Charge Entry and Claims Process

Accurate charge entry and claim submissions are crucial steps in the revenue cycle. Ensuring these are done correctly helps avoid denials and delays in reimbursement.

What is Charge Entry?

Charge entry involves inputting the correct billing codes and charges for services rendered by healthcare providers. This is the foundation for accurate claims submissions and timely reimbursement.

Key Steps in Charge Entry

Step 1: Gather Service Details

Collect the details of the services provided to the patient, including procedure codes, diagnosis codes, and any other necessary information from the healthcare provider.

Step 2: Code Selection

Select the appropriate ICD-10, CPT, and HCPCS codes based on the diagnosis and procedures performed. Accurate coding ensures proper reimbursement.

Step 3: Charge Entry in System

Input the codes and charge information into the practice management or billing system. Ensure all information is accurate and complete.

What is Claim Submission?

Once charges are entered, claims are generated and submitted to insurance companies for payment. Claim submission includes the claim form (CMS-1500 for outpatient or UB-04 for inpatient) with all required patient and service information.

Key Steps in Claim Submission

Step 1: Claim Generation

Once charges are entered, the system generates a claim with the necessary details, including patient information, diagnosis, and procedure codes.

Step 2: Review and Validation

Review the claim for accuracy. Check for missing or incorrect information, ensuring that all codes are accurate and correspond to the services provided.

Step 3: Submit to Payer

Submit the claim electronically or via paper to the insurance payer. Ensure submission follows the payer’s guidelines and is done in a timely manner.

Common Issues in Charge Entry & Claims

Common errors in charge entry and claims submission can lead to delays, denials, and lost revenue. Here are some common mistakes to avoid:

Incorrect Coding

Incorrect codes can lead to claim denials or underpayments. Always verify that the codes selected are accurate and up to date.

Missing Information

Claims missing important information, such as patient demographics or procedure details, can result in delays and rejections.

Untimely Submissions

Claims submitted after the payer’s deadline can lead to denials or reduced payments. Always follow submission timelines to ensure timely processing.

Optimize Your Charge Entry & Claims Process

Ensuring accuracy in charge entry and timely claim submissions can improve cash flow and reduce denials. Let us help streamline your process.