Payments should be posted at the time they are received, but staff should review each transaction carefully before entering the payment into the ledger. An error in the posting process may cause the patient’s account balance to be incorrect.
An insurance carrier normally sends an explanation of benefits (EOB) along with its payment. The EOB indicates how much of the charged fee was approved for payment, how much was applied to a deductible, how much was applied to a copayment, and how much was applied to other sources, such as a withhold in managed care plans. Most EOBs indicate how much of the charged fee the patient is ultimately responsible for paying. EOBs also provide data essential to the collection process in the office.
Before posting any insurance payment to the patient’s account, perform and document the following:
1. Compare the EOB with the original insurance claim and review each carefully. All charges on the claim form must be included on the EOB. Look for changes in current procedural terminology (CPT) coding by the insurance company (e.g., determine if a service was downcoded). The goal is to identify charges that can be appealed.
2. Investigate all denied charges, and appeal them, if necessary (these appear as zeros on the EOBs.).
3. Appeal all usual, customary, and reasonable (UCR) reductions, if necessary. UCRs are filed when the insurance company reduces the physician’s fee because the company feels it is too high for the practice area.
4. Respond quickly to any carrier request for additional information that appears on the EOB.