Payment posting

Payment posting is where the money meets the claim. Each ERA (835) or paper remittance lists, line by line, what the payer allowed, what it paid, what it adjusted and why, using CARC and RARC codes. Posting records those amounts against the matching claim lines, moves the contractual difference to a write-off, moves deductible, coinsurance and copay amounts to patient responsibility, and flags any line that was denied or paid less than the contract allows. Patient payments and refunds post in the same step.

Every report downstream depends on it. Days in A/R, the aging buckets, the net collection rate and the denial list all read the posted data, not the bank balance. A payment posted to the wrong patient leaves one account showing a false credit and another a false balance; a denial posted as an adjustment disappears from the work queue; an underpayment posted as paid in full is never appealed. The deposit can reconcile to the penny while the accounts are wrong.

The mistake is trusting auto-posting without rules. Electronic posting is fast, but the system needs to be told which CARC codes are denials, which are patient responsibility and which are contractual, and what to do when the payer’s allowed amount is below the contracted rate. Set those rules, review the exceptions the same day, and tie posted totals back to the deposit.