Payment Posting, Reconciliation, and Revenue Integrity
Domain 7: Payment Posting, Reconciliation, and Revenue Integrity
This domain tests cash posting, ERA/835 posting, contractual adjustments, reconciliation, refunds, and revenue integrity.
Core rules
- Post payments, patient responsibility, and contractual adjustments at the line level using CARC and RARC.
- Reconcile posted cash to bank deposits daily or monthly; investigate unapplied cash and variances.
- Credit balances: refund or apply according to payer rules; Medicare refunds are generally due within 60 days of identification.
- Recoupments and takebacks: post as negative payments or adjustments with the correct reason.
- Revenue integrity: charge reconciliation, charge description master maintenance, pricing, payer contract modeling, and underpayment review.
- Avoid posting write-offs without approval; track adjustment reasons.
Worked example
An 835 shows billed $700, allowed $500, paid $400, and patient responsibility $100. The contractual adjustment is $200 (CO-45). Post the $400 payment, $100 patient responsibility, and $200 CO-45. The bank deposit should be $400. If the deposit is $350, investigate a $50 takeback or fee before reconciling.
Traps
Posting patient responsibility as contractual; not reconciling deposits; missing refunds; posting recoupments as denials; failing to update the charge description master.