Auto Posting of Insurance Payments Must Handle Zero Payments From Insurance Companies

In a medical office that does not have an ERA auto poster, each zero payment received from a payer is reviewed manually to determine among other things, if the insurance company correct. If so, the billing clerk has a number of options for handling the balance: mark the claim as paid and write off the balance, or apply the deductible and then write of the balance, or several other options.

When you consider purchasing an automated posting program, handling zero payments correctly is a critical component of your evaluation. Here are some other things to review and be aware of. This is not an exhaustive list but a good start. It is this author's experience that an accurate, exhaustive list can only be prepared after the fact.

When you engage an ERA auto post system to apply payments for you it needs to accomplish the same tasks you would perform manually though not necessarily in the same way. To varying degrees all systems have been programmed to do just that. The short story, whatever it is designed to do, given the options you select and the data presented to it in the ANSI 835 file and the accompanying billing system, it will do quickly, accurately and relentlessly.

Accuracy is defined as following the rules it is programmed to follow using the data it has to work with. Exceptions are planned for and handled, ignored or processed using a set of rules that is inadequate or incorrect.

It is probably unrealistic to expect any software system, regardless of size and complexity, to function exactly the way you want it to. Most often the best results come from a combination of options in the system and modifications in clinic processes and procedures.

Handling a zero payment is a good example. It is not satisfactory to simply mark the transaction as paid and write off the balance. That may be correct most of the time but there remains a sizable number of transactions that require the application of other rules.

Some other features to look for before you buy:
1. will it accept any ANSII 835 from any clearinghouse
2. can you correct errors before posting
3. is the deductible posted and YTD deductible update in the patient record
4. are secondary payments posted
5. can you see Denial Code Definitions or do you have to remember the codes by number
6. can you define the posting date or is it forced
7. can you select any or all the ANSII 835 files you want to post
8. does it protect you from posting the same batch twice

There are others and you may have a list of your own. Ask the questions and look at the answers. Ask for a live demo. Among other things watch for HIPAA compliance with the data used in the demo. Has it been sanitized? The answer will be indicative of the care the vendor has taken to develop this and other software products.

Support for the product is an important consideration. It may seem unimportant and will be until you need it. Upgrades to the product and the ability to keep it current with your billing system as it is enhanced needs to be part of the package you purchase.

Once installed and working you will enjoy significant time savings, greater security from fraud and greater flexibility among your automated processes.