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Revenue Cycle Management Explained: Remittances, ERAs, and Portals
EPISODE SUMMARY
Jeremy breaks down the critical distinction between an EOB (what the patient sees) and a Remittance Advice (the professional version for the provider). He walks through the "detective work" required to audit these documents, highlighting why the Allowed Amount—not just the paid amount—is the number that determines if you’re being underpaid. The episode also explores the "digital pipeline," comparing the speed of ERAs to the "snail mail" of paper and warning about the hidden dangers of "set-and-forget" auto-posting. Finally, Jeremy shares a real-world case study where forensic remittance auditing recovered significant underpayments for a large agency.
KEYWORDS
Revenue Cycle Management, RCM, Remittance Advice, Explanation of Benefits, EOB, Electronic Remittance Advice, ERA, 835 File, Contractual Obligation, CO Codes, Patient Responsibility, Payer Portals
TAKEAWAYS
The Remittance as a Scorecard: A deposit without a remittance is like a box without a packing slip; you can’t post the money accurately without knowing the patient, date of service, and CPT code.
The Trap of the "Paid Amount": Never stop at the paid amount. You must audit the contractual adjustments (CO codes) and patient responsibility (PR codes) to ensure you aren't writing off money you should have collected.
ERAs vs. EOBs: Electronic Remittance Advice (ERA) files (835 files) arrive days or weeks faster than paper. However, always look for the PLB segment (provider level adjustments) to find "missing" money buried in recoupments.
Portals are a Fast Pass: Use payer portals like Availity or Optum to skip the 45-minute hold times. Portals allow for instant remittance downloads and "correction speed" for fixing claim modifiers in days rather than months.
CHAPTERS
00:00 Introduction: Making Sense of Remittances and Portals
02:48 Remittance vs. EOB: Knowing the Difference
06:48 From Paper to Digital: Understanding ERAs
09:56 The Secret Weapon: Payer Portals
12:20 Case Study: Finding Hidden Underpayments
15:47 Conclusion: The Winning Formula for Remittances and Portals
RESOURCES
Today Sponsors: Blueprint
Learn More About The Claim Game: Visit practicesol.com/podcast
The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visiting The Hourglass Learning Hub.
Our Blog: Explore years of educational articles on billing and practice management at Practice Solutions Blog.
Book: For a comprehensive guide on navigating insurance, grab your copy of Insurance Billing Basics: Steps for Therapists to Successfully Take Insurance.
Images: Guide to the Components of an EOB, Guide to the Components of an ERA
Get full access to The Claim Game at jeremyzug.substack.com/subscribe
View all episodes
By Jeremy and Kathryn ZugEPISODE SUMMARY
Jeremy breaks down the critical distinction between an EOB (what the patient sees) and a Remittance Advice (the professional version for the provider). He walks through the "detective work" required to audit these documents, highlighting why the Allowed Amount—not just the paid amount—is the number that determines if you’re being underpaid. The episode also explores the "digital pipeline," comparing the speed of ERAs to the "snail mail" of paper and warning about the hidden dangers of "set-and-forget" auto-posting. Finally, Jeremy shares a real-world case study where forensic remittance auditing recovered significant underpayments for a large agency.
KEYWORDS
Revenue Cycle Management, RCM, Remittance Advice, Explanation of Benefits, EOB, Electronic Remittance Advice, ERA, 835 File, Contractual Obligation, CO Codes, Patient Responsibility, Payer Portals
TAKEAWAYS
The Remittance as a Scorecard: A deposit without a remittance is like a box without a packing slip; you can’t post the money accurately without knowing the patient, date of service, and CPT code.
The Trap of the "Paid Amount": Never stop at the paid amount. You must audit the contractual adjustments (CO codes) and patient responsibility (PR codes) to ensure you aren't writing off money you should have collected.
ERAs vs. EOBs: Electronic Remittance Advice (ERA) files (835 files) arrive days or weeks faster than paper. However, always look for the PLB segment (provider level adjustments) to find "missing" money buried in recoupments.
Portals are a Fast Pass: Use payer portals like Availity or Optum to skip the 45-minute hold times. Portals allow for instant remittance downloads and "correction speed" for fixing claim modifiers in days rather than months.
CHAPTERS
00:00 Introduction: Making Sense of Remittances and Portals
02:48 Remittance vs. EOB: Knowing the Difference
06:48 From Paper to Digital: Understanding ERAs
09:56 The Secret Weapon: Payer Portals
12:20 Case Study: Finding Hidden Underpayments
15:47 Conclusion: The Winning Formula for Remittances and Portals
RESOURCES
Today Sponsors: Blueprint
Learn More About The Claim Game: Visit practicesol.com/podcast
The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visiting The Hourglass Learning Hub.
Our Blog: Explore years of educational articles on billing and practice management at Practice Solutions Blog.
Book: For a comprehensive guide on navigating insurance, grab your copy of Insurance Billing Basics: Steps for Therapists to Successfully Take Insurance.
Images: Guide to the Components of an EOB, Guide to the Components of an ERA
Get full access to The Claim Game at jeremyzug.substack.com/subscribe