Payment Posting Services

Payment posting sits inside a small amount of hard law, and most of what the industry publishes around it is not law at all. Three rules are worth knowing precisely. When Medicare may pay. Medicare fee-for-service operates a payment floor: a clean claim submitted electronically in a HIPAA-compliant format may be paid as early as the 14th day after the date of receipt, while a clean paper claim is not eligible for payment before the 29th day (Medicare Claims Processing Manual, Chapter 1). That is a floor on the earliest payment date, not a promise about the latest one, and it is why a posting backlog and a slow payer look identical on an aging report until someone separates them. Medicare Advantage prompt payment is narrower than it is usually quoted. Under 42 CFR 422.520, the rule that an MA organization pay 95 percent of clean claims within 30 days applies to claims submitted by or on behalf of an enrollee of an MA private fee-for-service plan, or to claims for services not furnished under a written agreement with the organization -- in other words, to non-contracted situations. All other claims from non-contracted providers must be paid or denied within 60 calendar days. Where you are a contracted provider, the prompt-payment terms are whatever your own contract says they are, which is one more reason posting and contracting belong in the same conversation. Credit balances have a statutory clock. Under 42 CFR 401.305, a person who has received a Medicare overpayment must report and return it by the later of 60 days after the overpayment was identified or the date any corresponding cost report is due. An overpayment is 'identified' when it is knowingly received or retained, on the knowledge standard in 31 U.S.C. 3729(b)(1)(A); the deadline is suspended while a timely, good-faith investigation into related overpayments is under way, but no later than 180 days after the initial identification. The lookback period is six years, and an overpayment retained past the deadline becomes an obligation for purposes of 31 U.S.C. 3729 -- the False Claims Act. This is the current text as amended on 9 December 2024. What we will not tell you. There is no freely-available primary source that publishes an average payer underpayment rate, an average contractual-adjustment share of charges, or a clean-claim-rate target for physician practices. Figures in circulation for all three trace back to secondary articles rather than published data, so we state the blank instead of borrowing one. The numbers we will give you are the ones your own remittances produce.