Quick Guide Revenue Cycle Management Companies

A Quick Guide on Charge Entry for Revenue Cycle Management Companies

A perfect denial management means zero-errors in the charge entry process. A well-structured charge entry process in revenue cycle management companies can witness a phenomenal growth of revenue as well as business.

Revenue Cycle Management companies heeds towards processes that can complete payments without any denials by holding a strong power in the healthcare industry.

Charge Entry process is considered to be crucial and substantial to manage denials and travels towards successful and profitable revenue payments.

Steps to Manage Charge Entry Process:

  • Files Receipt
  • Downloads and Allocations of Files
  • Patient Demographic Details Entry
  • EOB Follow-Up
  • Claim Denial Analysis
  • Feedback From Clients
  1. Files Receipt:

  • As mentioned earlier, Explanation of Benefits (EOBs) and cheques are supposed to be received from the healthcare professionals without fail in a scanned format through secured FTP sites.
  1. Downloads and Allocations of Files:

  • It’s the duty of medical billing team experts to download those files from the secured websites, check and review the materials or the files to allocate them to the payments posting team.
  • The allocated files are posted for the payments by the payments posting team successfully.
  1. Patient Demographic Details Entry:

  • The patient demographic data is captured by the payments posting team that includes patient account number, amount billed and amount allowed, amount adjusted and paid.
  • They also enter the denials if any found along with the patient demographic details.
  1. EOB Follow-up:

  • While having or making partial payments, it’s important and crucial to initiate necessary investigations and analysis to take respective steps.
  1. Claim Denial Analysis:

  • Revenue Cycle Management companies’ medical billing teams analyzes all the submitted claims thoroughly.
  • The billing team takes in charge to correct the errors in the claims and resubmit them for a post payment.
  1. Feedback from the Clients:

  • Feedback from the clients or healthcare professionals is very important. It’s useful to evaluate the data quality and refine the changes or errors and make improvements.
  • Positive feedback from healthcare professionals will boost revenue cycle management companies to deliver better services following revenue growth.

Factors that Cover Charge Entry:

  • Date of the service provided
  • Billing and Rendering providers
  • Admission Date
  • Place of service
  • Physician Reference
  • Pre-authorization
  • CPT coding and units performed
  • Diagnosis Codes
  • Modifiers

How Does Charge Entry Help Healthcare Providers Practice?

  1. Achieve Constant Revenue Flow:

  • Services rendered by the healthcare professionals are transcripted into codes and each service is separately charged accurately to obtain proper reimbursement.
  • Revenue Cycle Management companies take the responsibility of charge entry process which is considered as important for feasible and seamless flow of revenue.
  1. Prevents Claim Denials and Rejections:

  • Usually claim denials and rejections are caused due to errors in the patient demographic details or pre-authorization.
  • When errors occur, they are processed for next level to recorrect with accurate details and resubmit those claims within the deadline.
  • In order to avoid or prevent claim denials or rejections, revenue cycle management can be more attentive during charge entry process that eliminates the possibility of getting denied or rejected.
  1. Time Consumption is reduced:

  • Normal data entry consumes lot of time and effort for identifying errors.
  • At times, it’s evident that it takes days or weeks to find out the mistakes in the claims.
  • It will for sure have an impact on revenue cycle management process. Charge entry can change the situation.
  • Systematic charge entry process in revenue cycle management companies will help consume less time for investigating and identifying errors in the claims.

Importance of Charge Entry:

  • Charge entry is considered to be most important process as all the patients accounts are assigned with accurate monetary value with right coding system.
  • Revenue payments or the denials are decided by the charge entry for the services rendered by the healthcare professionals.
  • The very next process after charge entry would be claim denials and any errors in charge entry could lead to denials and revenue loss.
  • Most of revenue cycle management companies work on charge entry process to ensure no mistakes are found and won’t be a reason for denials for submitted claims.
  • To manage and maintain accurate and clean charge entry process, medical billing and coding team should coordinate and work for error free claims.
  • Two critical steps involved for zero-errors charge entry:
  1. Patient Demographic Details:

  • As it’s mentioned, patient demographic details are very essential and entering them accurately plays a crucial role in the process.
  • Correct details of the patient must be entered and processed before submitting the claim.
  • Double check the charge entry details especially all the information relates to patient including their name, ID numbers, and account details etc. to avoid denials.
  1. Medical Coding:

  • Medical coding is a phase of process where it requires experts and recognized medical coding systems.
  • Any mistake or mis-entry of medical codes for the services rendered by the healthcare professionals will be rejected by the insurance companies before submitting the claim.
  • There are few data entries that is particular and compulsory to be included in charge entry process.
  • They are admission dates, dates of services, place of service, healthcare provider details, pre-authorization and coding.
  • Charge entry in revenue cycle management companies ensures revenue payments or payment postings on time without any delay.
  • Entry must be in detail and should be done accurately with utmost attention.
  • When the data and coding is accurate, there will be less chances for denials and claim process for further payments will be done easily by insurance companies.
  • Experts in billing and coding teams in revenue cycle management companies must concentrate on charge entry to ensure growth in revenue and constant reimbursements.

Role of Charge Entry in Medical Billing Process:

  • Charge Entry has a unique and important role to play in assigning appropriate charges with suitable medical codes and applicable fee schedule.
  • Revenue payments for the rendered services will be especially determined by Charge Entry as it’s the crucial point.
  • Being attentive while charge entry process is essential as errors on charge entries will cause denials. So, in order to avoid denials or rejections, good coordination between charge entry and medical coding team that increases revenue reimbursements are to be encouraged.
  • Details to be included in Charge Entry:
  1. Admission Date
  2. Date of service provided
  3. Place of service
  4. Provider details
  5. Physician reference
  6. Pre-authorization
  7. Procedure and Diagnosis code.

Why you need a Charge Entry Specialist:

Having a specialist in the billing team for the purpose of charge entry can be beneficial to the organization, by making the revenue cycle management duties better functioning. Here is how a charge entry specialist boosts your system:

  • A specialist takes note of the patient accounts daily and updates them according to the latest accurate documents.
  • Revenue cycle management needs the attention of several components of the billing team. The professional makes it a point to get in touch with every sub-department to help in making an informed decision.
  • They are also capable of auditing all documents related to reimbursements in the organization.
  • Professionals stay up to date with any new legislation passed by the federal and state bodies and implement them for best results.
  • They have good knowledge of HIPAA compliance, which helps them to keep the patient records and health information secured.

Maintain and Update the Hospital Chargemaster

The chargemaster in a hospital or healthcare organization plays a crucial role in listing the services offered by the providers. It maintains a comprehensive list of services, procedures, diagnostic investigations and supplies offered by the healthcare organization along with the costs assigned to each. Maintaining and updating the hospital chargemaster frequently in line with the compliance measures of federal healthcare authorities are extremely critical to the revenue cycle management.

  • According to the American Academy of Professional Coders (AAPC), hospitals should ensure that codes under the chargemaster are compliant, correct and complete. This job can be challenging given the frequent changes in the reimbursement policies of private and Government payers.
  • Make sure that you keep an eye on any coding notification from the CMS. Billing teams also need to look at the different changes introduced by the private players. The line items in the bill must match exactly with the correct revenue codes or the CPT and HPCS codes.
  • Making mistakes such as assigning a CPT instead of an HPCS code or putting an unlisted HPCS code in place of a specific code could cost the revenue cycle of the healthcare organization dearly.
  • A complete understanding of the provided services is crucial for a clean claim. Make sure that the specific E/M codes are registered in the hospital chargemaster. Include the correct level of care with the add-on codes to ensure a healthy revenue cycle.

How to Keep Away Denials with Proper Charge Entry

  • Usage of proper diagnosis codes and procedural codes is highly vital in the charge entry process to make sure that the claims do not face any denials.
  • Apart from these issues, accurate provider details and patient demographic details are highly crucial for the proper processing of the claims.
  • According to the different surveys on medical billing workflows, more than 60% of the claims get rejected by the insurance panels due to clerical errors like spelling mistakes and incomplete information.
  • You can get rid of these issues with the help of automation tools specifically designed for charge entry issues. These tools can scan through significant amount of data in a very short span of time and look for any mistakes that can be potential causes of denials.
  • The in-house billing and coding teams can work more efficiently with ample time in their hands to focus on more complex decision-making.
  • Work towards making your revenue cycle management better and more beneficial for your organization by accommodating digital tools for your help.

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