Invoicing and Payments: Posting, Patient Responsibility, and A/R
Invoicing and payments covers the money side of the claim: how an allowed amount splits into payer payment, contractual adjustment, and patient responsibility; how to post an EOB or ERA; and how to manage patient statements and aging accounts receivable. The CBCS exam tests accurate posting and follow-up, not just arithmetic.
The payment equation
- Allowed amount = payer payment + patient responsibility.
- Contractual adjustment = charge − allowed amount; post it as a CO-45 write-off.
- Patient responsibility includes deductible (PR-1), coinsurance (PR-2), and copay (PR-3).
Posting and statements
- Post each ERA/835 or EOB line by line: contractual adjustment, payer payment, then patient balance.
- Reconcile the posted batch total to the EFT or check deposit.
- Send a patient statement for the remaining balance and apply the practice's payment-plan policy.
- Refund credit balances and overpayments promptly.
- Age A/R in 0–30, 31–60, 61–90, and 90+ day buckets; work the oldest balances first.
Worked example
Charge $500; allowed $300; deductible $100; coinsurance 20%. Payer calculation: $300 − $100 deductible = $200; 20% coinsurance = $40; payer pays $160. Patient owes $140 ($100 deductible + $40 coinsurance). Contractual adjustment is $200 ($500 − $300). Post $200 adjustment, $160 payment, and $140 to patient A/R. If the patient already paid a $20 copay, apply it and statement $120.
Traps
- Posting the full charge as the payment.
- Writing off patient responsibility as a contractual adjustment.
- Ignoring small credit balances.
- Confusing copay with coinsurance.
- Failing to reconcile the EFT deposit to posted payments.