Staff Series – R1 M5: Payment, Follow-Up & Collections
RCM Foundation Series  ·  Continuity Practice Partners Round 1  ·  Module 5 of 5

Payment, Follow-Up & Collections

Round 1 — Module 5  ·  What happens after the claim is accepted

Round 1 Progress
1
How It Works
2
Financial Clearance & Check-In
3
Charge Capture & Coding
4
Claims & Submission
5
Payment, Follow-Up & Collections
Overview

Acceptance is not payment — this is where the money actually arrives

A claim being accepted by the payer means it is being reviewed for payment. It does not mean payment is coming. From here, three things happen: the payer pays, partially pays, or denies. Every one of those outcomes needs to be acted on quickly, or the balance sits unresolved and the practice waits longer than it should to get paid.

This module covers the final three stages of the revenue cycle: posting payments, following up on what is unpaid, and collecting what the patient owes.

Speed matters here as much as accuracy. A correct payment posted three weeks late and a correct payment posted same-day have the same dollar amount — but very different effects on cash flow.

Payment Posting

Applying what the payer sent to the account

1
ERA — Electronic Remittance Advice
Most payments arrive as an ERA, an electronic file that explains exactly how a claim was processed — the allowed amount, what was paid, what was adjusted off per the contract, and what the patient owes. ERAs post automatically or semi-automatically and should be applied within 24 hours of receipt.
2
Manual posting
When a payer does not support ERA, payment information arrives on a paper EOB and has to be posted by hand, line by line. This takes longer and carries more risk of data entry error, which is why catching mistakes through review matters here especially.
3
Reading the remittance correctly
Every line on a remittance tells a story: the billed amount, the allowed amount, what insurance paid, what was adjusted per the contract, and what remains as patient responsibility. Misreading any one of these numbers means the patient could be billed incorrectly — either too much or too little.

If the numbers on a remittance do not add up — the payment plus the adjustment plus the patient responsibility does not equal the billed amount — do not post it as-is. Flag it for review. Posting an unbalanced remittance creates an error that is much harder to find later than it is to catch now.

Follow-Up

Working what did not get paid

Not every claim is paid in full on the first try. Some are denied outright. Some are paid less than expected. Some simply sit unprocessed past a reasonable timeframe. Follow-up is the work of chasing down every one of these until it is resolved — paid, corrected, appealed, or written off.

Denial
The payer reviewed the claim and is not paying it, in whole or in part. The remittance includes a reason code explaining why. Depending on the reason, the response is to correct and resubmit, appeal with supporting documentation, or write off the balance if it cannot be recovered.
Underpayment
The payer paid less than the contracted rate. This is different from a contractual adjustment, which is expected. An underpayment is a payer error and should be challenged — it will not be caught or corrected unless someone notices and follows up.
Aging claim
A claim that has not been paid, denied, or resolved within a reasonable window — typically 30 days. Aging claims need active follow-up. Left alone, they either get more difficult to collect or eventually pass a deadline that makes them uncollectible entirely.

Claims are typically worked by priority — oldest first, or highest balance first, depending on the practice’s approach. The goal is the same either way: nothing sits untouched past 30 days without someone actively trying to resolve it.

Patient Collections

Collecting the balance after insurance has paid

Once insurance has processed a claim, whatever remains — copay, coinsurance, deductible, or a denied amount the patient is responsible for — becomes the patient’s balance. This is communicated through a patient statement, and how that process is handled affects how quickly and how fully it gets collected.

1
Statements go out promptly and consistently
Statements should be sent on a predictable schedule. The longer a balance sits before the patient is notified, the less likely they are to remember the visit clearly or pay quickly. Returned mail due to bad addresses should be investigated and corrected right away — an undelivered statement is a balance that will never get collected through that channel.
2
Patient questions are answered clearly
Patients call confused about statements more often than practices expect. Being able to explain a balance clearly — what insurance paid, what was adjusted, and what they owe — prevents frustration and builds trust. A patient who understands their bill is more likely to pay it.
3
Unpaid balances follow a defined path
Most practices send a set number of statements before a balance moves to a collections agency. Following this process consistently — not skipping steps, not waiting too long — keeps the patient AR moving instead of accumulating indefinitely.
Your Role in This Stage

What billing staff own in payment, follow-up, and collections

  • Post ERAs and manual payments within 24 hours of receipt
  • Verify that the numbers on a remittance balance before posting
  • Flag underpayments — do not assume the payer paid correctly without checking
  • Work aging claims before they pass 30 days without resolution
  • Document every follow-up action taken on a claim, including payer conversations
  • Send patient statements on schedule and resolve returned mail quickly
  • Be able to explain a patient’s balance clearly when they call with questions

This module completes Round 1. You now understand the full path a patient’s visit takes — from the first phone call to the final payment. Every module after this builds on what you have learned here.

Check Your Understanding
Answer all three questions correctly to complete Round 1 and unlock your certificate.
1. You are posting a remittance and notice the payment plus the adjustment plus the patient responsibility does not add up to the billed amount. What should you do?
2. A claim has not been paid or denied 35 days after submission. What is the correct response?
3. A patient calls confused about a statement, saying their insurance should have covered the full amount. What is the best response?

Round 1 complete — your certificate is ready.

Get Your Round 1 Certificate →
Continuity Practice Partners  ·  Bend, Oregon
www.continuityrcm.com  ·  info@continuityrcm.com