The process of payment reconciliation is complex, yet vitally important since the health care provider is the only party with access to both the billing system and the bank account. A discrepancy between the records could be symptomatic of a delay between various events, faulty deposit process, or fraud.

The multitude of steps that occur on varying dates complicate reconciliation process, as they affect how and when money is received, deposited the bank account, and recorded in the billing system:

  • Office:

  1. Cash is collected in the office
  2. Explanation of Benefits (EOBs) are received in office

  • Billing system records:
    1. Cash is recorded in the billing system
    2. EOBs are entered in the billing system (may have different check date than EOB date created in the billing system or bank deposit date)
    3. Electronic Remittance Advice (ERAs) are recorded in the billing system (may have different check date than ERA date created in the billing system or EFT date)

  • Bank records:
    1. Cash that was collected in the office is deposited in the bank
    2. Checks received from insurance company are deposited in the bank
    3. Electronic Fund Transfers are deposited in the bank

    For example, you may receive an explanation of benefits and a check on February 28. Suppose you fax them both to the billing system on March 1. Although the check is dated February 28, it will not be entered in the billing system until March 1 at the earliest, causing that check to show up on your March invoice. Conversely, the delay between the ERA date and the actual bank deposit date may take a week or longer. the billing system may receive ERA notice of payment from the insurance company on May 27, but payment would not appear in your bank account until June 2, causing a similar discrepancy between collections and invoice in May and June.

    Know any health care providers who complain about shrinking insurance payments and increasing audit risk? Help them learn winning Internet strategies for the modern payer-provider conflict by steering them to Vericle – Medical Billing Network and Practice Management Software, which powers such leading-edge billing services as Billing Precision (http://www.chiro-billing.com), Billing Dynamix (http://www.pt-billing.com), and Affinity Billing, and is home for “Medical Billing Networks and Processes” book by Yuval Lirov, PhD and inventor of patents in artificial intelligence and computer security.

    Related posts:

    1. Some Details on the Power Steering Pump
    2. What is a Cat-Back System?
    3. How to Build a Go Kart – 5 Go Kart Building Secrets