Charges

Charge entry plays a crucial role in Revenue Cycle Management. Charge entry is a process of creating a claim for a service rendered by the provider to the patient. A claim is the most important aspect for getting reimbursements. Even a minor mistake in charge entry impacts the entire outcome. We give high importance for accurate charge entry in order to submit clean claims. 

Our goal is to get paid at the very first submission and the team relentlessly pushes harder to achieve higher first–pass rate of claims. We are experienced in various Practice Management Systems and various medical specialties. We have predefined rules in charge entry for different medical specialties, which reduces the room for errors and contributes to clean claims.

Charges entry includes the following

  • Charge/Superbill files
  • Patient demographics entry/verification
  • Eligibility verification
  • Claims creation
  • Reminder for missing charges

Charge file downloads

ABCLLC will download the charge files from Dropbox, Google Drive, PMS, FTP, Email, Fax etc. If the client did not have the setup, we will train them to upload the files in PMS.

Patient demo entry, data and eligibility verification

  • All new patients information such as patient, guarantor, Insurance information etc are captured.
  • All existing patients information are verified and updated if there is any change.
  • All non-office patients, demographics verified by logging into hospital portal/requesting through fax.
  • ABCLLC verifies insurance ID number, name/address of the insurance, group name/ number, effective/termination date, the name of the insured, date of birth and the relationship of the insured to the patient.
  • ABCLLC verifies coverage for primary / secondary / tertiary payers by utilizing payer websites, automated voice response systems, or by calling payers.
  • All self-pay/indigent patients are checked for Medicaid and other possible insurance eligibility.

Claims creation

All the claims were created within 8 hours of the charge/superbill files received..

  • Charges are entered in PMS based on speciality specific rules.
  • Handwritten diagnosis and procedures are analyzed to find the appropriate ICD-10 and CPTs.
  • Handwritten hospital patients diagnosis are cross checked with the patients progress notes by logging into hospital portal for accuracy.
  • Using appropriate modifiers, mapping, linking codes etc., to avoid denials.
  • Educating providers if any obsolete or deleted CPT’s handwritten in charge sheet/superbills.
  • Precertification number for non-office patients are requested through fax or by calling the facility before the claim is created.
  • Email request to the clients regarding missing Diagnosis, CPTs, DOS, etc,. 

Missing charges reminder

It is very important to submit claims to the insurance within the filing time limit period. Delay in the charge entry directly impacts the reimbursements.

  • Weekly reminders to provider regarding missing charges. 
  • Weekly reminders to providers on incomplete office progress notes.