The Stages of Remittance: A Guide for Therapists in Private Practice

As a therapist in private practice, understanding the remittance stages is crucial for effectively managing your revenue cycle. The remittance process can be complex, but breaking it down into clear stages can help you confidently navigate it. At Practice Solutions, we aim to make this process as smooth as possible for you, ensuring timely and accurate payments. Here’s a comprehensive guide to the stages of remittance, complete with helpful tips for your patients and a call to action to streamline your billing. 

The Stages of Remittance

Stage 1: Claim Submission

The remittance process begins with submitting a claim to the insurance company. This step involves gathering all necessary patient information, coding the services correctly, and ensuring that all documentation meets the insurer’s requirements. The preparation for claim submission is usually completed within your electronic health records (EHR) system.

For the claim submission process to operate smoothly, you must ensure that you and your staff know how to use the EHR system.  This means that you educate yourself and your team on how the system works and, more importantly, how you will use the system within your private practice. Each EHR system has its own “language,” and the better you know how to use the system, the more effective it will be in the life of your practice. The opposite is also true; the less you understand how the system works, the worse off it will be as a tool for your practice. Make sure you are an expert on your system. 

Successful claim submission is the foundation of remittance, and the foundation of successful claim submission is attention to detail. The less detailed a claim is, the less likely the claim will be processed correctly. You will want to make sure you have accurate information on the claim, from demographic details to coding. Accuracy is of the utmost importance when submitting claims. 

Finally, the most essential part of claim submission is submitting claims. That may seem obvious, but one of the biggest reasons that claims are denied is for lack of timely filing, which means that the claim was not submitted within the insurance company’s stated timely filing period. Make sure you are completing your notes and submitting your claims on a regular schedule to ensure this process is completed appropriately. 

Once a claim is submitted to the insurance company you can view status updates through a portal or clearinghouse. One of the status updates you might receive at this stage is that the claim has been “accepted”. This does not mean that the claim is approved, merely the insurance company has recognized and accepted the claim into their system for processing.

Tips for Providers

Ensure Accurate Information: Double-check patient details and service codes before submission.

Timely Submission: Submit claims promptly to avoid payment delays.

Use Technology: Utilize electronic health records (EHR) systems to streamline the submission process.

Helpful Tips for Patients

Educate your patients about the importance of providing accurate insurance information and keeping their details current. This can prevent claim denials and ensure a smoother billing process.

Stage 2: Claim Processing

Once the claim is submitted, the insurance company reviews it to verify the information and ensure it meets the policy’s requirements. During this stage, the insurer may request additional information or clarification. 

There are two primary mechanisms for an insurer to communicate about a claim. 

The first is called a claim rejection. A claim rejection is when the clearinghouse reviews a claim and does not forward it to the insurance company for final processing. It will likely happen if there are demographic problems, insurance ID discrepancies, or coding inaccuracies within the claim. Claim rejections are usually obvious but may require a professional to read and interpret the claim rejection report. 

The second mechanism insurers use to communicate with providers about a claim is explaining benefits (EOB) or electronic remittance advice (ERA). You will find out if your claim is denied as soon as you receive one of these documents for review. The explanations and subsequent solutions for a claim denial can be complicated and are usually best solved by a trained and experienced professional specializing in resolving claim issues. 

You will usually see a status update in the portal or your clearinghouse that says the claim has been “finalized.” This means the insurance company has reviewed the claim against the client’s insurance policy and your contract with the insurance company. The claim has reached a final decision at this point. Finalized doesn’t always mean paid. It could mean the claim has been denied, so you will want to pay special attention to the claim details. 

Claim processing goes well when two resources are present: organization and time. If you are organized with your claim processing and have all the information you need, then you will do well with claim processing. If you are disorganized or neglect claim processing out of fear, your billing will likely become disjointed, and you will not maximize your revenue. The second resource that is needed is time. Processing claims can be time-consuming and requires a baseline of knowledge. Outsourcing to Practice Solutions is the solution for both of these resources. It is cost-effective and sometimes even profitable to give your billing to an organized expert with the time and passion to see your claims through to the end. 

Tips for Providers

Stay Organized: Keep detailed records of all communications with the insurance company.

Respond Promptly: Address any requests for additional information quickly to avoid delays.

Monitor Progress: Use billing software to track the status of your claims.

Helpful Tips for Patients

Encourage your patients to communicate with their insurance company if they receive information requests. This can help expedite the claim processing stage.

Stage 3: Payment Posting

The final stage is payment posting, where the insurance company's payment is recorded in your financial system. If you are using a portal or clearinghouse to retrieve the information to be recorded, the claim status should show as “paid.” This step ensures that your accounts receivable are up to date and that you have an accurate picture of your practice’s revenue. Payment posting is critical to your practice's life because it provides three essential pieces of information to determine whether your practice is running smoothly. 

First, payment posting tells you what your practice is generating in revenue. Keeping track of your practice’s financial information in a separate accounting system is essential because your EHR and accounting software look at different data points that are also important in running a practice. However, you won’t see how much revenue your practice generates without posting the payment. 

Second, payment postings tell you what your practice is NOT making from specific insurance claims, clients, or companies. By knowing where your practice is weak, you or your biller will know where to spend time and focus. Additionally, you can begin to refine your practice’s processes around where you generate revenue and where your passions are. If something is not working, fix it or move on to something that is. 

Finally, payment posting will tell you what claim denials you receive the most and will inform process improvements within your practice. Many practices find they have credentialing issues simply because they review their denials or their biller advises them about the trends they see with denied claims. Find a process that can analyze your denials so you know what actions to take. 

Tips for Providers

Automate: Use billing software to automate the payment posting process.

Reconcile Accounts: Regularly reconcile your accounts to ensure all payments are accurately recorded.

Follow-up: Follow up on unpaid or partially paid claims to resolve outstanding issues.

Helpful Tips for Patients

Remind your patients to pay any outstanding balances promptly. Providing multiple payment options can help make this process easier for them.

Conclusion

By understanding the stages of remittance and implementing these tips, you can enhance the efficiency of your billing process and ensure a steady cash flow for your practice. 

Navigating the stages of remittance can be challenging, but you don’t have to do it alone. Partnering with Practice Solutions can take the burden off your shoulders, allowing you to concentrate on what you do best—helping your patients. At Practice Solutions, we specialize in managing the entire billing process for private practice therapists. Our expert team ensures that your claims are submitted accurately, processed efficiently, and paid promptly, allowing you to focus on providing quality patient care. Contact Practice Solutions today to learn how we can help streamline your billing and improve your revenue cycle management.