Payment posting & reconciliation
Payment posting that reconciles, remittance by remittance.
ERA and EOB posting, adjustment reconciliation, patient responsibility transfer and secondary billing.
The payer’s remittance arrives, electronically or as a paper EOB, and is logged against the day’s work.
Sample remittance A: Sample remittance A received from Payer A: one claim line.
Exceptions go to Matching review
Exceptions go to Adjustment review
One invented remittance line followed through posting, matching the example further down the page. Not a real payer, patient or claim, and not a Kitronixe result.
Why posting matters
Every dollar posted to the right place.
Posting is where a payer’s decision becomes the account’s balance. What goes where decides what is billed next.
Posting is where a remittance becomes information. Posted carelessly, a short payment looks like a paid claim and the underpayment is never noticed.
Anatomy of a remittance line
Where each dollar on a line actually goes.
- Billed amount − Contractual adjustment
- $240.00 − $80.00 = $160.00
- Payer payment + Patient responsibility + Other adjustment
- $120.00 + $40.00 + $0.00 = $160.00
Allowed amount · $160.00
What the payer recognises for the service under the plan and agreement that apply. It is shared between the payer’s payment and the patient’s responsibility.
Invented amounts; not actual payer terms, a real patient or a Kitronixe result. How a real line divides depends on the plan, the agreement and the payer’s decision.
When a line will not post cleanly
Six exceptions, each with a named review queue.
01Payment without match
A payment arrives that does not tie to any open claim line, or ties to more than one.
Matching review
The claim, patient account and payer detail are researched until the payment’s owner is certain; only then is it posted.
02Unexpected adjustment
The payer adjusted the line by a reason or amount that does not fit what was expected.
Adjustment review
The reason is checked against the remittance and, where available, the agreement on file, before it is accepted, corrected or passed to underpayment or denial work.
03Missing remittance
Money reached the account, or a claim shows as paid with the payer, but no remittance detail has arrived.
Remittance follow-up
The remittance is requested from the payer or retrieved from its portal, where access is granted, so the payment can be posted by line.
04Secondary coordination
A balance remains after the primary payer and another plan may be responsible for it.
Secondary billing review
Coverage on file and the primary remittance are checked, and the secondary claim is prepared where coordination of benefits applies.
05Patient balance transfer
The amount to move to the patient does not agree with the remittance, or a plan may still owe part of it.
Patient balance review
The patient portion is confirmed against the remittance before any statement goes out, so the patient is billed only what they owe.
06Unapplied amount
Part of a payment is left over after posting, with no line to apply it to.
Matching review
The leftover amount is traced to its claim, a refund review or a payer offset, and is not allowed to sit unexplained.
What the posting desk covers
The reconciliation checklist we work to.
- 01ERA and EOB postingElectronic and manual, reconciled to the deposit.
- 02Adjustment reviewContractual versus everything else, distinguished rather than lumped together.
- 03Patient responsibilityTransferred accurately so statements are correct.
- 04Secondary billingPrepared when applicable after primary adjudication.
After the primary payer answers
The patient is billed after the payers have answered.
Step 1: Primary remittance posted
The primary payer’s payment and adjustments are posted first. Nothing moves on until they are.
Step 2: Remaining balance classified
What is left is sorted into patient responsibility, an amount another plan may owe, or an item for review, based on the remittance and the coverage on file.
Step 3: Secondary claim preparedWhere applicable
When another plan is on file and coordination of benefits applies, a secondary claim goes out with the primary payer’s information the plan requires.
Step 4: Secondary response posted
The secondary payer’s remittance is posted the same way, and whatever remains is classified again.
Step 5: Patient statement follows
Only the balance left after the payers have answered moves to the patient statement, so a patient is not billed for what a plan may still pay.
The posting desk
A posting day, read as a ledger.
Remittances Received148
IncomingEverything that arrived today, electronic and paper.
Auto-Matched124
DoneLines that tied to a claim without a person deciding.
Needs Review24
In reviewLines a person must match before they post.
Adjustment Review9
In reviewAdjustments held until their reason is confirmed.
Secondary Ready14
ReadyBalances prepared for a secondary payer.
Patient Balance Review11
In reviewPatient portions checked before statements go out.
Reconciled96
DonePosted and agreed to the deposit record.
Invented counts for one fictional posting day. Rows overlap (a line can be auto-matched and later reconciled), so they are not meant to add up, and the bars only compare each count with remittances received. Not a Kitronixe result or a client’s volume.
What you see each week
The manager’s view: posted, pending, explained.
- Posting activityRemittances received and posted by day, electronic and paper shown apart.
- Exception logEvery exception by type and review queue, with what was decided and when.
- Unapplied and suspense itemsWhat is still unapplied, how long it has waited and what it is waiting on.
- Adjustment summaryContractual and other adjustments by reason, so unusual ones stand out.
- Reconciliation statusWhich deposits agree with posting and which are still open, where deposit access is granted.
Remittances Received
612
Payments Posted
$184.6K
Exceptions
57
Needs a decision
Unapplied Items
8
Needs a decision
Secondary Billing Ready
41
Reconciliation Pending
12
Remittance processing across a sample week
ReceivedPosted
| Day | Received | Posted |
|---|---|---|
| Mon | 138 | 121 |
| Tue | 124 | 130 |
| Wed | 117 | 119 |
| Thu | 109 | 112 |
| Fri | 124 | 118 |
Illustrative data for a fictional practice: counts of remittances, and a dollar total where marked. Posted can exceed received on a day when earlier work is caught up. Not a Kitronixe result.
In the revenue cycle
Between the payer’s answer and the patient’s statement.
Where Payment Posting sits in your revenue cycle
- 07Payment Posting & Reconciliation· Back End
- 10Patient Billing & Collections· Back End
Where the work happens
Posted in your systems, from your remittances.
- ERA / EOBElectronic remittances and paper explanations of benefits, read line by line.
- Remittance sourcesClearinghouse remittance files and payer portals, where the practice has access.
- Practice managementWhere payments, adjustments and patient balances are posted to the account.
- Bank / deposit reconciliationDeposit records compared with posting, where access is granted and appropriate.
How are ERA and paper EOB workflows handled?
Electronic remittances are posted from the remittance file, with each line checked as it posts rather than accepted in bulk. Paper EOBs are keyed from the document, line by line, into the same workflow, so both end up with the same review steps and the same exception queues.
How are unapplied payments reviewed?
An amount that cannot be applied to a line is logged as unapplied with the reason it could not post. It is researched against claims, refund review and payer offsets until it can be applied or explained, and the open list is reported each week with how long each item has waited.
How is secondary responsibility handled?
After the primary payer’s remittance is posted, the remaining balance is checked against the coverage on file. Where coordination of benefits applies, the balance is billed to the secondary plan before anything goes to the patient. Coordination rules vary by plan, so unclear cases go to review rather than being assumed.
Do you reconcile deposits to the bank?
Where the practice grants access to deposit or bank records and it is appropriate to do so, posted totals are compared with deposits and differences are listed for review. Where that access is not granted, reconciliation is done against the payment records available, and the report says which was used.
What happens when a payment can’t be matched?
It is not posted to a best guess. It goes to matching review, where the claim, account and payer detail are researched. If the payment still cannot be tied to a line, the payer is contacted for detail, and the item stays visible on the unapplied list until it is resolved.
Talk to us about your posting desk.
Tell us how remittances arrive, where exceptions pile up and how deposits are reconciled today, and we will describe how posting would run in your systems.
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