Charge Entry in Medical Billing

Charge Entry Process:

Charge Entry is a next very important step which is done after Medical Coding process in Medical billing.

Charge Entry in medical billing means entering of the diagnosis codes and procedure codes by seeing super bill along with this they also enter the related information like date the service rendered(DOS), Units of service,  CPT modifiers,  Authorizations number(Referral or Prior), Provider details, Onset Date, Billed amount etc.,

Charges entered will determine the reimbursement for physician’s service and this charge entry process is done by seeing the super bill which is also called as charge ticket.

Let us see the definitions of below terms which we come across during charge entry process in medical billing:

Diagnosis Code: Diagnosis code defines the details of Illness of the patient. It is also known as DX code in medical billing.

Procedure Code: Procedure code describes the services or treatment provided by the doctor or hospital. It is also called as PX code in medical billing

Modifiers: Modifiers is used with the procedure codes in order to differentiate the medical services rendered to the patient.

Date of Service: Date of Service is the date when the patient was treated from the health care provider.

Units of service: It indicates the quantity of health care procedures of the claim in medical billing.

Authorization#: Authorization number also known as prior authorization number or pre certification number. Provider has to take an approval from the insurance company before the patient receives the health care services in order for claim submitted get reimbursed. It relates not only whether a health care services of the procedure is covered but also to find whether the health care services is medically necessary.

Billed amount: Billed Amount also called as charge amount. It is the amount charged for each service performed by the provider and entered at the time of charge entry.

Super Bill: Super Bill is a form listing procedures, service and diagnosis codes used to record services performed for the patient and the patient’s diagnosis for a given visit.

Once the charges entry process completed, we proceed to create the claim which will be submitted to the insurance companies through paper or electronic (thru clearing house) for reimbursement.

What is the importance of Charge Entry Process in Medical billing?

Charge entry process is also a very important step in medical billing cycle, because incorrect entry of information may lead to denials of the claim or sometimes inappropriate reimbursement from the insurance company.

For examples:

Consider procedure code entered is incorrect by charge entry team:

As we know each procedure codes are assigned with the right monetary value. So if the procedure code entered is incorrect, then this may lead to improper reimbursement of claims or sometimes claims may get denied from the insurance companies if the medical report doesn’t support.

So it is very important for charge entry team to enter the details accurately with the coordination of medical coding team in order to get rid of denials or improper reimbursement from the insurance company.

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