Charge entry is the most fundamental part of medical billing, as medical reimbursement depends on it. It consists of the information that defines a patient’s first visit with the medical provider, and a claim is created based on the information declared in the charge entry form. This sensitive information must be accurate in all aspects to ensure that the provider will get maximum reimbursement for his provided medical practices from the insurance carrier. In this context, we are here to demonstrate a query about why charge entry is critical to medical billing.
Charge entry is a process where medical billing information is entered that includes admission date,
date of service provided, place of service, provider details, physician, pre-authorization details,
and codes for the procedures performed by the physician and the treatment patients received. Based
on this information, a claim is filed to the concerned insurance carrier to get reimbursement for
the rendered services.
Maintaining the accuracy of the charge entry is crucial because the financial health of medical practices is highly dependent on it. Therefore, paying attention to every detail is a must, and
ensuring every entry must be entered accurately before the claim adjudication process takes place at
the Payer’s end. Even a slight mistake in the patient’s demographic entry could lead you to a claim
rejection that would result in causing significant financial risks in your medical practice and
damage the provider-patient relationship.
The charge entry process is vital for all entities involved in the practice revenue cycle management, whether patients, medical providers, or Payers. Hence it is essential to optimize the process to get maximum output. Although, the entry-level charge entry can’t be defined in more than two steps. That is the entrance of all billing and payment information related to a patient’s visit and assigning the patient account an appropriate $ value as per the chosen medical codes and corresponding fee schedule. But, the most effective charge entry processes break down into several additional steps for which all entities are accounted.
The first step in the charge entry process refers to the patient’s registration, where the
information such as name, date of birth, address, and insurance information is identified and
collected by asking the right questions, following applicable laws, and using medical software. You
must maintain accuracy while collecting this information, including the insurance and patient
demographics, determining the payer whom you will send a final bill, and following up on the unpaid
claims. Instead, you might experience delays in the reimbursement process.
To ensure the accuracy of patient demographic information, you can use practice management software
that offers patient engagement tools, such as automated patient reminders and a patient portal. It
will reduce no-shows and cancellations while helping educate your patients and get them more
involved in their health and wellness.
Some medical organizations in the united states consider insurance information, medical history,
education, and employer as part of demographic data. Still, most of them view the following
information in the patient’s demographic data:
According to the financial regulations defined by the regulatory authorities, medical providers
can’t obtain reimbursement for their rendered medical services from the affiliated insurance carrier
if they lack their credentialing. Therefore, credentialing is increasingly important because the
process lets us know about the medical providers, including doctors and nurses, who acquire proper
training and experience to practice the healing arts. It allows patients to place their trust in
their chosen healthcare providers confidently.
Therefore, because of these circumstances, if you are a workforce in charge of practice revenue
cycle management, it is your crucial responsibility to submit and track provider credentialing and
re-credentialing applications based on insurance plan requirements. To follow the provider’s
credentialing, you need to take one step further by establishing consistent follow-ups with
insurance payers to ensure a provider is in-network.
An explanation of benefits is a document a medical provider receives from the concerned insurance provider that explains how the payer processed the claim for your rendered medical services to the patient. It comprises sensitive information, including services medical providers rendered, what doctor or hospital has charged, what the insurance covered and didn’t cover, and the payment you (patient) are responsible for paying before you receive a treatment from a provider.
Point Of Service Collection: To get reimbursement for your provided medical services, you need to follow up with the insurance carrier to perform verification and authentication of the information mentioned on the insurance card, and most importantly, follow up with the Payers to determine the patient’s financial responsibilities that, include copays, coinsurances, and deductibles. Providing complete financial information to your patients will allow you to establish a transparent relationship with the patients increasing patient satisfaction and ultimately saving you from future claim denials.
Deductible: Amount you are responsible for paying for receiving healthcare services before your insurance starts to pay anything.
Copay: It is a fixed patient’s due payment that is payable for healthcare services covered by your insurance before medical providers perform their practice.
Coinsurance: Aside from copayments or deductibles, coinsurance is the amount you must pay towards the claim based on your insurance benefit.
An encounter form also referred to as a superbill or free ticket, is used by the patient-help desk staff to communicate with patients on behalf of the medical provider to verify the number and type of services they received. This communication occurs by checking the appropriate boxes and signing the form to attest to getting the bill for the ticked performed services. In most cases encounter form is processed electronically if the provider uses an EHR or practice management software.
This stage of the medical billing cycle makes assure that the physician has completed the encounter form by giving them a follow-up call. If the patient’s financial responsibility is left, that is also collected. Once the patient checks out, the billing staff obtains medical records and converts the billable information into medical codes.
Charge entry staff processes the encounter form to double-check the performed services and
procedures and for what treatment. After that, the team enters these charges into the practice
management system, along with the paid patient’s responsibilities at the time of service.
If the encounter form lacks a diagnosis, the workforce in charge asks the provider for more
information. The charge entry workforce is also responsible for capturing reviews to confirm that
all invoices and receipts were added when adapting patient charges.
Based on this information, claims are generated and submitted to payers once verified through a
claim scrubbing process. Once the claim gets approved by the payer’s adjudication, the medical
biller receives the reimbursed amount, which is then posted to the provider’s account.
Statistical quality control is a strategy based on a set of procedures that incorporates the concepts of an analytic study, process thinking, prevention, stratification, stability, capability, and a prediction implied to improve medical procedures. The process is performed on the patient data, surveys, polls, or interviews of patients collected that assist medical organizations in seeking long-lasting, mutually beneficial relationships with their patients. Medical providers must perform continuity measures, including collecting client feedback and making adjustments as necessary.
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