Healthcare organizations must carefully execute their charge entry process to generate accurate medical bills and appropriately file reimbursement claims. It requires a step-by-step procedure that is important for all the stakeholders involved in the healthcare sector.
This blog will comprehensively cover those steps by exploring how they can lead to a successful execution of the charge entry process. We will also discuss its importance for you, your patients, and their insurers in the form of a recordkeeping framework.
What Is Charge Entry in Medical Billing Process?
A charge entry is a process in medical billing in which healthcare organizations record the exact charges for their medical services. You can submit those records to their insurance companies as your patients avail these services.
Insurance companies pay for the charges by reimbursing you in response to your charge entries. A charge entry includes details about the relevant treatments along with patient information. Before submitting charge entries, you can use that information to prepare them.
Step-By-Step Process of Making Charge Entries
By following this step-by-step process, you can make accurate charge entries for your healthcare procedures. This process includes ten steps, including recording patient demographics, streamlining medical insurance, and verifying pre-authorization details.
Healthcare organizations can also implement patient eligibility verification, regular submission of charge entries, and much more.
1. Patient Demographics
You must ensure that accurate patient demographics are entered for your charge entries. By doing this, you can prevent claim denials from insurance companies with verified details. These details can comprise the patient’s name, social security number, and insurance coverage.
In addition, you should include some secondary patient details as well and cross-reference them with the relevant medical codes. Such details include the date of admission, place of service, modifiers, and diagnosis, which determine the accuracy of your charge entry process.
2. Medical Insurance
You can also track your provider credentialing and improve it wherever required to maintain a streamlined flow of medical insurance. To do this, you have to optimize the credentials of your medical professionals to convince insurance companies.
In this way, they can ensure the competency of your medical professionals to reimburse payments for your services. Moreover, your patients can appropriately receive the necessary finances in the form of their medical insurance.
3. Pre-authorization Details
Charge entries can also be prepared based on the pre-authorization details of your patients. For this, their numbers for prior authorization have to be verified before they avail your healthcare treatments and procedures.
In addition, you also have to include these numbers in the reimbursement claims that have to be sent to insurance companies. By doing this, you can get approval from the insurers of your patients to prepare their relevant charge entries.
4. Patient Eligibility
Healthcare organizations must verify the eligibility of their patients to avail of specific medical treatments in order to accurately record their charge entries. For this step, you can validate the gathered insurance data and determine if any co-pays or deductibles are applicable.
With this verification, you can be in a better position to provide accurate charge entries to insurance companies. Furthermore, it is more likely to increase your patient satisfaction and prevent claim denials in the future.
5. Regular Submission
You can regularly submit your charge entries to optimize their preparation. Posting charges as soon as patients avail of your medical services enables you to file reimbursement claims sooner. It ensures a stable flow of charge entries that effectively drives your medical billing.
In this way, you can constantly prepare charge entries and file reimbursement claims, which will lead to prompt payments by insurance companies. An inefficient flow of the charge entry process reduces the growth of your accounts receivable.
This reduction adds further backlog to your work as you now also have to focus on optimizing your revenue cycle management. As a result, there are likely to be more billing errors, which can cause more problems for your healthcare organization.
6. Reimbursement Allocation
Charge entries can also be recorded with an efficient allocation of reimbursement claims as it maintains the rate of your accounts receivable. You must prepare your charge entries and file your claims in time, as most insurance companies have refiling rules.
These rules limit the time for refilling appeals to be made in case of claim denials. Therefore, you should optimize the allocation so that your charge entries are prepared and potential appeals are reported in time.
In addition, it enables you to generate your medical bills and receive payments for your healthcare services faster.
7. Medical Billing Codes
Healthcare organizations must also follow industry guidelines while assigning billing codes and conducting audits. These operations enable them to conduct an effective evaluation of their records to ensure that their reimbursement claims align with the relevant treatments.
This evaluation facilitates you to prepare accurate charge entries based on the medical services availed by your patients. You can ensure this by assigning correct medical codes for specific healthcare procedures and mentioning the relevant provider identifiers in your charge entries.
Keep in mind that billing modifiers are frequently misused, and you can avoid that through accurate identifiers and codes. Any irregularities can lead to extensive audits of your charge entry practices that can result in hefty fines on your healthcare organization.
8. Benefit Review
Insurance companies provide a statement named Explanation of Benefits after they receive reimbursement claims from healthcare providers. You can review the benefits mentioned in this statement to streamline your future charge entries.
These benefits usually comprise non-covered charges, total charges, deductibles, and co-pays based on the relevant charge entries. You can comprehensively review them to learn more about the status of charge entries and determine if they require any further changes.
Importance of Charge Entry in Medical Billing
Charge entry in healthcare sector is an important process for medical billing as it enables an accurate recordkeeping framework for healthcare organizations. You can seamlessly generate your medical bills through effective charge entries that appropriately depict the value of your medical services.
They protect you from getting into certain situations in which billing errors can cause miscommunication with insurance providers. In this way, they prevent claim denials and reduce your likelihood of filing appeals against them.
In other words, accurate charge entries can improve the medical billing process and make it easier for all the stakeholders involved. In most cases, healthcare providers, patients, and their insurers only are involved. Let’s consider how they are individually impacted by charge entries.
1. Patients
Charge entry in RCM is an important process for patients as it saves them from encountering any unexpected bills that can further delay their care.
In this way, they are more likely to trust healthcare organizations to accurately bill them for the relevant medical services. Furthermore, they also become certain enough that they can avail of those services.
2. Insurance Providers
The insurance providers of your patients can also find charge entries valuable as they prevent certain accounting and financial implications. Healthcare organizations can leave certain irregularities in their reimbursement claims, and insurance companies may not validate them.
Such errors can damage their finances as they may be overcompensated for the relevant healthcare procedures. Charge entries prevent that by providing an additional layer of verification that can protect the reputation of insurance providers.
3. Healthcare Organizations
Charge entries have the potential to enhance relationships for healthcare organizations as they regulate their compliance with industry guidelines. They make the billing practices more stable and efficient, which ultimately builds trust for their patients.
Moreover, you can also secure any breach and privacy notifications in terms of HIPAA rules through charge entries. This function enables you to preserve the rights of access for your patients.
The Bottom Line
This blog examined a range of different steps that can be executed by healthcare organizations to record and prepare their charge entries. We also saw how they can be generally important in the healthcare sector and contribute to the effective functioning of all the stakeholders involved.
Our Revenue Cycle Management professionals can work with you to optimize your medical charge entry process and effectively manage your revenue cycle. Join us today to outsource charge entry services so that insurance companies can appropriately reimburse you.
Frequently Asked Questions (FAQs)
1. What are the roles and responsibilities of charge entry?
The roles and responsibilities of charge entry include recording entries for the appropriate medical services availed by patients. The charge entry process in medical billing also enhances working relationships between healthcare organizations and their patients.
2. How do I learn charge entry?
You can learn charge entry by collecting information for medical bills about coding, healthcare organizations, and their patients. You can also enter charge entries into specific management systems based on industry rules and specifications.
3. What is charge capture in medical billing?
Charge capture is a process in medical billing in which you can convert the medical codes of your services into charges and earn money. For this, those codes must be accurately charged to prevent revenue leakage.
4. What is a charge entry?
A charge entry is a process in which you can record and prepare charges for your healthcare treatments. You can implement it by validating key patient information and details about your medical bills.
5. What skills do you need for charge entry?
The prominent skills required for charge entry comprise patient data entry and maintaining attention to detail while executing the relevant tasks. You should also be able to work independently under pressure and manage the workload on your own.
