Scope for each practice is confirmed in the engagement agreement, including systems, payers, and queues.
Lump-sum posting creates phantom A/R
A poster applies a check to the oldest claims until the dollars run out. Contractual write-offs land on the wrong encounter, denials look unpaid, and a refund becomes a credit nobody owns. Reconciliation is the habit of matching the 835 or the EOB, the batch total, and the deposit before the day is closed.
What the work includes
- Line-level posting from electronic remits where the file is usable
- Manual posting from portal and paper EOBs when no 835 exists
- Separation of payment, contractual adjustment, patient responsibility, and denial
- Deposit reconciliation to the posted batch
- Credit-balance and takeback identification
- A variance log when the remit total and the deposit differ
How the work moves
Step 1
Match the money first
The deposit amount, the remit total, and any non-claim withhold are listed before a line is posted. A mismatch is a variance, not a silent plug.
Step 2
Post at the line
Each claim line receives the payment and the adjustment the remit assigned. Patient responsibility is not buried inside a contractual code.
Step 3
Route what remains
Denials go to denial work. Patient balances go to the statement rules. Takebacks and refunds go to a credit queue.
Step 4
Close the day
The posted total is compared with the deposit again. Unposted remits are a dated list, not a folder.
Operational benefits
- A/R that finance can tie to cash
- Fewer false denial follow-ups on contractual write-offs
- Visible credit balances
- A cleaner starting point for underpayment questions
Common challenges
- PLB and other provider-level adjustments do not belong on a single claim line
- Recoupments can arrive months after the original payment
- Patient payments at the front desk never hit the posting queue if nobody records them
- Auto-posting rules can apply a denial as a write-off
Technology
Auto-post rules in the practice management system are reviewed before they are trusted. A rule that writes off every denial is turned off or narrowed. We do not claim a bank feed unless the practice's accounting system already has one.
Where specialty changes the work
High-volume primary care stresses deposit matching. Surgical practices stress line-level posting of multiple procedures and assistant fees. The reconciliation standard does not change.
Questions
Should every denial be written off at posting?
No. A denial is a status that needs a reason and a next action. Writing it off at posting hides recoverable items and compliance problems in the same bucket.
What if the bank deposit is short?
The variance stays open. We do not spread the difference across claims to force a balanced day.
Do you post patient payments?
Yes, when the practice wants that in scope and the payments are recorded in a system we can see. Cash at the front desk needs a daily log either way.