The Avea Way: Best Practices for Payment Posters

Objective

As a payment poster, your number one priority is to post payments in a timely manner so claims can be closed or sent back to the payer for reprocessing, while also diligently labeling claims in AveaOffice so billing collections can follow up on reimbursement issues with the payer. Payment posting is crucial and should be prioritized to avoid team members calling on claims for status and wasting time on the phone.

Responsible

Payment posters are responsible for posting payments in a timely manner, closing claims that are paid according to the expected rate, and assigning claims back to the Billing Collections team for triage.

Billing collections will take over triage once the payment has been posted and sent back to the payer queue for follow-up.

 

Daily Process

Step

Action

Tips & Notes

Match Payments In Review

Go to Work Center > Insurance Payments > Review Insurance Payments

Resolve all payments in this list.

 

 

  • Matching ERA payments first ensures that there is no double posting from the payments you will post manually.

  • Don’t worry about closing these claims or triaging them now. The claims will automatically be placed in the Payment Review queue for follow-up on the next business day.

  • Adding a payment note while in the Resolve screen will show on the claim page when “Payment Notes” is check-marked.

Post Payments Received

Go to Work Center > Insurance Payments > Enter Insurance Payment Collections.

Select the organization.

Click Create Payment Collection

 

  • Shortcut: Use Work Center Home > Upload Documents to upload an EOB file that creates the shell of the check for you. Create all the checks you’ll be posting, then go back in to post the payment details.

  • Posting these payments to claims will automatically put them in the Payment Review queue for your next step.

Review Payments Received

  1. Go to Work Center > Insurance Claims > Work Claims
  2. Filter to “Payment Review” Queue
  3. Expand payers
  4. Open each claim in a new tab
  5. Review the payment note
  6. Go to Payments
  7. View the EOB
  8. Click on the Check number to see how the payment applied.
  • It may be helpful to review previous notes to get an idea of the claim’s history before adjudication.

  • Use the Claim and Service Totals table at the top of the claim page to quickly see if there is a balance on the claim. If the Balance (Difference Covered vs Expected) is not zero, the reimbursement might not meet the expected rate.

  • Compare the reimbursement to similar claim reimbursements to ensure claims are paid similarly.

Update claim workflow in AveaOffice

  1. Click Edit Claim Workflow within the payment.
  2. Update the Queue
  3. Update the Status
  4. Add an Issue (optional)
  5. Assign a user (optional)
  6. Update the follow-up date
  • Set up your queues so it’s easy for payment posters to find where to send a claim i.e. “Closed” for closing claims or “Payer” for troubleshooting reimbursement issues.

Close the Claim (Situational)

Click Close Claim Instance

  • Only close the claim if the payment meets the expected rate. Otherwise, the claim should be sent back to the Payer queue for Billing Collections to troubleshoot the reimbursement with the payer.

  • You can also close claims from the Workflow tab or the patient’s Claims tab.

Repeat for each claim that has received payments in the Work Center.
 

 

Weekly Process

Step

Action

Tips & Notes

Review Insurance Payment Collections

Go to Work Center > Insurance Payments > Review Insurance Payment Collections

Resolve all payments in this list.

 

 

 

Review Insurance Claims Out of Balance

  1. Go to Work Center > Insurance Payments > Insurance Claims Out of Balance
  2. Open up each claim’s “Resolve” in a new tab.
  3. Review the list of payments for that claim.

 

  • Ensuring accurate and complete payment posting is key to the claim’s lifecycle. Reviewing claims out of balance reduces the chance for a surprise recoup or possible refund.

  • Use Apply Reversal to adjust remittance that was reversed and reimbursed again.

  • Watch out for remits with both PI and OA reversals; those amounts don’t cancel each other out and one code will need to be updated to reflect the true balance.

Add a note to the claim

Click the Notes tab on the Work Claim screen.

  • It’s worthwhile to add a note to the claim any time you make a change to the claim, including adjusting payments received or applying reversals on the claim.

Update claim workflow in AveaOffice

  1. Click the Workflow tab on the Work Claim screen.
  2. Update the Queue
  3. Update the Status
  4. Add an Issue (optional)
  5. Assign a user (optional)
  6. Update the follow-up date
  • Set up your queues so it’s easy for payment posters to find where to send a claim i.e. “Closed” for closing claims or “Payer” for troubleshooting reimbursement issues.

Close the Claim (Situational)

Click Close Claim Instance

  • Only close the claim if the payment meets the expected rate. Otherwise, the claim should be sent back to the Payer queue for Billing Collections to troubleshoot the reimbursement with the payer.

  • You can also close claims from the Workflow tab or the patient’s Claims tab.

Repeat for each claim that has received payments in the Work Center.

 
 

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