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The medical billing process is complex and challenging, not least because it impacts so many stakeholders across the country. One of its most notable components is the entry of charges. Charges have a significant impact on the revenue cycle management process, making it essential for healthcare providers to master.
To that end, this guide will break down all you need to know about “charge entry”:
- What exactly charge entry is and its position within the broader medical billing process
- Why charge entry matters, both to the billing process generally and for its stakeholders
- How to implement a sound charge entry process
What Exactly is Charge Entry In Medical Billing?
Charge entry, or charge capture, is the process or set of processes by which charges for medical services and other patient-facing services are submitted to the appropriate insurance company for billing. It involves a detailed accounting for services rendered, as well as an initial intake of important information.
Data that needs to be collected, analyzed, and prepared for entry begins with patient information, including demographics, health history, and health insurance or payment plan. Then, there is more information collected about the payors in question, as well as all details of the care appointment itself (date, providers seen, services provided, etc.).
Charge Entry and the Rest of the Medical Billing Cycle
Charge entry is a pivotal step in the medical billing cycle. The entire medical billing process comprises 8 steps:1
- Registering patients, collecting demographic and payment information
- Establishing financial responsibility for past, current, and future visits
- Creating a “superbill” to compile collected information and copays
- Generating claims from superbill to facilitate submission to payors
- Submitting claims to payor(s), usually via medical clearinghouses
- Monitoring adjudication of claims, making adjustments as needed
- Preparing patient statements for outstanding charges, as needed
- Following up with patients to ensure payments are made in full
Depending on the depth or breadth of your charge entry process, it may span steps 4-6 or all 8.
Why Does The Charge Entry Process Matter?
As noted above, charge entry is one piece of the larger process of medical billing. Charge entry matters simply because of seamless accurate recordkeeping matters. Even for situations in which one individual error in a reported charge or insurance claim leads to a minor miscommunication, the stage is still set for bigger, more impactful errors down the road.
For all healthcare providers who strive to ensure quality and comfort across all interactions with clients, it’s essential.
Stakes for Healthcare Patients, Payors, and Providers
The stakeholders impacted by charge entry are those directly involved in the care relationship between the patient, payor, and healthcare provider. Their respective stakes include but are not limited to:
- Patients – Improper charge entry can lead to unexpected bills and even delayed care. This can make patients hesitant to get the care they need in a timely manner.
- Payors – Charge entry mishaps can have financial, accounting, and legal implications. Certain mistakes can also damage reputations with both patients and providers.
- Providers – Charge entry is critical to reputation, relationships, and even compliance. Additionally, charge entry management leads to efficiency and stable, timely payments.
On the last point, it’s important to secure every step in the charge entry process per HIPAA rules on privacy, security, and breach notification while preserving patients’ rights of access.2 Other stakeholders for charge entry are partners or investors with an interest in providers’ success.
The Charge Entry Process Steps and Best Practices
Because of its critical importance to patients, providers, payors, and all other stakeholders in the healthcare industry, it’s essential to optimize the charge entry process. At the most basic level, charge entry can be considered a fairly straightforward two-step process:
- First, the entrance of all billing and payment information pertaining to a patient’s visit
- Then, accurate assignment of charge entry transactions by medical codes related to the visit
However, the most impactful charge capture process breaks down into several additional steps to ensure all stakeholders’ needs are accounted for.
Consider the following 5-step process.
File or Document Intake
The first step corresponds to patient registration and establishment of financial responsibility from the overall billing cycle process detailed above. It includes collecting all required forms pertinent to patient care and commensurate payment for it, such as Explanation of Benefits (EOBs) and checks, cash, card payments, or other payment options for co-pays due upfront.
Once all required documentation and files have been received, it is a medical biller’s job to allocate them to appropriate storage locations compliant with HIPAA and prepares for further entry and analysis.
Entry of Relevant Details
The second step in the process is the most important and the only one that is required to be completed in full in all cases. It corresponds with both of the steps detailed in the simplified, two-step process alluded to above.
There are two important categories of details to enter:
- Patient reference data, including demographics like age, sex, vitals, medical history, etc.
- Billing reference data, including account numbers, dates of service, amounts paid, etc.
These are then cross-referenced with medical coding for services provided to generate accurate costs. The value of breaking all these entries out into their own step alongside four others is greater assurance that the data reported is accurate.
A more deliberate process prevents potential revenue leakage in the future.
Follow-up on Benefits
In cases where patients are responsible for some or all of the balances due, and there are issues such as late or missing payments, the provider may conduct an investigation into the EOB and other details of their coverage (or lack thereof) to determine what further actions are needed.
This investigation may result in legal actions or negotiations between the provider, payor, and patient.
Analysis And Recovery
In addition to cases in which patients may neglect partial or full payment of balances they owe, similar disputes may arise with other payors, such as insurance payers. A similar process to that of step #3 then takes place, with the focus instead shifted to the analysis of the payors’ responsibilities.
If claim denials or rejections are presented to the providers, these may be indicative of issues in the medical coding or billing process. Possible reasons include inaccurate coding or one or more treatments that fall outside of what the payors have decided are appropriate or covered for the patient.
To recover any funds owed in these cases, in-depth analysis is a key consideration.
Customer Satisfaction
The last step in the process is optional with respect to legal or financial requirements, but not for companies seeking long-lasting, mutually beneficial relationships with patients. Providers should enact continuity measures, such as collecting client feedback and making adjustments, as necessary.
If surveys, polls, or interviews of patients indicate challenges in the data collection process or any other element of charge entry, resolving these and by taking note of customer experience in healthcare are best practices toward facilitating all other (required and optional) steps along the way.
PayrHealth: Professional Charge Entry Services Made Simple
Given the importance of charge entry, most companies can benefit from guidance and oversight provided by quality managed care contracting services, like PayrHealth. Our solutions include holistic revenue cycle management and individual tailored services, such as contract optimization, rate negotiation, and overall team expansion.
Get in touch with our experts to get started today!
Sources:
- Bryant & Stratton College. 10 Steps in the Medical Billing Process. https://www.bryantstratton.edu/blog/2018/january/medical-billing-process
- HHS. Individuals’ Right under HIPAA to Access their Health Information 45 CFR § 164.524. https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/access/index.html
- Flatworld Solutions. Charge Entry Process in Medical Billing. https://www.flatworldsolutions.com/healthcare/medicalbilling-charge-entry-process.php
- Qway Health. A Quick Guide on Charge Entry for Revenue Cycle Management Companies.
- RCM Guide. Charge Entry in Medical Billing. https://rcmguide.com/charge-entry-in-medical-billing
