participating provider.

3. Paid Amount    = Allowed Amount - Patient Responsibility.

4. Allowed Amount = Paid Amount + Patient Responsibility.

5. Patient Responsibility = Allowed Amount - Paid Amount.

Denied or Paid

If the claim is approved and paid insurance will send a copy of paid EOB along with check to the pay to address (where provider wants to receive their payment). 

If the claim is denied insurance will send a copy of denial EOB with out check. In denial EOB they will mention the denial reason with denial code. Payment posting team will post all the paid claim and make the account Zero where as denied accounts will be moved to AR (Account Receivable) Analyst for further clarification.