8 Best Ways To Manage Charges Entry In Medical Billing
Charges entry is one of the most important steps in the medical billing cycle—it’s where the claims are created. Accurate charge entry is critical to optometric billing so you can collect maximum reimbursements, prevent claim denials and rejections, improve billing productivity, and increase cash flow.
A complete revenue cycle management (RCM) solution that includes an efficient charge entry process eliminates worrying about entering error-free patient demographics before you file vision plans and medical insurance claims.
Let’s explore how you can better manage the charge entry process with these helpful tips.
What is Charges Entry?
Charges entry is a process where you enter valid medical billing information and assign diagnosis codes, procedures codes, and modifiers before you file a vision plan or medical insurance claim.
Even one mistake could lead to a rejected or denied claim, resulting in thousands of dollars in lost revenue. Medical claim errors can also cause conflicts or damage your patient-provider relationship.
8 Steps to Managing the Charges Entry Process
1. Enter accurate patient demographics.
A majority of claim denials are due to administrative errors. Verify the patient and guarantor’s name, ID, gender, date of birth, SSN, address, phone number, guarantor details, and insurance details.
Always ensure you include the following information on the superbill before you submit it to a clearinghouse or third-party payers, and cross-reference medical codes with patient information. Pay close attention as these elements are critical to the charge entry process:
- Date of service (DOS)
- Place of service (POS)
- Rendering provider details
- Date of admission
- Prior or pre-authorization details
- Diagnosis and procedure codes, and number of units provided
- Modifiers (if needed)
2. Verify the insurance payer has approved the provider.
Remember to submit and track provider credentialing and re-credentialing applications based on insurance plan requirements. Take it one step further and follow up with insurance payers regularly to ensure the providers are enrolled “in-network” when enrollment is open.
3. Confirm pre-authorization details.
Verify if you need a prior authorization number before you see the patient. Make sure you include the prior authorization number on the insurance claim.
4. Verify patient eligibility and benefits.
Eligibility verification ensures the insurance data is correct and helps determine the amount a patient may owe (e.g., co-pays, co-insurance, and deductibles). Providing more accurate cost estimates to your patients can significantly boost patient satisfaction and save you from future claim denials.
5. Enter charges and submit claims daily.
Don’t delay entering charges during the charge entry process; post charges the same day you provide the services to the patient. The longer you wait to post charges, the longer it takes to file a medical claim or bill the patient.
For instance, if your biller who is posting the charges overlooks a charge marked on an encounter form, or the doctor forgets to indicate all the charges on the encounter, this will cause future problems with your medical billing.
By submitting claims either the day of the appointment or within one business day, you can maintain a constant flow of claims to get them paid promptly. If you file claims only once a week, your accounts receivable (AR) will grow like a weed, which means a bigger backlog to work through that often results in more billing errors. Remember, most major medical payers process claims in just five to seven business days.
6. Allocate payments received to your payment posting team.
Delaying posting payments keeps your AR artificially high and you could be missing denials. If you think getting EFT payments means you can wait to post, think again. Some payers have strict refiling rules, which limit your time to appeal a claim from the date of the remit.
By handling remits within one to two days, you can move the balance to the secondary insurance and bill that much quicker. Or, you can transfer the balance that is due from the patient and generate a statement. It becomes increasingly difficult to collect payments the longer it’s been since the patient’s visit.
7. Scrub your claims to confirm you assign correct medical billing codes and modifiers.
Not only do you have to adhere to strict state-specific coding and audit guidelines, but you must also evaluate medical documents and physician notes to ensure claims are not under- or over-coding services and procedures.
For instance, always make sure the diagnosis and procedure codes are correct or the patient identifier and/or provider identifier (NPI) isn’t missing or incorrect. Don’t forget to indicate the number of units performed.
It’s not uncommon for optometry and ophthalmology practices to frequently misuse billing modifiers. When insurance and third-party payers determine you incorrectly used a medical billing modifier on a claim, this can become a costly mistake. Misusing medical billing modifiers can trigger an audit that can lead to hefty fines—audits can go back many years.
8. Download and review explanation of benefits (EOBs).
An EOB is a statement the insurance company sends after processing a claim received from the healthcare provider. The EOB lists the total charges (amount billed), allowed amount, non-covered charges, the amount paid to the provider, and any co-pay, co-insurance, and deductibles the patient pays.
By reviewing EOBs when they arrive, you can determine if you need to perform a more in-depth investigation into a claim or determine what further actions are needed.
Vozo Medical Billing Software To Get Paid Faster
Vozo medical billing software will automate your entire billing process helps you to grow your practice financial health and boost your revenue collections by leveraging the best practices.
The top billing software features include:
- Accurate claim submission
- Secure patient payment processing
- Easy to use RCM dashboard
- Automated medical scheduling
- Real-time performance reporting
- Insurance eligibility check
- Automated payment posting
Vozo helps you to get paid quickly with HIPAA-compliant systems and more advanced billing features. Ready to achieve medical claim billing success? Contact us today.