What do You need to Know About Charge Entry in Medical Billing?

A crucial phase of the medical billing process is charge entry. There are 8 steps in the complete medical billing process:

  1. Registering people, gathering payment and demographic data
  2. Establishing the cost of previous, ongoing, and prospective visits
  3. Putting together a “superbill” with the data gathered and copays
  4. Making claims from superbills to make payor filing easier
  5. Claims submission to the payor(s), typically through medical clearinghouses
  6. Keeping track of the resolution of claims and making changes as necessary
  7. If necessary, preparing patient records for unpaid fees
  8. Contacting patients again to confirm complete payment has been received

Why Does The Charge Entry Process, Matter?

Charge entry is a part of the larger medical billing procedure, as was already mentioned. Charge entry is important purely because precise recordkeeping is important. The stage is still set for bigger, more impactful mistakes down the road, even in instances where one small error in a reported charge or insurance claim results in a minor miscommunication. It is crucial for all healthcare professionals who work to ensure comfort and quality in all of their encounters with patients.

Stakes for Healthcare Patients, Payors, and Providers

The parties engaged in the process including the patient, payor, and healthcare provider, are immediately impacted by charge entry. Their separate stakes, which are not restricted, consist of:

  • Patients – Incorrect charge entry may result in unforeseen costs or even a delay in treatment. Patients may be reluctant to obtain the treatment they require quickly as a result of this.
  • Payors – Charge entry errors may have monetary, fiscal, and civil repercussions. Additionally, some errors can harm one’s image with patients and healthcare professionals.
  • Providers – Charge entry is important for compliance, image, and even relationships. Charge entry administration also promotes effectiveness and reliable, timely payments.

Regarding the final point, it’s critical to safeguard each stage of the charge entry process by HIPAA privacy, security, and breach notification requirements while protecting patients’ access rights.2 Partners or investors with a stake in the success of providers are additional players for charge entry.

1. File or Document Intake

Patient registration and the creation of financial responsibility from the overall billing cycle process described above constitute the first step. It entails gathering all necessary paperwork relating to patient treatment as well as the payment that goes with it, such as Explanation of Benefits (EOB) forms and checks, cash, or other payment methods for co-pays that are due upfront.

A medical biller’s responsibility after receiving all necessary paperwork and files is to place them in HIPAA-compliant storage areas and get everything ready for additional entry and analysis.

2. Entry of Relevant Details

The second step of the procedure is the most crucial and the only one that must always be finished in its entirety. It is consistent with both of the stages listed in the streamlined, two-step procedure mentioned above.

There are two crucial types of information to include:

  • Patient reference information, such as age, sex, vital signs, medical history, etc.
  • Billing reference information, such as account numbers, service dates, payment sums, etc.

To produce correct costs, these are then cross-referenced with medical coding for the services rendered. Greater assurance that the data given is accurate is the benefit of separating each of these entries into its step along with four others. Future income leaks can be avoided with a more methodical procedure.

3. Follow-up on Benefits

The provider may look into the EOB and other information about the patient’s coverage to determine what further steps are necessary for situations where patients are liable for some or all of the outstanding balances due and there are problems like late or missed payments. Legal action or negotiations between the patient, payor, and provider could come from this investigation.

4. Analysis And Recovery

Patients may neglect to make partial or complete payments on balances they owe, but other payers, like insurance payers, may also be involved in similar disputes. The process then proceeds similarly to step 3 with the emphasis now being placed on the study of the payors’ obligations.

If providers are given denials or rejections, there may be problems with the medical billing or coding procedure. Possible causes include incorrect coding or one or more treatments that are not deemed necessary or paid for by the patient by the payors. An in-depth study is a crucial factor when trying to recover any money owed in these situations.

5. Customer Satisfaction

Regarding legal or financial requirements, the final step in the process is optional, but it is not optional for billing companies looking to build enduring, mutually beneficial relationships with patients. Providers should implement continuity strategies, such as gathering client input and making required adjustments.

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