The medical billing cycle carries the highest significance in healthcare reimbursements. A perfectly carried out billing cycle ensures successful claims without worrying about denials, appeal expenses, coding errors, or fraud claims. The medical billing cycle starts with the charge entry. Because of its significance in the medical billing cycle, charge entry should be free of errors.
Using a charge entry, the healthcare provider allocates a specific amount to the patient's account based on the medical services provided. Codes for the medical services and the fee structure are also provided to validate the amount mentioned in a charge entry. Charge entry is then used for filing an insurance claim. On successful insurance claims, the insurance provider then offers respective reimbursements to the healthcare provider.
While making a charge entry, one should be very careful to mention accurate patient details. It includes the patients' identity, address, insurance, etc. Along with the patient details, one should also look for the patient's guarantor details. After confirming the patients' details, one should include the patients' treatment details at the healthcare facility. It has their admission date, medical services provided along with the date and place, medical codes for diagnosis and related healthcare expenses, insurance details, and pre-authorization details.
During the process, the healthcare provider must communicate with the patient to ensure that the cost is covered in their health insurance. Interacting with the patient regarding reimbursement estimates ensures significant customer satisfaction. Such interaction also helps decide the reimbursement cost, leading to successful insurance claims.
A charge entry is a daily procedure. Immediate charge entry ensures error-free documentation. It also helps eliminate the delay in the medical billing cycle and thus, claim the reimbursements. Performing charge entry within a day reduces the probability of human error, decreasing the load on healthcare professionals.
After completing the insurance claim, the EOB or explanation of benefits is received from the insurance provider. It highlights the reimbursement and cost to be paid by the patient. By analyzing the EOB, the healthcare provider can understand their efficiency in making a charge entry and filing an insurance claim.
Coding audits can help streamline the charge entry process and thus perfecting the organization's billing cycle. Such practices can reduce the frequency of denial claims and appeal expenses. It also improves the patient-provider relationship, as successful insurance claims offer maximum customer satisfaction.