completing the Claim Entry section, the next step in the patient visit process
is Payment Posting. This tab is where
you will post all insurance payments (EOB) contained in the workbook .
SEE THE “REMINDERS”
and “SAMPLE OF INSURANCE PAYMENT FORMS” IN THE WORKBOOK! Following are the page numbers for each
Payment Posting section:
| Rocky Shore, pg 127 || West Point, pg 105 || Crown Valley, pg 87|| Sunset Springs, pg 119|
| Maple Hills, pg 123|| Hidden Cities, pg 101 || Prime Smile, pg 139|| Harbor Lake, pg 99|
| Cherry Hills, pg 75|| || || |Select Payment to enter each EOB statement.
Review the Tabs
It is important to understand the seven tabs and their functions; however, you only use three of the tabs. Understanding what tabs
to use when posting the payments will minimize your scoring errors.
Line Item Posting: If you forgot to
enter the patient co-payment at the time of the claim entry, you can post it
Account Posting: Not applicable.
EOB Posting: Enter all EOBs
here. It will calculate what you have applied and what remains, based on the total check
amount. Also, you can retrieve an EOB anytime and edit
the financial information.
EOB Auto-Apply: Not applicable.
Adjustment: Not applicable.
The opportunity to delete any charge, payment, adjustment or procedure.
Credit Management: Not applicable.
Enter in Patient Co-Payment (in the 1 Line Item Posting Tab)
1 Line Item Posting: If you forgot to enter the patient co-pay
at the time of the charge entry, you can enter it here. Complete the posting in this six-step
the Add button and search for your patient.
Type of Transaction “D- Patient Co-pay.”
the Enter Data button on the office visit charge; the Enter Patient
Co-Payment screen displays.
Payment Amount, Payment Type, and Check #.
the Save button on this payment screen.
the Save button on the main screen.
Enter EOBs (in the 3 EOB Posting Tab)
3 EOB Posting: Enter all EOBs here. To begin, click the
Add button. Complete the posting in this five-step sequence:
1. Check From: Enter the payer name.
2. Check Date: Also called Payment Date. Enter a date.
3. Check Number: Listed on EOB. Enter the number here.
Check Amount: Enter the total amount of the check.
click the Add Payments for Claim
button. A claim search will display for you to enter the first initial of the first or last name that is given on the EOB. Press the Enter key or click Search button.
The Claim Payment screen will display for you to continue with the EOB posting by entering in the patient insurance amounts.
Claim Payment Screen
Understand the columns and the various synonyms that may be listed on the EOBs. To begin entering in the amounts from the insurance statement, place your cursor in the Allowed field. Press Tab on the keyboard to continue to the next field. You may toggle through each field and enter data as you go. Use the Totals row to also confirm your entry prior to applying.
1. Payment by: The payer will default, but it often does not choose correctly. Make sure the Payment By is the same as the EOB payer you are posting from.
2. Date: The date of service you entered from the claim form during the claim entry process.
3. Proc: Procedure; the charge code you entered from the claim during the claim entry process.
4. Amount: The amount of the procedure/charge you entered from the claim during the claim entry process.
5. Balance: The balance will adjust automatically based on any payments/adjustments/unpaid/deductible amounts entered in this screen and from the claim entry screen.
6. Allowed: Place your cursor on the top line in the Allowed field, and enter the allowed amount given on the EOB. If the Allowed on the EOB is 0.00 (zero), you must manually calculate and enter the adjustment as the system does NOT calculate zero dollars allowed. The formula for Allowed is: Amount Billed - Adjustment = Allowed.
7. Payment: Locate the Payment column and place the cursor in the top line field and enter the paid amount.
8. Adjust: This field auto-calculates the Amount - Allowed column; however, if different adjustments are listed on the EOB,
you can override this auto-filled amount.
9. Unpaid: This field auto-calculates the Allowed - Payment column. This bucket should combine the totals stated on
the EOB of both the co-insurance/copayment and deductible. This field is the patient responsibility and is calculated into the
10. Deduct: This field is informational only and does not count toward the patient’s debit. The deductible does not populate or calculate; you are to enter in the deductible amount if given on the EOB.
11. Details: Not applicable.
12. Billing Status: This defaults to the
proper status; however, you can manually select a status of the charge. If there is a
balance in the Unpaid or
the patient has a secondary insurance, the billing status should be “Send to “Name of 2nd Insurance”.”
the patient does not have a secondary insurance, the billing status should be
“Balance Due Patient,” as they owe the deductible and/or coinsurance.
13. Remove: Check this box and
immediately the Totals adjust as if
you changed the fields to all zeros or removed this line.
PROFESSIONAL CLAIM PAYMENT ENTRY:
following Claim Payment screens are for institutional and dental entries. The only additional column is the third column
that provides additional information to help distinguish between the line items
of the claim.
INSTITUTIONAL CLAIM PAYMENT ENTRY:
DENTAL CLAIM PAYMENT ENTRY:
When you are satisfied with your entries, click the Apply button at the bottom, right of the screen, to save this posting. You will return to the previous screen.
To continue to add another patient to this EOB,click the Add Payments for Claim button.
Once all the patient(s) payments/denials have been entered, verify the Remaining amount is $0.00, and click the Save button.
Retrieve Any EOB to View or Edit:
the Find button.
the Search Checks screen displays.
Immediately click Search (intentionally leaving the screen blank
to bring up all EOBs posted).
Find Insurance Payment screen displays.
Click on the desired EOB.
EOB will display for you to view.
To edit any payment, see the next topic.
Edit Any Payment Postings:
View the totals here. The benefit of posting all EOB entries under the 3 EOB Posting tab is that at anytime, you can edit the allowed, payment, and adjustment fields. By clicking on the patient name, you will be taken to the Claim Payment screen. Make any corrections, and click the Apply button again.
On the Claim Payment screen, click in the desired field to update amount. Click the Apply and then Save button to save edits.
_______________________________________________________________________________________________________________Auto-Calculates Your Posting:
sure your Applied total is the same amount as the EOB's Check Amount, and the
Remaining total is $0.00.
Add Multiple Patients from the EOB:
the EOB contains entries for multiple patients, simply click the Add
Payments For Claim button for each additional patient.
____________________________________________________________________________________________________________________________________________ Delete an EOB Entry:
a patient EOB entry is incorrect, you can select Remove on the right
side of the patient’s claim to remove all payment, adjustment, and allowed
data. To edit the information, click the
patient name to display the Claim Payment screen to re-enter the data
Save the EOB
Once all the money from this check has been applied (Remaining = $0.00), click the Save
Delete/Review Any Transaction (in the 6 Transaction Maintenance Tab)
Transaction Maintenance provides the opportunity to delete any charge, payment, or adjustment. Complete the six-step sequence:
1. Click the Find button and retrieve the desired patient.
2. Check to show ALL five Transaction Types.
3. Click to refresh the transactions by clicking on the Refresh Transactions button.
4. Transaction(s) will display. Click the Expand All button to simultaneously view all transactions.
5. All transaction types display. The only thing you can do here is delete a charge, payment, or adjustment. Do so cautiously by
selecting the appropriate line(s) in the Delete column.
6. Click the Save button to permanently delete the items checked or click the Close button to not save the deletions.
Practice Revenue Cycle Activities: Collections
The practice revenue cycle activities are a combination of discussion questions and activities using ClaimGear and its workbook .
It is important to post payments by both patients and insurance companies correctly. After you have applied all payments, complete
the following tasks to further enhance your revenue cycle experience as it relates to your current ClaimGear assignment.
1. Did you post the patient co-payment as indicated on the claim, during the claim entry process?
a. If you forgot to post the patient payment at the time of claim entry, did you enter it correctly under Payment, 1 Line
Item Posting tab?
2. When posting an EOB, did the remaining amount display $0.00 as it should? Did it ever not? If so, how did you fix this
3. Some EOB’s include multiple patients on one EOB. Was the auto-calculating of the applied amount and remaining amount
helpful to you?
4. Did you have to delete any transactions, such as a charge, payment, or adjustment?
The insurance industry has a variety of names for the same function. Note the ClaimGear
insurance payment columns
are labeled: Billed, Allowed, Paid, Adjustment, and Unpaid. Each payer uses a different name than our column names. Can
you list the multiple synonyms from the different payers in this assignment?
6. The claim scoring will also include scoring of the payment postings.
a. How many claims did you receive 100% on when you scored your assignment for the first time?
b. How can you improve your payment posting? Suggestions for improvement include becoming more efficient, taking
more time to do the job correctly, understanding the process better or understanding the terms used between payers