Cash posting originally was a very data entry-oriented job, but today its nothing like that at all. Most of the world only sees the advances in healthcare from a clinical perspective, but the business side of healthcare is ever changing, and cash posting has not been immune to those changes. Electronic Fund Transfers (EFTs) and Electronic Remittance Advice (ERAs) have changed the way cash posting works in a fundamental way. Traditionally a payment was received and posted to the account manually by physically entering the data from checks that were mailed to the facility. Now EFTs and ERAs come with robust logic that automates and cuts out the need to physically touch an account, and it does it at a volume level that no person could ever compete with.
Providers can now enroll with payers to have payments made electronically available via an ERA 835 file, allowing for quicker processing and posting. Additionally, many banking institutions provide the same functionality by converting paper checks and explanation of benefit files into ERA 835 remittance files to post payments received in the lock box. Special consideration must be taken when implementing ERA 835 posting to ensure accurate mapping to result in the most efficient utilization of resources. This is especially important during the transition from one electronic health record to another. Because legacy accounts receivable (A/R) is not converted in most instances, organizations are required to wind-down legacy A/R while maintaining current A/R. This forces organizations to:
- Work with two account numbers and understand which payment goes to which system and account.
- Create clean and concise account mapping to ensure correct posting of payments to accounts.
- Utilize integration between legacy systems, clearinghouses and the new system to ensure a smooth transition during cut over. With the correct enrollment, a clearinghouse can do most of the heavy lifting by creating two separate ERA files. One for the legacy system and one for the newly implemented system based on claim number mappings.
So, what does this all mean? Business offices still need cash posters, but the role has now changed dramatically from its origins. The role has become more of an accounting/research role, it’s not about posting line item after line item, because that is what the system does. The role now requires more of a research-oriented mind than a robotic one. The robotic mind is great for productivity and volume, but now the role requires less of the repetition and more of the critical thinking. Kelly Wescott, a former revenue cycle management director and Culbert Health Solutions Senior Consultant says “It’s about working with the technology to verify funded/unfunded EFTs/ERAs, uploading the funded ERA files for electronic posting, and then confirming the amount posted. Anything that doesn’t post is a unique exception that needs to be researched.” In many cases the reason for the exception is due to a system configuration issue that requires a system update. This is a routine occurrence and requires consistent maintenance to ensure the system is functioning as designed.
This also changes the type of person hired for the role. Moving to more of a research role, the job description becomes more complex requiring more of an accounting background that likely demands more pay. More pay hits the budget and hitting the budget means analyzing staffing needs. While this sounds all pretty negative, it’s not. Evolution is not a bad thing and with the research and analysis function added, modern-day cash posting has evolved to more of an accounting role. The team is diverse and should be flexible in thinking, they aren’t data entry clerks, they are puzzle solvers. It is no longer getting paper checks, keying entire batches, printing the batch reports, and logging them in a spreadsheet. It’s working in collaboration with technology, banks and finance to ensure that there is a home for every dollar.