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The Importance of charge entry process in medical billing
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The Importance of charge entry process in medical billing

Correctly entering each piece of patient and provider’s data is essential during the claim processing. Healthcare providers need specialists to handle the RCM and medical billing services process. Therefore, it is necessary to look for one-stop services that understand the importance of the charge entry process. Each data entered during the process must be accurate, as even a small error can lead to claim denials.
Before going any further, let’s explore:

What is Charge Entry?

The charge entry process is vital to effective RCM and billing for medical care providers. The process refers to accurately recording and posting charges for medical procedures and services given to patients.
The initial process starts with the collection of all relevant information. This information relates to the medical services provided – which shall include:

  • Patient’s demographic information
  • Insurance information
  • Medical codes for provided services
  • The associating fee for services

Healthcare practices must ensure that all information entered into the billing systems must be accurate and complete to remove errors. Your billing team must also fully understand the anatomy of a clean claim.
After accurately recording charges, the next step is posting them to the billing system, which leads to submissions to the insurance providers for payment of services. It is essential to ensure that the entire process is completed on time to avoid delays in payments or subsequent claim denials.
Procedural effectiveness, especially in the charge entry process, is essential to the financial success of the healthcare practices. Accuracy in charge entry optimizes the RCM process by extension. Furthermore, implementing the best practices below can help healthcare practices reduce the risk of errors, boost efficiency, and improve overall revenue performance.

Importance of Charge Entry Process

According to the medical coding, all patient accounts must have a correct monetary value. Moreover, the reimbursement for services the provider offers patients depends on the proper charge entry process. To that effect, automated coding techniques help avoid errors.
Impact of Incorrect Charge Entry Process

  • For Patients – erroneous charge entry can delay patient care and lead to unexpected billing of services.
  • For Providers – errors inside the charge entry process can lead to delayed or insufficient payments.

‍Best Practices and Steps to Effective Charge Entry Process

It is essential to optimize the charge entry procedure – owing to its importance for all stakeholders, including the patients, providers, payers, etc. For initial understanding, the charge entry can be a relatively straightforward procedure – comprising of only two steps including:

  • The entering of payment and billing information in regards to a patient’s visit
  • Precise assignment of charge entry transactions through medical codes – all concerning a patient’s visit

However, the most impactful and comprehensive charge entry process can be divided into multiple additional steps to meet all stakeholders’ needs.

5-Step Charge Entry Process

Below is an elaboration of a comprehensive 5-step charge entry process:

1. Document or File Intakes

The first step of the charge entry process is patient registration. It also extends to establishing financial responsibility from the entire billing cycle process. The process includes collecting all required forms relating to patient care and corresponding payments for it – including EOBs (Explanation of Benefits), cash, check, card payments, or any other payment options for due co-pays.
After collecting and receiving all documentation and files, a medical biller must allocate them to the appropriate storage locations compliant with HIPAA. This process leads to further entries and analysis.

2. Entering Relevant Details

The next step of the charge entry process is also the most important. Furthermore, this step is the only one requiring full completion in all cases. The second step of the process corresponds to both steps detailed in the simplified two-step process above.
Ideally, there are two essential categories of details that need entry:

  1. Patient data, like demographics, including:

    • Age
    • Sex
    • Vitals
    • Medical history, and more.
 
      2. Billing reference data, including:

    • Account numbers
    • Date of service
    • Amount paid
 

This data is then cross-referenced with medical coding (including modifier coding) for provided care services – to generate accurate costs. It is important to note that a more detailed process helps prevent potential revenue leakage.

3. Following up on the Benefits

For instances where the patients are responsible for some, or for all of the balances due – and there are also some issues like late or missing payments: A provider may investigate the explanation of benefits. This is done to determine the coverage detail, or the lack thereof, to see what further actions are necessary.
Such an investigation may lead to legal actions or negotiations between the stakeholders, including:

  • Healthcare provider
  • Insurance payors
  • Patients

4. Analysis and Recovery

In addition to instances where patients neglect partial or complete payments of balances they owe – similar issues may also arise with other payers, including the insurance companies. When this is the case, a process similar to step 3, kicks in; however, the focus here shifts to analyzing a payer’s responsibilities.
Consequently, if rejections and denials are presented to providers, they may indicate issues with medical coding and billing processes. The possible reasons might include incorrect coding or one or two services that might fall outside the spectrum decided by the insurance payers.
An in-detail analysis is essential for recovering reimbursements in such cases.

5. Customer Satisfaction

The last step of the charge entry process is optional, especially for the legal or financial requirements. However, this step is essential for healthcare practices seeking long-lasting and mutually beneficial relationships with patients. Healthcare providers must practice continuity measures, including collecting client feedback and making adjustments when necessary.
Furthermore, if polls, surveys, or patient interviews pinpoint challenges in the data collection process or any other part of the charge entry process, promptly resolving these is necessary. Moreover, taking note of the customer experience in healthcare is also a best practice for facilitating all other steps along the way.

Conclusion

The charge entry process is essential for financial success in healthcare practices. Furthermore, embracing precise charge entry processes and practices ensures persistent revenue flow while cultivating lasting patient relationships. For seamless operations, consider partnering with medical billing services providers to amplify your revenue and build defenses against errors in charge entries.

Frequently Asked Questions

The charge capture process is where healthcare providers document and record their care services. The process then moves on to submitting the relevant payment charges from patients to insurance providers.
The essential components of a charge entry include a patient’s demographics, date of service, billing providers, referring healthcare providers, date and time of admission, place of service, number of units, ICD/CPT coding, and modifiers.
CMS and AMA conclude that modifiers provide a means to report or indicate that a particular service or procedure has been performed and then altered by some specific circumstance while remaining unchanged in the definition.

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