Home health payment posting, checked against what every line was owed
Payment posting in home health and hospice applies each remittance to its claims and compares the payment to what was owed. Our AI agents do both line by line; our experts take the flags.
Payment posting, in the order our study ranks the work
- Expected-payment variance for home health periodsIn the top three of 169 workflowsWorth it, ready now
- Medicare Advantage, Medicaid and private duty contract varianceIn the top ten of 169 workflowsWorth it, ready now
- Expected-payment variance for hospice daysIn the top 25 of 169 workflowsWorth it, ready now
- Electronic remittance ingestion and auto-postingIn the top half of 169 workflows
- Patient and family payment posting and reconciliationIn the lower half of 169 workflows
- Credit balance, refund and overpayment processingIn the lower half of 169 workflows
- Unapplied cash and payer recoupment reconciliationIn the lower half of 169 workflows
- Paper remittance and explanation-of-benefits captureIn the lower half of 169 workflows
Every remittance posted and checked the day it lands, starting where you lose most.
Talk about your posting workflow
The gap between what the payer sent and what was owed
Cash posting hides the losses: the balance looks right because the payer's number was accepted without question, and the difference never gets chased.
Posted as sent
payer numbers reach balance without recalculating owed period or visit amounts.
Contracts in a spreadsheet
per-visit rates and cost share sit where the posting desk never checks against them.
Credits found late
cap and overpayment credits surface at quarter close, when the surprise is already booked.
Every remittance posted, then checked against what was owed
Each workflow below posts first and asks second: what your payer rules and contracts say the line was owed, on every period, visit and day.
Catch the case-mix downgrade the remittance never announces
Period payments get posted as sent, so the case-mix downgrade and the notice penalty land quietly. Our AI agents recompute each period from the code and the adjustments, then queue each gap by cause for follow-up.
- Every period payment compared to what was owed
- Shortfalls grouped by cause before your month closes
- Downgraded periods flagged the same day
Contract rates stop living in a spreadsheet nobody checks
Per-visit payments get accepted as posted while your contract rates sit in a spreadsheet. Our AI agents compute what each visit and episode was owed and queue shortfalls by payer; our experts load your contracts and take exceptions.
- Every visit checked against its contracted rate
- Shortfalls listed by payer before the month closes
- Cost share applied checked against the contract
Spot the cap overpayment on day one
Credits wait for a quarterly clean-up, so cap liabilities arrive as a surprise. Our AI agents detect credits at posting and project your cap and limit liabilities for reserve; our experts release each refund with its reason.
- Credits caught as they post
- Cap and limit liabilities projected and reserved
- Refunds queued with the reason attached
How building custom AI works, inside your posting desk
Your posting desk runs on habits no vendor has ever asked about; our engineers start there.
01What your agency brings
Your remittances as they arrive, your payer contracts, and the posting rules your team applies today. Our experts watch the workflow as it runs before anything is built.
02What our experts do
They fix the data posting depends on, set the expected-payment rules for your payers, and write them where your staff can see and change them.
03What our AI agents do
They read every remittance the day it lands, match it to its claim, and group each gap by cause so your team sees the month before it closes.
What your posting desk has now, honestly
Your agency already has software, an EMR module or a billing company on this work. Here is what each is good at, and where it stops, for posting and variance.
Variance checks built for your payers
Standard software covers the standard path; your payer's quirks stay manual work. Our engineers build the variance checks for your contracts and your tier rules, and our AI agents run them beside your EMR.
- Built on your payer mix alone
- Runs beside your EMR, no replacement
- Rules your staff can see and change
Billing and RCM software
Good at organizing the posting you already do; it usually posts what the payer sent without recomputing what was owed.*
Your EMR's billing module
Good at staying connected to the chart; it usually posts the payer's numbers as sent, so variance checks ride on workarounds.*
An outsourced billing company
Good at taking the posting pile off your desk; most follow their playbook, so your payer's quirks usually get posted as sent.*
* These describe each category as commonly sold. Your contract and agency set the terms.
Your desk stays yours: the four answers owners need first
How is this priced?
A fee plus a part tied to outcomes, metered by the workflows our AI agents take over. Your team can grow without the bill moving.
Do we replace our EMR?
No. Our AI agents run beside your existing EMR, clearinghouse and payer portals, reading and writing back. Your agency keeps the systems it has, and its data stays its own.
Who makes the calls?
Your own staff. Our AI agents check and flag; your team reviews every flag and decides. The software makes no clinical decisions.
What must we have ready?
Less than you think: access to your remittance files and payer contracts. Our experts sit with your posting team, learn the rules they apply today, and start from there.
A posting desk that knows what every line was owed
One conversation about one workflow: where your desk loses money, what our AI agents would take over, what your team would keep. Nothing to prepare; the workflow does the talking.
Common questions
What is an 835 in healthcare billing?
An 835 is the electronic remittance a payer sends under the HIPAA ASC X12N 835 (005010X221) standard, listing what was paid, adjusted and denied per claim.
What does SIA mean in hospice terms?
SIA is the service intensity add-on, extra paid hours attached to a hospice claim on top of the routine per-diem. Our AI agents recompute these hours on every hospice day.
What is patient liability in Medicaid?
Patient liability is the share of care the patient owes out of pocket after Medicaid pays. Our AI agents post it daily against the patient balance; our experts take mismatches.
What are the top 5 denial codes in medical billing?
There is no single top five; the list depends on your payer mix. CARC codes carry the denial reason and RARC codes the detail, and our AI agents read each as remittances arrive.
What formulas are used for payment posting in medical billing?
Payment posting runs on matching each remittance line to its claim, adjustments and patient balance; the formulas that matter are your contracted rates and expected amounts, which our AI agents compute.
What is payment posting in RCM?
Payment posting is where each payment, adjustment and denial from a remittance lands on the right claim and patient balance. In home health it also means knowing what each period and visit was owed.
The full study, PDF · 636 KB
The winner is the dullest job in the building
Claim editing and cash posting beat every clever idea in the study, and they beat it every single time we re-ran the numbers.