Charge Entry in the Medical Practice: Here’s How to Optimize
Charge entry should be done frequently. The process requires attention to detail and accurate data entry. When charges are entered, all insurance and demographic information should be in the billing system. After the service is performed and properly documented and coded, the procedure and diagnosis codes need to be entered for the appropriate patient, with the correct date of service (DOS), and assigned to the correct physician. The next step is keying in the correct procedure and diagnosis codes that will attach a charge for the visit. If these items are not entered correctly, the result is often denied or delayed claims and potential risk for future audits.
Common performance indicators for charge entry include:
Days to enter charges—average elapsed days from the date of service to the date that the charge is completed and posted to the account. The goal for most practices is to post the charges the same day the services are rendered. The longer it takes to post the charges, the longer it will take to get paid for the services. Set a goal for the number of acceptable days to post charges. Most practice management systems have reports to monitor the number of days to post charges.
Missing charges—appointments that do not have charges posted. This can occur if the employee posting the charges misses a charge marked on the encounter form, or if the physician doesn’t mark all the charges on the encounter form. Missing charges reports should be run from the practice management system to determine appointments that do not have any charges posted. To find partially missed charges, review the charts with the encounter forms and the charges posted to the accounts. You can use the results of the review to monitor the performance of the staff responsible for posting charges.
Coding accuracy—percentage of claims that fail the coding editor. Most practice management and/or billing systems have claim scrubbers to identify claim errors before the claims are transmitted. This gives the staff an opportunity to fix all errors prior to claim submission. An example of a coding edit is an invalid code. This can occur if there has been a code change, such as a deleted code, and the practice management system has not been updated with the new CPT®, ICD-10-CM, and HCPCS Level II codes.
For a small office, the charge entry person can also help code the claim, as can the person collecting on accounts receivable. For larger groups, charge entry may be the only responsibility of the employee. Assess the practice needs to identify how to create the greatest efficiencies with charge entry.
A review of charges that reveals a variance may be due to several factors, including: a change in patient volume, a problem with charge entry, provider absences, failure of providers to report timely charges, issues with managed care contracts, or a change in coding patterns. Charges should be consistent from month to month, barring changes in office productivity such as vacations or illness.
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