Charge entry is the process or set of processes by which charges for medical procedures and other patient facing services are submitted to the appropriate payors for billing. It involves a detailed accounting for services rendered, as well as 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 is a pivotal step in the medical billing cycle. The entire medical billing process comprises 8 steps:1
Depending on the depth or breadth of your charge entry process, it may span steps 4-6 or all 8.
As noted above, charge entry is one piece of the larger process of medical billing. Charge entry matters simply because seamless accurate record-keeping matters. Even for situations in which one individual error in a reported charge leads to a minor miscommunication, the stage is still set for bigger, more impactful errors down the road.
For all healthcare professionals who strive to ensure quality and comfort across all interactions with clients, it’s essential.
The stakeholders impacted by charge entry are those directly involved in the care relationship between patient, payor, and provider. Their respective stakes include but are not limited to:
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. Other stakeholders for charge entry are partners or investors with an interest in providers’ success.
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:
However, the most impactful charge entry processes break down into several additional steps to ensure all stakeholders’ needs are accounted for.
Consider the following 5-step process.
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, a dedicated professional team allocates them to appropriate storage locations compliant with HIPAA and prepares for further entry and analysis
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:
These are then cross-referenced with medical coding for services provided to generate accurate costs. The value of breaking all this entry out into its own step alongside four others is greater assurance that data reported is accurate.
A more deliberate process prevents potential revenue leakage in the future.
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 provider, payor, and patient.
In addition to cases in which patients may neglect partial or full payment of balances they owe, similar disputes may arise with other payers, such as insurers. A similar process to that of step #3 then takes place, with the focus instead shifted to analysis of the payors’ responsibilities.
If 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.
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.
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