What is Charge Entry in Medical Billing?

The charge entry process involves coding and submitting accurate charges against the medical services, medication, and procedures performed on a patient. Collecting accurate patient information, such as patient demographics, eligibility verification, and payment methods, is crucial for practices to receive complete reimbursements for the services rendered.

Understanding the charge entry process is essential for an effective medical billing process, maintaining records, and preparing a charge document for submission to payers. Following the process step by step helps practices Increase reimbursements and streamline the overall practice revenue cycle. In this article, we will discuss the charge entry process in medical billing and the steps for efficient charge entry management.

Importance of Charge Entry In Medical Billing

As discussed earlier, charge entry is a crucial aspect of the medical billing process, even a small mistake like missing the entity code or even a CLIA number against the laboratory while entering the charges can affect the practice financially and cause problems for the payers and the patients. Matching the chargemaster data is a time-consuming and difficult task that causes multiple issues, such as additional work for the practice, revenue loss, and legal penalties. Finding the errors made while coding the services or the medications and correcting them is a big part of the process, which takes a lot of time and energy. That is why having an understanding of the charge entry process is crucial for the practices to avoid common coding mistakes and repetitive errors while preparing and submitting the claims.

How Does Charge Entry Affect the Stakeholders?

Here, by stakeholders, we mean those directly involved in the medical services, which can be affected by errors in the charge entry process in terms of improper care delivery, difficulty understanding the charges, or revenue loss. Those stakeholders can be patients, providers, and payers.

Let’s discuss how accurate charge entry can help perform the billing process accurately by following these parameters:

Managing critical information and codes
Maintaining patient data
Staying compliant
Managing the billing process for smooth reimbursements
Minimizes unexpected bills
Help providers give proper care delivery
Minimizes delays in care

Efficient Management of the Charge Entry Process

Managing the charge entry process efficiently, healthcare providers must pay attention to minor to major mistakes. Healthcare providers, billing companies, or in-house medical billing teams can not overlook the continuous changes and challenges in the medical industry for robust revenue cycle management. The charge entry process involves following two major steps that are very easy to understand:

Gathering patient data
Accurately coding services rendered by the patient

However, following only these two steps is not enough for flawless charge entry processing. A few additional steps are necessary to manage the charge entry process. Here are a few more steps to manage and understand charge entry in medical billing.

Accurate Patient Demographics Collection

The main reason for the claim denial is incorrect patient information and demographics. Practices should automate patient information collection using HIPAA-compliant software like (EHR) or digital forms, making it easier to maintain the data digitally instead of collecting it physically on registers or physical forms.

The patient information includes:

Personal information (Name, Age, DOB, Gander, etc.)
Patient demographics
Patient’s medical history
Explanation of benefits (EOB)
Payment methods
Insurance details
Preauthorization
Diagnosis & procedure codes
Modifiers
Date of admission
Date of service provided along with place of service

Eligibility Verification

Patient eligibility verification is crucial before providing medical services to the patient. Your front desk staff’s duty is to check the patient’s insurance plan and type. If the patient’s insurance plan has just changed, your staff must be aware of this and collect all required details for the new plan.

Accurate Use of Codes and Modifiers

Always ensure that all the codes and modifiers for the procedure, diagnosis, and medications are accurate. The claim will be rejected if any of the codes for any procedure or medication are found wrong or if any of the services are over-coded by the provider.

Review Explanation of Benefits

An explanation of benefits (EOB) is a statement the insurance company sends to healthcare providers once the claims are reimbursed. In the EOB, the insurance company mentions the complete payment details, which helps providers understand the payment and the pending charges. If the payer has not provided the EOB, practices should follow up with the insurance companies.

EOB has the following details mentioned in it:

Total charges
Allowed amount
Payable charges
Non-covered charges
Amount paid to the provider
Copay
Co-insurance
Deductibles

Consistent Charge Entry Process:

Some insurance companies follow strict rules, as physicians must submit claims within a time limit. Otherwise, the payer will not accept those claims. In that case, practices must submit the claims timely and manage AR backlogs efficiently to receive full reimbursements. As long as the practice delay in payment posting increases the AR days, payments will be delayed. Maintaining a consistent charge entry process can save practices from experiencing revenue loss.

Trained Medical Billing Team

Practices should ensure that their staff is well trained and always has complete knowledge about regulations, compliance, and the parameters on which the payers will check their claims. Payers use the claim adjudication process to verify claim accuracy and avoid offset amounts, so the billing team must be aware of these measures and keep themselves updated with new trends and processes.

Conclusion

Charge entry is an integral part of revenue cycle management that allows the care providers to receive accurate payments for the services rendered. To manage the charge entry process promptly, It is necessary to record accurate patient information and code the provided services. Making errors in the charge entry process will cause claim denials, prolonged payments, and revenue leakages. Using wrong medical codes for services is a fraudulent activity in the billing process, so the practice should have complete knowledge of codes. Practices are always under pressure due to a lot of patient visits and chances to make mistakes are higher; in that case, practices can hire professional medical billing companies like Physicians Revenue Group, Inc. to outsource medical billing services.