Autopost ERAs (Advanced Training Session)

With PCC, you can automatically post most payments and adjustments sent to your practice as an ERA. If a response requires manual attention or you receive a paper EOB, you can manually post the payments and adjustments.

While most claims are transmitted to payors electronically, sometimes you may need to generate a paper 1500 HCFA form.

You can use PCC's tools to work on claims with errors, rejections, and denials. But what if a problem is fixed, but the claim wasn't resubmitted? Or what if an insurance payor simply never responds? Are some insurance payers regularly failing to pay you in a timely fashion? You may need specialized tools to track and work down your practice’s insurance A/R.

Every insurance claim in your PCC system has a unique identification number. The number appears in various reports and programs, and you can use it to improve claim tracking and payment posting.

Sometimes a credit should be written off and counted as income to your practice. For example, if an account credit or insurance overpayment remains on your books for several years, your practice may decide to write it off and treat it as revenue.

When you need to refund a personal credit to a family, you can post a refund adjustment.

From time to time, insurance companies will ask you to reimburse them for an overpayment. Sometimes, the company will ask you to send them a refund check. Sometimes, they will underpay you for more recent charges in order to make up for the overpayment on an old charge.

When insurance carriers send payment and adjustment information, either on an EOB or an ERA, they often include a code with a small message. These codes are known as CARC values, or Claim Adjustment Reason Codes, and they are an industry-wide standard.

When a check bounces, or a credit card payment is stopped, you can quickly reverse the payment in the Payments tool in PCC EHR. You can optionally post a fee, in accordance with your office's financial policy.

Learn how to post personal payments in PCC. When a family pays their bill, you can enter their payment, link it to charges, and optionally enter account notes.

The medical biller's job would be easier if accounts paid on time and insurance companies reimbursed the correct amount. Unfortunately, accounts build up balances and credits and insurance companies overpay, underpay, and demand "takebacks."

After a payer reviews your electronic claim, they will send your practice an explanation of what charges are paid, adjusted, or denied. On paper, this information arrives as an Explanation of Benefits (EOB) and a check. The electronic version of an EOB is called an Electronic Remittance Advice, or ERA. An ERA usually arrives in coordination with a direct deposit to your practice's bank account. You can use PCC software to post payment and adjustment information from both ERAs and traditional EOBs.

Occasionally, insurance carriers pay you interest for charges they have failed to pay in a timely manner. How can you record that interest in PCC, without throwing off your Accounts Receivable? An interest payment is unexpected revenue that should not be posted against the original charges. Is there a "correct" way of keeping track of the income in PCC?

Insurance companies sometimes pay you more than the remaining balance due on a charge or more than the contracted amount. Since you can not post more money than was due, and the payment may be “taken back” later, how can you track the overpayment?

Contents1 Create the Insurance Groups, Plans, Fees, Payment Types, and Accounts to Record and Track Payments2 Post Capitation Payments Capitation payments are not like other income. How should you configure the PCC billing system so you can enter and track capitation payments over time? Read the steps below to learn how to create appropriate insurance […]

You can review payment history by encounter, or see all payment history for an account. You can also edit payments that were posted incorrectly and adjust how payments are applied to charges. Read below to learn how.

You can print a receipt whenever you post a payment. You can also print a receipt for any payment(s) in an account's history.

After you prepare and submit claims, you must deal with claims that could not be submitted or were rejected.

When you want to write off a charge that is unrecoverable ("bad debt"), or post other account adjustments that reduce the amount due for a charge and decrease an account's outstanding personal balance, use the Payments tool.