I am the lead medical biller at an inpatient psychiatric facility. We have some limitations with payment posting in our electronic health record (EHR) system. For institutional payments, my director believes that we can post all adjustments—write offs/sequestrations—required on the first few days of the claim and then just allocate the payment to the remaining days. For standard accounting purposes, this would be the way to post payments/adjustments—issuing the adjustments first then the payment. However, I believe healthcare insurance payments need to be posted differently. It is my understanding that payments and adjustments must be allocated evenly/individually based on the insurance payment itself.
In other EHR systems, you are able to post the payment to the claim, and it disperses the payment and coins amounts for you. However, with our EHR system, it is not possible to post it to the claim and have it automatically allocated.
During an audit process, we need to be able to provide what the insurance paid for each day along with what amount is patient responsibility. Without correctly dispersing the payments and write offs each day, I wonder how our information will be perceived/received by an auditor and/or a patient.
Can you share any documentation that states how payments are to be posted to charges on a compliance level?
Answer: I’m not familiar with inpatient psychiatric facility payments and adjustments but I found this document, Inpatient Psychiatric Facility Prospective Payment System, from the Centers for Medicare & Medicaid Services that might be helpful.
This question was answered by: Suzanne Lestina, FHFMA, CPC, vice president, revenue cycle innovation, AvadyneHealth, and a member of HFMA’s First Illinois Chapter.
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