Skills Activity Posting Payments And Adjustments Learning Ob

Skills Activity Posting Payments And Adjustmentslearning Objectives1

Perform accounts receivable procedures to patient accounts including posting payments and adjustments. Manage the use of clinical data required by various payment and reimbursement systems. Take part in selection and development of applications and processes for chargemaster and claims management. Apply principles of healthcare finance for revenue management.

If you have questions about this activity, please contact your instructor for assistance. You will review the chart of Liu Huang to complete this activity. Your instructor has provided you with a link to the Posting Payments and Adjustments activity. Click on Launch EHR to review the patient chart and begin this activity.

Refer to the patient chart and any suggested resources to complete this activity. You will complete documentation in EHR Go as instructed below. When you complete this activity, you will download your Progress Report in EHR Go under 3: Download Work, save the Progress Report to your device, and then upload the Progress Report to your Learning Management System (LMS).

Review the guide found under Help/Guides on ehrgo.com, which defines terms such as Allowed Charges, Coinsurance, Deductible, and Provider Charges. The activity involves a claim submitted for services rendered to Liu Huang, an outpatient visit at Central Clinic for a glenohumeral joint injection, with insurance payment and adjustments detailed in the Explanation of Benefits (EOB). You will review the claim under Liu’s Account section, update the ledger for insurance adjustments and payments, and account for the cost-sharing via coinsurance and patient responsibility adjustments.

The insurance has covered 80% of Allowed Charges after the deductible was met, with the remaining 20% (coinsurance) owed by Liu. The insurance has discounted any charges exceeding the Allowed Charges, so these are to be adjusted as credits, with insurance payments entered as EFT, and Liu’s responsibility reflected as an adjustment with a transfer balance to the patient.

Complete the documentation accordingly, save your work, then download the Progress Report from EHR Go and upload it to your LMS as per instructions. For questions about submission or clarifications, contact your instructor.

Paper For Above instruction

The process of posting payments and adjustments in healthcare revenue cycle management is fundamental to accurate patient accounting and revenue cycle integrity. This activity simulates the real-world task of managing patient accounts, especially focusing on the interplay between insurance payments, patient responsibility, and adjustments made for allowed charges and discounts. The core objective is to ensure that collections reflect the contractual obligations, and adjustments are accurately recorded to represent discounts, write-offs, or payments made by third-party payers and patients.

Successful revenue cycle management hinges on precise posting of payments and adjustments. Healthcare providers receive claims from services rendered, which are then processed through insurance payers based on contractual agreements, clinical data, and patient-specific factors. When an insurance company processes a claim, they determine coverage levels, allowed charges, and patient liabilities such as coinsurance or copayments. The Explanation of Benefits (EOB) details these aspects, guiding the provider or biller to accurately update the patient's ledger. This includes recording insurer payments, applying discounts or adjustments, and calculating patient responsibility.

In the scenario involving Liu Huang, the provider received an EOB indicating coverage details. The insurer paid 80% of the Allowed Charges electronically, and the remaining 20% (coinsurance) was Liu’s responsibility. Charges exceeding the Allowed Charges were discounted, so no further payment is expected for those amounts. The posting process involves making a credit adjustment to reflect the discounted amount, recording the insurer’s EFT payment, and establishing the patient responsibility as an adjustment, which transfers the balance owed from the insurer to the patient. This ensures that the patient ledger accurately reflects what Liu owes for this services visit.

Accurate posting affects not only accounts receivable but also financial reporting, compliance, and revenue cycle efficiency. Properly posted adjustments prevent billing errors, reduce accounts receivable aging, and improve cash flow. Moreover, it is vital for maintaining compliance with billing regulations and avoiding claims denials or penalties. The tasks demonstrated in this exercise manage clinical data leading to effective revenue collection and financial health for healthcare organizations.

The significance of such activities extends to the broader healthcare finance principles. These include understanding allowed charges, provider charges, and patient liabilities—concepts that influence billing strategies and patient communication. Robust knowledge of these principles ensures that billing staff can resolve discrepancies, comply with payer policies, and optimize revenue streams. The transition from clinical services to financial reconciliation underscores the importance of cross-disciplinary skills and accuracy in healthcare finance roles.

In conclusion, this simulation exemplifies the real-world application of accounts receivable procedures encompassing the posting of payments, adjustments, and transfer balances. It emphasizes the importance of precision, compliance, and understanding payer and patient responsibilities. Mastery of these tasks is essential for healthcare administrators, billers, and revenue cycle professionals aiming to maintain financial stability and deliver transparent, compliant patient billing experiences.

References

• HealthCare.gov. (n.d.). Glossary. Retrieved from https://www.healthcare.gov/glossary/
• Heizer, J., Render, B., & Munson, C. (2020). Operations Management: Sustainability and Supply Chain Management (13th ed.). Pearson.
• Nugroho, T. W., & Nurcahyo, R. (2018). Analysis of Total Quality Management (TQM) implementation in small medium industries. Proceedings of the International Conference on Industrial Engineering and Operations Management.
• Saxena, M. M., & Rao, K. S. (2019). TQM, Six Sigma, and Lean. International Journal of Applied Engineering Research, 14(15), 62-69.
• Project Management Institute. (2017). A Guide to the Project Management Body of Knowledge (PMBOK Guide) (6th ed.). PMI.
• Centers for Medicare & Medicaid Services. (2021). Medicare Claims Processing Manual. CMS.
• American Medical Association. (2020). CPT Professional Edition. AMA.
• Healthcare Financial Management Association. (2019). Revenue Cycle Management Strategies. HFMA Publications.
• Rao, K. S., & Saxena, M. M. (2018). Lean and Six Sigma in healthcare. International Journal of Productivity and Performance Management, 67(2), 224-239.
• U.S. Department of Health & Human Services. (2022). Healthcare Billing and Coding Guidelines. HHS.gov.