Post Capitation Checks, Incentive Payments, Interest Payments, and Withhold Payments
How do you record a payment that does not correspond to amounts due for encounter charges?
When an insurance company sends you an ERA, PCC can automatically post payments and adjustments or you can record them manually (see Post Insurance Payments).
But what about capitation checks, incentive (pay-for-performance) payments, insurance interest, and end-of-year withhold payments?
Option 1: Your practice may decide to track this revenue outside of PCC EHR, such as in your accounting system. These payments are income for your practice, but they do not directly correspond to specific charges you have billed.
Option 2: Your practice can use holding accounts to record these types of payments as revenue in PCC EHR. Open the holding account, create an administrative encounter, and then select an adjustment procedure and enter the payment. Read the sections below to learn more.
Video: Watch Post Less-Common Payments to learn more.
Contents
Create Holding Accounts
When you enter all types of payor payments into PCC EHR, it improves reporting and payer analysis. PCC does not have a formal accounting entity for payments that are not attached to a patient. Your practice can set up holding accounts for each type of payment you need to record.
The simplest way to do this is to create a patient record and a corresponding billing account using the name of the type of payment. For example, if you need to record end-of-year payments related to withhold payments, you could create patient and family records named “Withhold Withhold”, and post an adjustment and payment to that patient.
Create patients and accounts as you would for a normal family, using names for each type of payment you need to track. For example:
- Capitation Capitation
- Incentive Incentive
- Interest Interest
- Withhold Withhold
Many practices find it useful to be more specific and track these payments by insurance group. To do so, create holding accounts with the insurance group as the first name and the type of payment as the last name for the patient and the billing account. For example:
- BCBS Capitation
- BCBS Incentive
- BCBS Interest
- BCBS Withhold
Your practice’s billers can decide what holding accounts you need and how to name them. If you use the insurance group name (or “Medicaid”) as the first name for the patient and account, it can make reviewing what happened and calculating total income from a payer easier later on. However, if you rarely receive one of these types of payments, you may decide instead to use a generic account and simply note the source of the income in an encounter billing note.
Post Capitation Checks, Incentive Payments, Interest Payments, and Withhold Payments
When you receive a payment in the form of a capitation check, incentive payment, insurance interest, or withhold payment, follow the procedure below.
Open the Holding Account
Open your practice's holding patient account named for the type of payment you need to post.
Your practice can set up holding accounts named for different kinds of payments and optionally include the name of a specific insurance group.
Navigate to the Billing History
Click on the History chart navigation button and then click Billing History.
Click Create Encounter
You can use the "Create Encounter" feature to record many different types of financial transactions, such as any fee not associated with an encounter or the less-common types of income described above.
Select a Provider and Optionally Update the Place of Service or Date
Select a provider for the administrative encounter. According to your practice's accounting practices, you may also need to adjust the place of service or date of service.
Select the Appropriate Adjustment Procedure and Enter an Amount
What is the payment for? In the Procedures section, find the adjustment procedure (such as "Insurance Interest") that will offset the payment you received. Enter the amount of the payment as the "Price" of this adjustment.
Self Pay: Whenever you enter an adjustment procedure to offset these types of payments on a holding account, you post the procedure as "Self Pay". Self Pay will be selected by default.
Enter Payment Details
In the Payments section, select the Payment Type (such as "Insurance Interest"), and enter the amount and check number. The full amount of the payment should be applied to "today's visit".
Click Save + Post
Click "Save + Post" to record the adjustment procedure and payment on the holding account.
You can review what was posted on the Billing History and use the Billing History Index to review all payments posted to the account.
What About Overpayments?
An “overpayment” is when a payor sends more than is due on a charge, such as when you receive a duplicate payment for an encounter. In the past, some practices used holding accounts and administrative encounters to track overpayments. If your practice used this method, those holding accounts, containing insurance credits, may remain on your system.
However, overpayments should attach to the original encounter and charges shown on the ERA/EOB, even if they are unable to be applied towards those charges. As of the PCC Fall 2026 release, you can post an overpayment, or edit an existing insurance payment and turn it into an overpayment.
Post an overpayment any time you want to enter remittance information without the payments or adjustments affecting the encounter’s charges.
See Use Overpayments to Keep Track of Insurance Credits to learn more.
Configure Adjustment Procedures and Payment Types on Your PCC System
When you record these less-common payment situations, you use adjustment procedures and payment types that reflect their purpose.
PCC Can Do This Configuration For You: Your PCC system is configured by default with adjustment procedures and payment types, and PCC Support can help you make changes as needed.
The adjustments and payment types are defined in your practice’s Procedures table and Payment Types tables, found in the Tables tool.
For example, when you post an insurance interest payment, it will be offset by a procedure called “Insurance Interest”, which indicates what the payment was for. These adjustment procedures are found in your Procedures table in the Tables tool. They have an accounting type of “Revenue – Non-Service” and have no billing code or price. (As shown in the procedure above, you enter the amount of the adjustment when you post it.)
For each adjustment procedure, you use a corresponding payment type, such as an “Insurance Interest” payment type. Payment types are found in your Payment Types table in the Tables tool. Payments for insurance interest, capitation payments, and similar should have a Class of “Insurance” for reporting purposes. These payments types should include the option to be used when posting charges so they can be used when you create administrative encounters as shown in the procedure above.
To learn more about making changes to these tables, see Edit Your Practice’s Procedures and Adjustments and Edit Your Practice’s Configuration Tables.