Medical billing charge entry plays a central role in healthcare operations. It keeps healthcare providers healthy much the same way a heartbeat keeps a person alive. Charge entry translates medical services into financial transactions, without which the revenue cycle would stop, and healthcare providers would cease to function.
This seemingly simple process holds a large sway over healthcare revenue management, so its accuracy is vital. Here’s a deeper dive into the role of accurate charge entry in the entire revenue cycle management process and how it is connected with the rest of the process.
Charge entry process in the revenue cycle
At its core, charge entry meticulously records all healthcare services rendered to patients and their corresponding charges within the medical billing system. The process may involve gathering information about patients and payers, analyzing, and preparing it before being entered.
Charge entry is a component of the medical billing process and could encompass the following steps.
- Patient inquiry and document intake: This involves collecting information related to patient care and corresponding payment, such as insurance details, explanation of benefits, physician identification, and dates of service. If a patient record is not found, a follow-up with the healthcare service provider is necessary.
- Entry of relevant details: This involves entering patient and billing reference data and is the most important. Standardized medical codes like CPT, ICD-10, and HCPCS translate diagnoses, procedures, and supplies into billable charges.
- Information verification: Each piece of information must be re-checked and verified. Only then can the charges be passed on for billing.
- Fee capture: Each service has an accurate, contractually agreed-upon fee associated, adhering to both payer guidelines and the provider’s fee schedule. The prepared bill is presented to the payer, who may be the patient or an insurance company. In cases where the bill is rejected or only partial payments are made, denial analysis or EOB follow-up may be done.
Role of charge entry in the healthcare revenue cycle management
It would be helpful to think of the revenue cycle as a series of steps to understand charge entry’s broader role. Each step relies on the one before it, with some of the steps playing a more vital role. Charge entry is one of the more critical ones, and it influences several others.
Information collection: After a patient receives care, their medical history, insurance details, diagnosis and treatment procedures, etc., are recorded.
Charge entry: The patient information and details of services rendered are then meticulously translated into charges within the medical billing system. Think of it as translating the medical services into a financial language that the payer—insurance companies or patients—understand.
Claims submission and processing: Medical billers create claims submitted to the payer for reimbursement using the data from charge entry.
Payment: The healthcare provider receives payment based on the submitted claims and their review by the insurance company. Charge entry data is then compared with the received payment to ensure everything matches.
Denial management and accounts receivable: If any claims are denied (meaning the insurance company refuses payment), the data from charge entry becomes crucial for investigating the reason for denial, appealing the decision, and resubmitting claims. It also helps identify any outstanding patient responsibility (deductibles, co-pays) that needs to be collected.
Essentially, charge entry acts as a bridge connecting the clinical side of healthcare (patient encounters and medical records) with the financial side (claims submission, payments, and collections). Its accuracy and completeness are vital for ensuring each stage in the revenue cycle functions smoothly and efficiently.
How charge entry affects the revenue cycle
As noted above, charge entry in the medical billing process affects nearly every step in revenue cycle management. Its accuracy thus has notable impacts downstream, and its inaccuracy can result in financial loss, operational inefficiency, and reputational and relational damage.
Charge entry errors result in the denial of billing claims or outright rejection. This necessitates tedious and costly rework and claim appeals, leading to operational inefficiencies further eroding the bottom line. Errors in charge entry, such as undercoding, also directly impact revenue directly. Errors such as overcoding, on the other hand, can invite legal troubles and hefty penalties.
Inaccurate charge entry is more than just a financial issue. It can negatively impact patient-provider relationships, fueling disputes over unexpected bills. If not carefully resolved, it’ll leave patients angry, leading to a loss of loyalty and trust.
Moving forward
The importance of accurate charge entry in the medical billing process cannot be overemphasized. It makes the whole process of billing and revenue cycle management efficient. A precise and efficient charge entry process is vital to staying healthy financially and operationally for any healthcare provider. If inaccuracies in charge entry fester, it’ll affect not just the provider but patients and payers too.
Given the significance of charge entry, companies must give utmost importance to maintaining accuracy. But given that time, expertise, and resources are often inadequate, this can be challenging. Companies can thus outsource charge entry services to specialized firms. This can help enhance accuracy and efficiency and reduce costs. It would also allow them to focus on what matters most—delivering quality care to their patients.
