Charge Entry
Charge entry is a critical step in the medical billing process where patient services are translated into billable charges. This step ensures accurate claim submission and proper reimbursement from insurance providers. Precisely entering charges to maintain accurate billing and maximize reimbursement.
Here’s a step-by-step breakdown of the charge entry process in medical billing:
Step 1. Review Patient Information
Verify the patient's identity, insurance information, and the services they received.
Confirm that the patient's insurance coverage is active and up-to-date.
Ensure that all necessary pre-authorizations or referrals have been obtained, if applicable.
Step 2. Obtain the CPT/HCPCS and ICD Codes
CPT Codes (Current Procedural Terminology) are used to describe the medical, surgical, and diagnostic procedures performed.
ICD Codes (International Classification of Diseases) represent the diagnosis or condition that justifies the treatment or service.
HCPCS Codes (Healthcare Common Procedure Coding System) are used for services and products not covered by CPT codes (e.g., durable medical equipment, ambulance services).
Step 3. Enter Charge Details
Enter the charges for each service or procedure provided, using the correct codes for the diagnosis (ICD) and procedure (CPT/HCPCS).
The billing software will often automatically populate the fee schedule based on the entered codes, but the amount can also be adjusted based on contract rates with insurers.
Step 4. Verify Insurance Information
Check if the patient’s insurance plan is covering the service.
Ensure the entered charges correspond to the insurance plan’s fee schedule and billing rules.
Make sure the diagnosis codes (ICD) match the procedures and services (CPT/HCPCS) billed.
Step 5. Apply Modifiers (if applicable)
Modifiers are two-digit codes added to CPT or HCPCS codes to provide additional information about the service provided (e.g., whether a procedure was altered in some way).
Common modifiers include those indicating that a procedure was performed bilaterally, or a service was provided in an emergency situation.
Step 6. Submit the Charges
After entering the charges into the billing system, they are typically submitted to insurance companies via electronic claims (using the 837 format) or paper claims (using the CMS-1500 form).
Charges may also be billed directly to the patient, particularly if they are self-pay or if there are copays or deductibles.