A Quick Guide to Smooth Healthcare Payment Reconciliation

End of the month reconciliation is a time both dreaded and feared by business office professionals across the world. Whether you’re in healthcare, education, or retail, every money-handler and accountant knows the drill. Maybe a few have come to terms with the long hours of reviewing records and comparing totals for payments, costs, and bad debt, but most view the 10 to 12-hour days associated with month end as a trial to be survived.

In a way, it is. It’s a trial to determine how efficiently and effectively your office has performed over the last 30 or so days, which can then be compared to previous months and previous years. End of the month reconciliation is a very necessary part of revenue cycle management, one that allows you to track the progress of your practice in both the short and the long term.

And with modern technology in play, it doesn’t have to be so painful.

The fact is that most money-related processes can be automated these days, particularly those requiring good record-keeping and quick calculations. After all, that’s what computers were made to do, and your practice has every right and every opportunity to take advantage of software advances that will make the revenue cycle management process easier.

Automation for Healthcare Payments and Reconciliation

In healthcare, revenue cycle management is a bit more complicated than most other industries. Insurance billing and coding processes are not as straightforward as patient healthcare payments, especially when you consider claim adjustments and denials. With the right technological tools, however, and proactive policies, month end and year end reconciliations could me made much simpler.

According to the Healthcare Information and Management Systems Society (HIMSS), a new set of Operating Rules for the Affordable Care Act (ACT) went into effect as of Jan. 1, 2014. These rules officially supported and encouraged the development of Electronic Fund Transmittal (EFT) and Electronic Remittance Advice (ERA) transactions for healthcare payments.

Basically, this ACA policy opened the door to developing electronic and automated processes for healthcare payments and reconciliation systems. Even better, improved systems are being developed to facilitate easier claims submissions and adjustment procedures. It’s up to each practice or hospital to find the best system for their needs.

Proactive Accounts Management

While technology can and should play a major role in your practice’s current revenue cycle management policies, there are some basic steps that must be respected in every business office for a smooth month end or year end reporting.

  • Organize your office and keep patient records organized in a consistent and recognizable format (same tabs of information, consistent color coding, etc.).
  • Develop clear and consistent practices for managing patient accounts that include weekly reviews from a designated account manager.
  • Train your staff on both the technology and accounts management expectations.
  • Allot ample time for claims adjustments and resubmissions.
  • Be willing to adjust for better practices and new approaches.

No amount of technology can replace simple human ingenuity, but it can make your job a lot easier. Don’t hesitate to explore potential system upgrades, particularly those that will make your monthly and yearly healthcare payment reconciliations easier.

That being said, don’t forget the basics either. Effective revenue cycle management is built on a foundation of clear policies and procedures. If you forget those, no technology in the world can help you, as all software relies on efficient humans to enter the right data and to monitor the system. The right balance—between well-trained employee and account management software—is what every practice needs to make the reconciliation process smooth and hassle-free.