Frequent instances of claim denials, dishonest charging of bills to patients, inadequate security framework to guard confidential patient information, are some of the imposing factors that are derailing the revenue management systems of some of the leading names in the healthcare sector. Lack of resources with the requisite expertise or an overburdened healthcare staff in a healthcare organization are prone to commit erroneous charge entry in medical billing process. This results in either an under or overcharges which ultimately results in the filing of incorrect claims to insurance providers. Absence of proper audit services leads to an improper enforcement of governance processes that weakens the healthcare enterprise’s level of compliance with the regional or standard regulatory frameworks. Both these scenarios have severe implications on an enterprise’s prospects of revenue generation as well as their reputation in their customer base. This reinstates the importance of expert charge entry services and audit services in the medical billing process.
Charge entry and audit services are integral parts of the medical billing process that ensure an uninhibited cash flow, fewer delays in payments delays, lesser instances of claim denials, and ensure compliance of a healthcare enterprise to the gold standard regulatory and ethical frameworks. However, to gain an in-depth understanding of the value of medical billing charge entry services and audit services, lets get to know more about what they are like and what are their functions.
What is Charge Entry in Medical Billing Process?
Charge Entry in medical billing involves entering the diagnosis and medical procedure codes in line with the super bill. It includes entering other relevant information such as the actual date on which service was provided, units of service, authorization numbers, CPT modifiers, details of the healthcare provider, total amount billed, among others. A diagnosis code also referred to as the DX code describes patients’ ailments; a procedure code also known as the PX code refers to the type of treatment to patients based on their illnesses; modifiers are used with PX codes to highlight the different medical services availed by a patient; the date of service refers to the actual day when the patient in question received treatment; the units of service refers to the number of healthcare procedures of the claim; the term authorization also known as pre certification number or prior authorization number.
A healthcare provider is required to take an approval from the insurance firm prior to treating a patient to get done with claim submission for reimbursement; the billed amount also termed as the charge amount refers to the charges against all the services provided by the healthcare giver and were included during the charge entry process; a super bill is a comprehensive constitution of services and diagnostic bills and form listing procedures that record all the medical services offered to patients in every visits. This information is critical to constitute an error-free claim filing to facilitate an appropriate reimbursement for the healthcare provider from the insurance giver.
What are Auditing Services in Medical Billing Process?
A suboptimal reimbursement for the healthcare giver, inaccurate verification of patients’ details, wrong entry of diagnostic and procedure codes are some of the commonly occurring errors that can be easily avoided by maintaining a robust auditing services framework in place. Essentially, medical auditing services enables a fool-proof charge entry services, thereby ensuring submitting correct claims to insurance providers. Auditing services aid to identify and flag coding malpractices that could bring a healthcare organization under the radar of federal watchdogs for abusive healthcare practices. Akin to all other kind of auditing processed, medical auditing involves a thorough scrutiny and review of medical records and documents to promote accuracy and compliance to all the pertinent regulations in the medical field.
Importance of Medical Billing Charge Entry Services and Auditing Services
An error-free execution of medical billing charge entry services is critical to facilitate reimbursement of the right amount to the healthcare provider which is why charge entry services is regarded as the most important part of the medical billing process. It is essential to keep a sharp eye on any instance of miscoded billing charges that trigger anomalies in the claims. One must be careful about the fact that the charges that are deciphered from the coded documents are accurate. A way of ensuring a perfectly streamlined medical billing charge entry services is to ensure seamless co-ordination between the coding process and the professionals tasked to execute the charge entry services. Ensuring all these steps, with the help of proper workflow solutions in place, will have a cumulative positive impact on the claim submit process to the insurance payer.
Charge auditing services insulate a healthcare organization from potential fraudulent claims and inappropriate billing activities. These services are functional in proactively identifying risk areas such as inaccurate medical coding and aids to identify opportunities for medical reimbursements. Implementing charge auditing services serves as a learning experiences for coding professionals who are made aware of their potential areas of weaknesses. Engaging charge auditing services on an annual basis can identify and flag potential errors such as improper unbundling practices, inaccurate coding, and over usage of codes. A stark improvement in medical coding accuracy, prior identification of erroneous coding, minimizing anomalies and maximizing documentation reliability, identify the potential areas of weaknesses and strength in the workflow, organizing and bringing accuracy in charges towards insurance providers, drive promptness in payments are some of the benefits that reinstate the importance of charge auditing services in medical billing process.
Few Things to Remember for Charge Entry in Medical Billing Process and Auditing Services
It is advised that healthcare providers deepen their focus on charge entry services lines that entail the maximum risk and are more prone to errors. It especially includes areas that involve manual involvement in charge entry. Focus must be on the areas that are associated with high investment returns and offers opportunities for revenue boost such as emergency center, catheterization laboratories, pain and trauma center, operating rooms, among others. Missing supplies in cath labs, incorrect or missing medical implants, inaccurate fluoroscopy charges on pain management processes, inaccurate visit assignments at emergency department visit level assignments, are some of the commonly occurring charge entry services errors in these high ROI medical care areas that administrators must keep a keen eye on.
The process to ensure error-free charge entry in medical billing process starts with streamlined steps that include the following:
- Upon a patient’s arrival, a logbook must be maintained that captures every detail of the patient’s date f arrival, ailment, number of medical services availed. It is crucial to match the previously existing patient account number in medical record documentation prior to starting the treatment.
- All medical departments in a healthcare organization must have a charge sheet that keeps an account of all chargeable supplies and treatment procedures.
- All charges must be entered either on or closer to the day when the treatment was provided, and it is essential to verify the patient account number before entering the charges.
- Charge sheets should be tallied with the logbook to ensure that charges for all the services rendered to patients are captured correctly.
- Administrators must conduct personal investigation of the processes undertaken across specific coding departments to assess the quality of processes for medical coding, documentation, charge reconciliation. This effectively aids in identifying and addressing quality gaps in processes and helps to determine variations to implement accuracy in the processes. Personal observation also helps in spotting potential areas of risks so that prompt mitigation measures can be implemented.
- Charge audit services include steps such as sample-based testing, analysis of data, and reviewing document that enable accurate charge entry in medical billing process. An auditor is expected to conduct a careful scrutiny of medical bills and records by reviewing various clinical documents such as physician orders, notes taken by nurses, charge sheets prepared by clinicians. This further enables accurate assignment of charges as per the medical services provided to a patient.
- It is an essential to include the revenue integrity department and the key decision-makers across departments in the discussion which is aimed at identifying the auditing scopes. This ensures the inclusion of all departments that involve high risk and exhibits room for improvement in executing charge entry services. Stakeholders in the revenue integrity department have an inkling about the commonplace errors that occur in charge entry in medical billing process prior to submitting a claim. They also stay updated with any change in reimbursement policies that helps in staying compliant to the dynamic regulations while ensuring a satisfactory reimbursement.
- An overall enterprise-wide standard process framework should be established to bring consistency in quality in medical billing charge entry services. Doing so ensures accountability and common charge entry practices across a healthcare enterprise.
- Healthcare enterprises must determine and threshold price for materiality posting criteria. Quantity of supply that is more than the determined amount must be assigned with a charge description master (CDM) number and should be properly registered. It is strictly advised that miscellaneous charge posting (MCP) is not used for any purpose apart from posting charges for supplies that are identified as miscellaneous objects.
Outsource Charge Entry Services and Audit Services?
Outsourcing firms with the required specialization design charge entry services and audit services to amplify the rate of improvement of cash flow, reduce instances of delay in payments, and above all minimize the chances of claim denials. They work in close quarters with healthcare enterprises to understand their main pain points in delivering medical billing charge entry services, identify their areas of strength, and accordingly customize services and set periodic audit services to befit clients’ best interests. Medical enterprises outsource charge entry services with an expectation to achieve error-free service delivery model that empowers them to get reimbursements of payments from the claims submitted in a timely fashion. Here’s a look at the benefits you will obtain as you outsource charge entry services and medical audit services.
Absolute compliance– Most of the charge entry services providers are ISO 9001:2015 certified and are known to maintain strict adherence to HIPAA. They conduct period audit services to ensure that all the medical practices conducted within their ambit are aligned with the standard rules and regulations in the healthcare field.
Patient information security– Medical billing charge entry services providers maintain team of experts that comprises of signatories of non-disclosure agreements. The terms of NDAs are aimed to shield confidential patient information. They have the integrity of maintaining a strict healthcare data security framework in place to prevent exposure of your data to any unauthorized entities. They conduct data transaction through VPN or SFTP which is not only safe but also is less time-consuming.
Improved accuracy– Outsourced firms maintain the strictest medical audit processes and QA procedures to keep a constant eye on the accuracy in the charge entry services rendered to enterprises. They believe in maintaining a certain standard in the execution of our medical billing charge entry services to readily spot and flag any factor during the process that contribute to a potential claim denial.
Reduced turnaround time– Charge entry services providers have the ability to execute the complete process that include entry of charges, verification, and dispatching claims within an impressive turnaround time.
Better technological adoption– Outsourced firms have an arsenal of the latest innovation in billing software such as Kareo, QRS, Medical Manager, Altapoint, among others. This empowers to improve accuracy as well as minimize the time taken by them to deliver charge entry services to their clients.
Who We Are and Why We Are an Industry Authority?
This article is authored by MedBillingExperts, a medical support service provider with over a decade long experience and proficiency in providing medical services to the leading names in the healthcare sector. Our services are aimed at supporting you in finalizing an accurate reimbursement amount that would be conveyed to the insurance provider for a particular patient. We have earned a global recognition in the charge entry services and audit services fields as our team of experts have in-depth insights into workflow solutions that foster error-free medical billing charge entry services. Our streamlined workflow solutions help you achieve about 40% reduction in the overall operational expenditure.