Payment Entry Process

Cash Posting or Payment Entry Department | * Posting of the details contained in the EOB * Should post the relevant charge in the appropriate patient’s account * Initiate the process for the denied claims. Payment Entry Process - Flowchart | | | | | | | | | | | | | | | | CASH POSTING OR PAYMENTS | When a claim has been processed and paid, the amount paid will have to be applied to the amount charged for individual patient’s treatment in the Medical Billing Software. This makes it possible for the billing office to track the payments received from different angles. The billing office would want to track the payments received based on differed criteria.

Cash posting or the correct application of
This is the amount charged by a physician as a compensation for his services. The billed amount will reflect on the claim against the treatment that was performed.Allowed Amount. Most insurance companies have a fixed payable amount for each of the different services performed by the physicians. They fix this amount based on various in-house calculations like cost of the treatment, geographical location of the practice, average charge of all physicians for that procedure etc., Insurance companies will pay only their allowed amount regardless of how much the physician bills.Write-off: When the physician’s billed amount is more than a participating insurance company’s allowed amount, the insurance company will pay it’s allowed amount and the difference between the billed and the allowed amount will be written off or adjusted.WRITE OFF=BILLED AMOUNT – ALLOWED AMOUNTParticipating/Non-participating: A physician can either have a participating or a non-participating relationship with an insurance company. A participating relationship is one in which the physician accepts a payment of the insurance company’s allowed amount as full payment, for any of that insurance company’s beneficiaries. This is regardless of how much the physician billed for his services. If the physician bills over the allowed amount, the insurance company pays the allowed
Depending on the type of coverage, the patient will have to pay $500 or $1000 for his medical treatment before his insurance company starts paying on his behalf. Some insurance companies have a yearly deductible, which means that every calendar year the patient would be responsible for a certain amount of money before their insurance starts paying their medical bills for that year. Other insurances have a lifetime deductible, which means that the patient will have to pay for his treatment until a certain limit (like $5000) and then the insurance would start paying till his coverage is valid.Co-insurance/co-payment: A primary insurance company makes a payment on a claim to a participating physician. They instruct the physician’s office to collect a specified amount from the secondary insurance or the patient. This specified amount is called a co-insurance or co-payment.Balance bill: When a non-participating primary insurance co. pays a part of a claim, the balance on the claim can be billed to the patient or secondary ins. Regardless of the non-participating ins. Allowed amount.Out of pocket Expenses: A medical bill or part of medical bill paid by patient out of his pocket because of non payment of his insurance company is called Out of pocket expenses. Deductible, co-pay, co-insurance and balance bills are “Out of pocket