We know that effective revenue cycle management demands minimal denials and maximum revenue collection at a rapid pace. It is not possible without the proficiency of charge entry specialists in medical billing. It is a pivotal part of the RCM and requires more focus. Let’s explore how your charge entry team efficiency can put your RCM in the upward direction.
The Role & Job Of Charge Entry Specialists In Medical Billing:
The charge entry team as the name suggests works for the billing. When a patient makes an appointment with a doctor or health care facility, the medical transcription or scribers send readable data to medical coders. The readable records help medical coding teams determine which kind of treatment the doctors or health care providers have provided. The data that medical coders send to the charge entry team has many important components that need sorting and classification.
Different Ways In Which Medical Coders Classify Data:
Medical coders and charge entry teams use different classification standards. These standards work as per the Insurance guidelines like LCD/NCD (Local Coverage Determination/ National Coverage Determination) and Provider manuals. They use it to prepare a Fee Ticket and then Send a Bill or Claim to the Insurance Company.
The charge entry specialists along with the medical coders need to have a thorough understanding of these classification standards. These include CPT(Current Procedural Terminology) ICD (International Classification of Disease), HCPCS (Healthcare common procedure coding system) POS (Place of service) & modifiers. Let us learn more about these classification standards.
Description Of Different Classification Codes
CPT Codes: It describes as Current Procedural Terminology the treatment provided by the doctor to the patient. Also we can say the procedure a patient has undergone during the consultation. It includes all types of treatments diagnostic, laboratory, radiology, and surgical procedures etc
- HCPCS: These are Alphanumeric codes that are part of CPT. These come into the billing when any equipment or Instrument gets enrolled during patient care.
- ICD Codes– Medical coders CPC(Certified Professional Coders) use ICD codes or Diagnosis(Dx) Codes to identify or describe diseases, cause of treatment and medical conditions. ICD codes usually include 4 to 6 Characters starting with an Alphabet followed by 2 numeric digits then a decimal and followed by 1,2 or 3 Numeric or alphanumeric characters. For example, the ICD code for Covid-19 is U07.1.
- POS(Place Of Service)– These are two-digit codes that form an important part of a healthcare insurance claim. They describe the setting in which the patient received the treatment.
- Modifier- A Modifier can be an indicator, identifier or distinguisher which completes the CPT or HCPCS code. It denotes in 2 digits and might be in a numeric, alphanumeric or alphabetic form. They indicate whether a bilateral or unilateral code has been used as per insurance guidelines in any treatment. Modifiers serve many purposes. For example, medical coders use them to prove medical necessity, side indicator or to distinguish a service that the patient received. Some examples of Modifiers are- KX(Use to prove medical necessity), Modifier80(Assistant Surgeon use it bill a separate claim for any surgery) etc.
The Process Charge Entry Specialists In Medical Billing Follow-
The charge entry specialists determine the exact amount that the insurance company is liable to pay against the treatment that patient received.
They check the patient’s insurance policy details and collect demographic information. Furthermore, charge entry team record and update information related to many other important pieces of information. These include dates of service, billing providers, referral healthcare providers, Point of Service, data and time of admission.
They use FTP servers, EHR, or document management systems to manage superbills, charge tickets, and the related clinical documentation. Their tasks include reviewing any pending or held documents with the client daily to reduce any backlog as well. The timely audit services are also part of efficient billing. It helps detect errors in medical coding, overbilling, and missed charges.
They use FTP servers, EHR, or document management systems to manage superbills, charge tickets, and the related clinical documentation. Their tasks include reviewing any pending or held documents with the client daily to reduce any backlog as well. The timely audit services are also part of efficient billing. It helps detect errors in medical coding, overbilling, and missed charges.
They also need to deal with clients via telephone & use statistical and accounting software for maintaining data.
How Charge Entry Specialists In Medical Billing Drives RCM :
The descriptions above show that charge entry professional mistakes or laziness can lead to denial and rejections
USA healthcare sector stats have shown that simple errors like inputting an incorrect patient ID result in many denials. Not to mention the incorrect recording of information by either medical coders or the charge entry team.
The charge entry team efficiency can lead to a hassle-free customer experience for the patients. It is also crucial that the charge entry team performs well to maintain a low offset rate and refund rate.
A health care entity cannot allow Charge Entry Specialists in medical billing to fail. You are looking at a pile of denials and rejections if it happens so. In this scenario, offset and refund rates will also rise.
How To Reduce Inefficiency In Charge Entry Working:
While completing patient billing and visiting information, charge entry professionals in medical billing need to be extra careful before they enter the information into the system.
They can identify the pattern in the kind of mistakes the charge entry team is committing. By identifying those areas, they can improve on the work process and lead to decreasing denials, rejections and refunds.
When gathering information from patients or the front desk, always remember to get these details right on the first attempt.
It is vital that to update and train medical coders on the latest medical coding systems.
Why You Should Consider Virtual Healthcare For Charge Entry :
Are you experience a high number of denied or rejected claims due to incorrect patient billing information? If yes, it is time for you to look into the working of your charge entry specialist.
Contact Virtual healthcare for a professional medical charge entry service to make your RCM process robust. We offer complete healthcare billing services that enhance one or all aspects of your revenue cycle management process.
We focus on fixes, training, skills and experience while dealing with your charge entry functions. As a leading medical billing company for USA healthcare, we have a proven record of helping doctors and hospitals. So, give Virtual Healthcare a chance to serve you.