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Charge Entry And
Claims Submission

Accurate Charge Entries.
Faster Claims Submissions.
Errors in charge entry can lead to claim denials, the medical practice being underpaid for its services, or the practice overcharging its clients. That in turn can lead to significant revenue leakages, patient dissonance, and even compliance issues for the medical practice.
Charge Entry
Charge entry is the assignment of the dollar value for the medical service performed, per the chosen medical codes and corresponding payer fee schedule. Charge entry is done for all in-patient settings, surgical procedures, office visits, telehealth consultations, and ancillary supplies/services. Charge entry requires close collaboration between the medical coding and the charge entry teams to ensure that all the medical services are billed, and the codes are accurate.
Steps In Charge Entry

  • Review the medical documents captured through the practice management system, including the physician notes.
  • Capture the patient's demographic information and details of the medical service, which include the date of service, place of service, referring provider, and other relevant information.
  • Audit the charge entry to ensure that the details captured are comprehensive.
  • Check that the charge entry is as per the provider's fee schedule.

Critical Challenges In Charge Entry

  • The charge entry is not undervalued or overvalued vis-à-vis the services rendered.
  • All ancillary services and supplies are captured.
  • Ensuring that no patient visits are missed.
  • Ensuring that each medical procedure is documented.
  • Any errors in charge entry are caught before claims submission.
  • Evaluating denials due to charge entry errors and taking steps to improve accuracies in charge entry.

Claims Submission
Once the charge entry is done, the next step is claims submission through the practice management system. Claims are submitted via a clearing house or to the insurance company through a cloud-based system.
Critical Errors In Claims Submission
Incorrectly captured claims result in claim denials and loss of revenue for the medical practice. Here are the top reasons for claim denials:

  • The claim is submitted late.
  • The insurance number is incorrectly captured.
  • The claim submitted is for non-covered services.
  • The service is not viewed as a medical necessity (this is usually because of insufficient documentation to support the physician's diagnosis).
  • The service is incorrectly bundled, or the code used is for a higher-paying service.
  • The incorrect modifier is used.
  • A duplicate claim is submitted.
  • The patient deductible is not met.
  • The benefits have been exhausted.
  • Prior authorization is not attached.
  • Demographic information is incorrect.
  • The provider is out-of-network.

If your medical practice regularly faces claim denials, you must improve the charge entry and claims scrubbing processes. An efficient way to make that change is through outsourcing charge entry and claims submission to an experienced medical billing partner.

Advantages of Outsourcing Charge Entry and Claims Submission to Elite Offshore

  • Your practice will experience an immediate boost in clean claims submissions.
  • Your cash flow position will improve.
  • You experience these efficiencies while lowering the cost of operations.
  • You have ready access to a team of medical coders, billers, and claim auditors whose sole aim is claim approvals.
  • Improved performance in compliance audits of your billing processes.
  • Reports of claims submissions, errors, rebills, and secondary claims trends by the outsourced partner will better understand gaps in your insurance eligibility, prior authorizations, and demographic captures.

What Does Our Charge Entry and Claims Submission Process Include

  • Access all the documents – Our team reviews all the documents received from your office (Charge tickets, clinical documentation, physician's notes, insurance documents).
  • The information is recorded on a workflow system – The medical coder captures the charge value, the demographics information, relevant OCD/ CPT codes, modifiers, point of service, and date/ time of admission.
  • Audit of information- Each coder's work is checked for over-billing, missed charges, and adherence to specific charge capture rules, before claims submission.
  • Follow up on pending claims – All pending and discrepant claims are reviewed daily and reported to the practice for resolution.

Charge entry accuracy is paramount for successful medical billing, and even a minor mistake in charge of entry impacts the entire outcome. With Elite, you can improve your charge entry and claims submissions starting today!

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