Payment Posting & Reconciliation

Payment posting is the step where money and explanations come back into your system. Each payer payment arrives with a remittance advice that shows what was paid, what was adjusted, and what the patient owes. Posting that data correctly keeps your accounts receivable accurate.

Payment posting services record insurance and patient payments, apply adjustments, and reconcile every deposit to the bank. Just as important, they spot underpayments, denials, and patient balances hidden in the remittance data.

Westmont Revenue Partners connects practices and facilities with vetted medical billing experts who provide outsourced payment posting. We match you with a team that fits your payers, your systems, and your volume.

Who this is for

• Practices with a backlog of unposted checks or electronic remittances
• Groups where the same person posts payments and handles the bank deposit
• Practices whose A/R reports do not match their bank balance
• Organizations that receive many paper checks, lockbox files, or virtual card payments
• Facilities with high payer volume and complex adjustments
• Owners who want underpayments and denials found at posting time

What's included

• Manual and automatic posting of electronic remittance advice
• Posting of paper explanations of benefits and checks
• Posting of patient payments from the front desk, portal, and mail
• Application of contractual adjustments, write-offs, and transfers to patient responsibility
• Review of reason and remark codes to sort denials, underpayments, and patient balances
• Deposit reconciliation against bank records
• Handling of electronic funds transfers and virtual card payments
• Management of refunds, overpayments, and payer recoupments
• Identification of payments that do not match the expected contract rate
• Forwarding of denials to denial management with clear notes
• Daily or weekly posting and reconciliation reports

How it works

1. Remittances and payments are collected from payers, banks, and patient channels.
2. Each payment is matched to the claim and patient account.
3. Payments and adjustments are posted, and reason codes are reviewed for denials or short payments.
4. Deposits are reconciled so posted totals match bank totals.
5. Denials, underpayments, and patient balances are routed to the right team with notes.
6. You receive reports on posting status, unapplied cash, and exceptions.

Common challenges

• Unapplied or misapplied cash. Payments without a clear match sit in suspense and distort A/R. An experienced biller researches them and corrects misposts quickly.
• Bundled or batch payments. One check or transfer may cover many patients. Billers split and match each line, then tie the total back to the deposit.
• Underpayments hidden in adjustments. If every difference is written off, short payments go unnoticed. Billers compare payments to expected contract rates and flag variances.
• Wrong adjustment categories. Posting a denial as a contractual write-off hides it from follow-up. Billers read the adjustment codes and handle each type correctly.
• Virtual card and fee-bearing payments. Some payers pay by virtual card, which may carry processing fees. Billers track these and report their effect.
• Overpayments and recoupments. Payers sometimes take money back from later payments. Billers watch for these and match them to the original claim.
• Split deposits and timing gaps. A payment may show up in the bank before the remittance arrives. Billers keep a reconciliation log until both match.

Metrics worth tracking

• Unapplied cash: payments received but not posted; shows posting backlog or matching problems.
• Posting lag: time from payment receipt to posting; affects how current your A/R is.
• Deposit variance: differences between posted totals and bank totals; points to missed or misposted items.
• Net collection rate: payments compared with what was allowed; shows how well contracts are being honored.
• Underpayment rate by payer: shows which payers pay below contract terms.
• Adjustment mix: how much is contractual versus denial or patient responsibility.

Codes and standards

Code or standard	Type	What it covers
835 (005010X221)	EDI transaction	Electronic payment and remittance advice adopted under HIPAA
ACH CCD+Addenda	EFT standard	NACHA payment format adopted under HIPAA for electronic funds transfer of claim payments
CARC (Claim Adjustment Reason Codes)	Code set	Explain why a claim or line was paid differently than billed, maintained through X12
RARC (Remittance Advice Remark Codes)	Code set	Add detail to a CARC or give processing alerts
837 Professional and Institutional	EDI transaction	Electronic claims that the 835 responds to
276/277 (005010X212)	EDI transaction	Claim status request and response, used when a payment or remittance is missing

Note

Codes and standards are examples for orientation, not a complete list, and do not guarantee coverage or payment. Always check current code sets and payer policy.

Specialties that use this service

• Internal Medicine
• Cardiology
• Oncology
• Radiology
• Dialysis Centers
• Infusion Centers
• Hospitals

How Westmont can help

• We match you with vetted billing experts experienced in payment posting and reconciliation.
• We look for teams that can work with your remittance setup, bank, and software.
• We help you find providers that report on underpayments, not just posting totals.
• We start with a conversation about your volume and systems so the match fits.

Frequently asked questions

What is payment posting in medical billing?

Payment posting means recording payments, adjustments, and patient balances from insurers and patients in your billing system. Each payment is matched to a claim. The remittance advice shows what was paid and why. Accurate posting keeps your accounts receivable and patient statements correct.

What is an ERA and how is it different from an EOB?

An ERA is an electronic remittance advice, usually in the 835 format. An EOB is the paper or portal explanation of benefits. Both explain payment decisions. The ERA can be loaded into billing software for auto-posting, while paper EOBs usually need manual entry.

Why does deposit reconciliation matter?

Reconciliation checks that the money in your bank matches what was posted. It catches missing payments, misposted checks, and unusual fees. Without it, errors can sit in your books for months. Regular reconciliation is also a basic internal control against loss.

Can payment posting find underpayments?

It can, if the poster compares each payment to your expected contract rate and reads the adjustment codes. A provider that only posts and moves on will miss these. Ask any vendor how they flag and report short payments.

Should posting and deposits be handled by different people?

Many practices separate them as a basic control, so one person does not control both the money and the records. Outsourcing posting can add that separation. Ask your accountant what controls fit your practice.

Related services

• Claims Submission & Clearinghouse Management
• Denial Management & Appeals
• Accounts Receivable Follow-Up & Recovery
• Patient Billing & Collections
• Practice Analytics & Reporting
• Medical Revenue Cycle Management (RCM)