Paul Sanchez
Efficient management of insurance payments in eClinicalWorks is critical for healthcare organizations to streamline billing, minimize outstanding balances, and ensure optimal cash flow. This process involves recording precise insurance details, including the insured's name, relationship to the insured, group number, and address verification. Additionally, healthcare providers should follow structured steps for entering and verifying patient information, insurance coverage, obtaining required authorizations, and collecting charges to facilitate accurate and timely fund distribution. By optimizing the payment posting process, healthcare providers can enhance overall financial management, improve patient satisfaction, and focus more on patient care.
| Characteristics | Values |
|---|---|
| Importance of efficient payment allocation and posting | Critical for healthcare organizations using eClinicalWorks to streamline billing, minimize outstanding balances, and ensure optimal cash flow |
| Posting payments | Click on 'Payments' in Billing, enter Payment ID# and click Lookup. Select the payment and click 'Delete'. Find the payment ID in Claim – Insurance & Payments. To delete a particular claim's payment, double-click the payment ID# in the claims |
| Adding insurance information | Navigate to the Insurance section in the patient's profile, click 'Add' to start a new entry, and search for the insurance provider. Check the Primary Insurance Box if applicable, and enter the subscriber number |
| Managing payment posting | Prepare new patients with necessary documentation, verify patient insurance coverage, obtain required authorizations, collect charges, post payments, and work accounts receivables |
| Outsourcing | Services like BillingParadise offer eClinicalWorks EOB posting services to streamline payment posting and management, making it quick and easy |
| eClinicalWorks financial integrations | Customizable mapping solutions for importing General Ledger Account codes, custom interfaces for bank lock boxes, and integrations with EHRs for exchanging financial transactions |
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What You'll Learn
Posting insurance payments manually
Step 1: Access the Patient's Information
Start by opening the Patient Lookup tool and searching for the patient with the unposted funds. Once you have located their file, access their Hub.
Step 2: Review Billing Details
In the Hub, navigate to the Guarantor Balance under the Billing section. Here, you can review the patient's billing details, including any outstanding balances or payments that need to be posted.
Step 3: Select the Relevant Payment
In the Billing section, click on 'Payments' and enter the Payment ID# to look up the specific payment you want to post. Alternatively, you can find the payment by navigating to Claim – Insurance & Payments.
Step 4: Post the Payment
Once you have located the correct payment, follow these steps:
- Click on 'Payments' in Billing.
- Click on the tab 'Add Ins Payment'.
- Select the relevant insurance company.
- Enter the payment amount, method (e.g., check, credit card), and payment class.
- Click 'Save' to load the payment.
- Double-click in the Allocate column for the specific line item to apply the payment.
- Enter the amount, reducing the unallocated balance to zero.
- Click 'Post' to finalize the payment.
Additional Tips:
- If you need to delete a payment, simply select the payment ID# and click 'Delete'.
- To delete only a particular claim's payment and not the entire batch, double-click the payment ID# in the claims, select the particular claim, and then click 'Delete'.
- To reverse a payment, select the line item containing the payment, click 'Edit Charge', highlight the payment, and select 'Reverse'. Specify the amount and click 'Post'.
- It is important to verify patient insurance coverage and benefits before posting payments.
- To streamline the payment posting process and improve cash flow, consider outsourcing to a specialized service that can handle the posting process for you.
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Posting payments quickly and accurately
Prepare the necessary documentation:
Before posting insurance payments, ensure that you have all the necessary documentation, including patient information, insurance details, and payment information. Verify the patient's insurance coverage, benefits, and eligibility. Obtain any required authorizations and collect charges to file claims correctly.
Access the patient's account:
To post an insurance payment, you need to access the patient's account in eClinicalWorks. Search for the patient by name or ID in the system. Once you have located the patient's file, navigate to the "Billing" or "Payments" section.
Enter payment information:
Click on the "Add Ins Payment" or "New Guarantor Payment" tab. Select the appropriate insurance provider from the list. Enter the payment amount, method (e.g., check, credit card), and payment class. Ensure that the payment information matches the patient's insurance coverage and benefits.
Allocate the payment:
Double-check the payment details and allocate the payment to the specific line item or claim. Ensure that the payment is applied to the correct patient and claim. Enter any necessary adjustment codes or amounts and add any relevant comments. Finalize the payment by clicking "Post" or "Save."
Monitor and review:
Regularly monitor the patient's account to ensure that the payment has been posted correctly. Review the patient's billing details, including the guarantor balance and unposted payments. Generate reports to track outstanding claims and payments, and address any issues promptly. By staying organized and proactive, you can maintain accurate records and streamline the payment process.
Accurate and timely payment posting is essential for efficient financial management and improved patient satisfaction. It helps to minimize billing discrepancies, reduce administrative burdens, and ensure optimal cash flow for healthcare organizations. By following these steps and staying attentive to details, you can enhance the overall payment posting process in eClinicalWorks.
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Adding insurance information
Adding accurate insurance information is crucial for efficient billing and claims processing in eClinicalWorks (eCW). Ensuring that a patient’s insurance details are recorded accurately minimises claim denials, reduces delays, and improves patient satisfaction.
To add insurance information, start by navigating to the patient's profile. Here, you will find the 'Additional Information' button at the bottom left of the screen. Clicking on this button opens the extended data entry section, where custom details can be added. Within the 'Structured Data' section, practice-specific identifiers, such as Dataset # or Med #, can be added. This links the patient's profile to practice records.
In the patient’s profile, navigate to the 'Insurance' section at the bottom of the screen and click 'Add' to start a new entry. Click the magnifying glass icon to search for the insurance provider. Check the 'Primary Insurance Box' if the entry is for the patient’s primary insurance provider. Selecting 'Show All' allows you to view all available insurance providers, helping to find the correct provider when multiple similar entries exist. Enter the subscriber number (found on the patient's insurance card) in the 'Subscriber Number' field.
Before saving, confirm that the address and zip code on the insurance card match the details in eCW. If the policyholder is different from the patient, use the 'Guarantor' function to search for or create a profile for the policyholder. If no existing profile is found, select 'Create New' to add the policyholder’s details, such as name, contact information, and date of birth. Review all entered details, then click 'OK' to save the insurance information.
Verify that the insurance details appear correctly in the 'Insurance' section of the patient’s profile for future reference. Recording precise insurance details helps prevent billing errors, minimises the risk of denied claims, and streamlines payment processing.
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Handling pre-collected and unapplied credits
Pre-collected credits refer to funds collected in advance of service delivery, while unapplied credits are leftover payments from prior transactions that haven't been allocated. Unapplied credits can arise in several situations, including customer overpayments, prepayments, and deposits, or credit memos. These credits can cause issues with financial reporting, cash flow prediction, and confusion for both businesses and customers.
To handle pre-collected and unapplied credits in eClinicalWorks (eCW), follow these steps:
- Open the Patient Lookup tool and search for the patient with unposted funds.
- Once you find the patient, access their Hub.
- In the Hub, go to the Billing section and review the Guarantor Balance to understand the patient's billing details.
- Choose the entry under "Responsible For" and click "View Pt. Account."
- In the Patient Inquiry Detail window, find the Unposted Payments column and click the hyperlink.
- In the Unposted Patient Payments & Refunds window, double-click on the specific payment you want to allocate.
- In the Allocate column, select either "Pre-collected" or "Unapplied Credit" based on the fund type.
- Choose the credit amount you want to allocate to a line item and click "OK."
- Enter the amount to be allocated in the Allocate column and click "Post." The allocated amount will now appear in the Receipts column.
Additionally, to allocate unapplied credits in general, you can use AI-powered tools for automating cash applications, periodically reconcile accounts receivable, improve internal payment processes by standardizing how payments are recorded, and train your finance team on best practices.
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Reversing payments
In Account Payment Posting, adjustments can be reversed by selecting Adjustment from the Allocate drop-down menu and entering a negative amount. This will reverse the adjustment, and clicking Post will finalize the process.
It is important to note that recoupments, or instances where an insurance company takes back money, can be tricky to manage. It is recommended to leave recoupments in unallocated accounts rather than on the original reversed claim, as it becomes more challenging to reallocate funds once the claim being paid with the recoupment is identified.
Additionally, generating monthly Aging Reports for Guarantor and Insurance accounts is a useful way to monitor overdue claims and payments, helping to streamline payment allocation and enhance overall financial management.
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Frequently asked questions
To post insurance payments in eClinicalWorks, first, select ‘Payments’ in Billing and click the tab ‘Add Ins Payment’. Then, select the Insurance and enter the payment amount, method, and payment class. Finally, click 'Save' to load the payment.
To add insurance information, go to the patient’s profile and navigate to the Insurance section at the bottom of the screen. Click 'Add' to start a new entry and search for the insurance provider. Check the 'Primary Insurance Box' if the entry is for the patient’s primary insurance provider. Enter the policyholder’s subscriber number from their insurance card.
If a patient’s insurance changes, open the Insurance section in their profile, add the new insurance information, and mark it as primary. Set the previous insurance to “Inactive” to prevent it from being used in future billing.
The Guarantor profile is used when the policyholder is someone other than the patient, such as a parent or spouse.
