September 4, 2019

5 Strategies to Elevate your Payment Posting Department

Brandon Hall

Payment Posting may not be a on leadership’s radar for an area of concern/improvement, but it can routinely be a source of trouble.

Inappropriate adjustments and denials can stack up by the thousands in a matter of days, and usually requires lengthy cleanup. Inaccurate posting requires manual intervention and can create guarantor confusion and unhappiness. The lack of timely and accurate posting can also bloat your A/R. Look at the strategies below to improve your payment posting landscape.

  1. Listen to your Neighbors
    • Who better to provide feedback to your area than the teams impacted by your work? Stand-up a weekly workgroup with Follow-up, Credits/Undistributed, and IT to share feedback about cash posting. This is the proper workgroup to address reason code action changes, work queue ownership, and other integration issues/projects that will improve posting accuracy and keep exceptions down.
  2. Automate Processes – Let the system do the work!
    • ERA/EFT Enrollments – Work with your clearinghouse to determine what ERA/EFT enrollment opportunities exist and evaluate the time savings from moving away from manual posting for those opportunity payers. If your organization has several NPI and Tax ID combinations, make sure to audit to see if gaps exists, and if they do, work to close them.
    • EOB to 835 Conversions – Most banks will offer a solution to covert paper EOBs, or in some cases, denial/$0 payment letters into 835s. These projects can take valuable resources to implement, but usually offer significant time savings in the long haul.
    • Electronic Self-Pay Payments – Like EOB to 835, most banks, bad debt, and early out vendors can convert their self-pay payments into electronic files. These files often only contain a handful of data elements, so conforming to a consumable format should be straightforward.
  3. Move to Electronic Reconciliation
    • One of the most difficult and time-consuming daily tasks within cash posting is reconciliation. If you’re still using paper or a variety of spreadsheets, it’s time to move to an electronic solution that will eliminate numerous manual steps and endless research. There are a variety of solutions to choose from, whether it’s from your bank, your EHR, or a third party, moving this process to an electronic solution should be a priority. There will be a resource investment to implement a reconciliation solution and work exceptions, but the long-term time savings and accuracy will speak for itself.
  4. Dedicate Time to Work Queue and Clearing Account Hygiene
    • There are a variety of reasons for work queues and clearing accounts, but ownership and maintenance can be challenging. Follow-up, Finance, Credits, and Self-Pay billing are just some of the areas that rely on timely and accurate payment and adjustment posting-keeping payment related issues/inquires low will keep those teams happy.
  5. Update Policies & Procedures and Training
    • When was the last time your department reviewed your P&Ps? Do they even exist? Creating and/or updating P&Ps can really help when staff have routine questions, and it forces your experienced staff to put what is in their head, or on their desktop down on paper. The same is true for training. Making sure your training resources encompass your workflows and contain ample detail will aid with onboarding new staff and serve as a great refresher. Put in the extra effort to make sure your artifacts are an accurate representation of your department’s daily work.
  6. Bonus Item – PLBs (Provider Level Adjustments)
    • PLBs can be confusing and stack up very quickly in terms of count and dollars. There are a variety of approaches to handling PLBs from a systematic and manual standpoint but understanding what each type of PLB means is key for control and management. Your system can do most of the heavy lifting for you, but that intelligence needs to be programmed by IT based on your business requirements.

The recommendations above are from a recent Wilshire engagement with a large academic health system. We’ve achieved significant improvements on unposted cash lag, percent of electronic payments, monthly cash goals, and staff productivity. This organization is truly doing more with less due to the efficiencies gained through the items above.

Do you need help elevating your Payment Posting Department? If so, send us a message or leave a comment below.

Brandon Hall

Senior Strategic Advisor

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