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Claimocity Charge Capture

Our integrated software and services platform addresses all the backend functions your practice needs from capturing patient encounters to getting paid.

Claimocity Glossary

Use our guide to get up to speed with charge capture lingo.

Charge Capture

Charge capture is a process healthcare providers use to record and bill for patient services. It involves converting medical procedures, treatments, medications, and supplies into billable charges. This ensures providers are properly reimbursed for their services.

A charge capture specialist ensures all billable services are accurately recorded and coded. They review patient encounters, verify procedures performed, and assign appropriate billing codes. Their work is essential for maximizing revenue and maintaining compliance with healthcare billing regulations.

Charge capture is sometimes called encounter capture, charge capture revenue cycle, medical charge capture, and healthcare charge capture. These terms all refer to the process of documenting and coding healthcare services for billing purposes.

Charge capture is one of the first steps in the medical billing cycle. It occurs after patient care but before claim submission. During this phase, providers document all services performed and translate them into billable codes. It is the foundation for accurate claim submission and proper reimbursement.

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Credentialing

Credentialing is a critical healthcare process that evaluates a provider’s qualifications and clinical background. It involves verifying education, training, licenses, and practice history. It ensures providers meet specific standards before they can work in healthcare facilities or join insurance networks.

Examples of medical credentialing may involve verifying a healthcare provider’s education and training, board certifications, and state medical licenses. It may also include checking their work history, malpractice insurance, and any disciplinary actions.

During credentialing, aspects of a provider’s background are verified, including education, training, licensure, board certifications, work history, and malpractice claims. References may be checked, and criminal background screenings are often conducted.

A credentialing specialist verifies healthcare professionals’ qualifications to make sure they can provide proper care. This includes checking their licenses, certifications, and work experience. This role is crucial for maintaining healthcare quality and compliance.

Medical credentialing is essential for patient safety and quality care. It ensures providers have the necessary qualifications and good practice histories. Credentialing also affects healthcare facilities’ liability, insurance reimbursements, and regulatory compliance.

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Electronic Health Records (EHRs)

Electronic health records (EHRs) are digital versions of a patient’s medical history. They contain comprehensive information, including diagnoses, medications, treatment plans, immunizations, allergies, test results, and more. EHRs allow authorized healthcare providers to access and update patient information securely and efficiently.

Electronic Health Records (EHRs) are more comprehensive than Electronic Medical Records (EMRs). EMRs are digital versions of paper charts in a single practice, while EHRs include broader patient information and can be shared across different healthcare organizations to help coordinate care between different providers.

The primary purpose of Electronic Health Records (EHRs) is to improve patient care by providing a complete, accurate, and easily accessible record of a patient’s health history. They enhance care coordination, support clinical decision-making, increase efficiency, and reduce medical errors and redundant tests.

There are various types of EHR systems, including cloud-based systems that offer remote access, physician-hosted systems with local data storage, and remotely hosted systems that store patient data on a vendor’s servers. Some EHRs are designed for specific medical specialties, while others are more general.

Epic is the largest EHR in the US, widely used by major hospitals and healthcare organizations. Other top players include Cerner, Meditech, and Allscripts. While these dominate large healthcare systems, numerous options exist for smaller or specialty practices to cater to specific provider needs.

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EHR / EMR Integration

EHR integration is the process of connecting electronic health records (EHRs) with other healthcare software systems in order to share patient histories and coordinate care. This data sharing provides a comprehensive view of patient information across facilities.

The time to integrate into an EHR system varies widely, typically ranging from a few months to over a year. The time to integrate depends on the complexity of the existing systems, the scope of integration, staff training needs, and the healthcare organization’s size and resources.

EMR (electronic medical record) and EHR (electronic health record) are essentially the same thing. However, an EMR is generally thought to be records from one provider or one practice, while an EHR combines multiple providers together.

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Medical Billing

Medical billing is how healthcare providers get paid for their services. It is the process of submitting claims with health insurance companies to receive payment. It involves translating healthcare services into billing codes, submitting claims, and managing payments and denials.

A medical biller is responsible for managing healthcare payments. They convert medical services into billing codes, submit claims to insurance companies, and ensure providers get paid. They also verify insurance coverage, track payments, handle denied claims, and help patients understand their bills.

There are three main types of medical billing systems: open, closed, and isolated. Open systems are cloud-based systems that offer remote accessibility. Closed systems are used within a single practice and don’t permit collaboration with other providers. Isolated systems allow patients to manage their health information independently, separate from provider systems.
Medical billing is a technical process that demands accuracy and attention to detail. It requires familiarity with medical terminology, deep knowledge of insurance policies,  understanding of intricate coding systems, staying updated on changing regulations, and coordinating between patients, providers, and insurance companies.

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Medical Coding

Medical coding is the process of translating healthcare diagnoses, treatments, and services into standardized coding systems such as ICD-10, CPT, and HCPCS. It’s a critical step in medical billing, ensuring accurate documentation of patient encounters and proper reimbursement for healthcare providers.

Medical coders review clinical statements and assign standardized codes to diagnoses, treatments, and medical procedures to ensure proper billing, insurance reimbursement, and accurate patient records. They work with healthcare providers and billing departments to ensure coding accuracy and compliance with regulations.

Medical coding translates healthcare services into standardized codes for billing and record-keeping. For example, CPT code 85025 represents a blood test ordered, while CPT code 99213 represents the time a provider spent evaluating an established patient.

While AI is being used in medical coding to improve efficiency and accuracy, it’s unlikely to fully replace human coders. AI can assist with routine coding tasks, but complex cases still require human expertise for interpretation, context understanding, and ensuring compliance with ever-changing regulations.

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MIPS Compliance

MIPS compliance means adhering to the reporting and performance standards of the Merit-based Incentive Payment System. MIPS compliance impacts medicare reimbursement rates based on performance. MIPS evaluates healthcare providers on quality, improvement activities, promoting interoperability, and cost.

It depends. Factors such as billing amount, patient volume, and type of services provided determine eligibility for mandatory MIPS reporting. Practices and providers must verify eligibility for MIPS through the CMS Quality Payment Program (QPP) website annually.

MIPS evaluates providers in four categories: quality, promoting interoperability, improvement activities, and cost. Quality measures the standard of care. Promoting interoperability focuses on the use of EHRs to promote care coordination. Improvement activities evaluates efforts to enhance care. Cost assesses the efficiency of care and resource utilization
If eligible providers don’t report MIPS data, they may face financial penalties on their Medicare reimbursements. The penalty percentage increases each year of non-compliance.
To determine MIPS reporting requirements, log into qpp.cms.gov.  Choose “Check Participation Status” and select the performance year pull-down under “Eligibility and Reporting”.  Download your MIPS reporting requirements following the prompts.

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Mobile Billing

Mobile billing allows healthcare providers to manage billing processes on the go. It allows healthcare providers to capture charges, submit claims, and manage billing tasks from smartphones and tablets, making the billing process more flexible and efficient.

The medical billing process starts with patient registration. The provider documents the visit and assigns diagnostic codes. A claim is then submitted to the insurance company. The insurer reviews the claim, processes it, and sends payment. If denied, the biller may appeal or bill the patient directly.

Medical billing can be stressful due to its complexity and high level of responsibility. Billers must manage precise coding, meet strict deadlines, handle claim denials, and stay current on changing regulations. There may also be pressure to maintain cash flow, and errors can be costly.

Medical billing is a complicated process due to its many steps and the need for precision. It involves intricate coding systems, claim submission, and coordination among patients, providers, and insurers. The process requires knowledge of medical terminology, handling denials, and staying current with evolving regulations.

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Revenue Cycle Management

Revenue Cycle Management (RCM) is the process healthcare providers use to track and manage patient care services from initial appointment to final payment. RCM covers everything from registration and insurance verification to coding, billing, and collecting payments. Effective RCM ensures timely reimbursement, minimizes denials, and optimizes financial performance.

A revenue cycle manager oversees the financial processes of a healthcare organization. They supervise billing and coding, insurance claims and denials, and work with staff to optimize the revenue cycle workflow. Ultimately, their goal is to ensure the organization’s financial health and stability.

Revenue cycle management involves four key steps: registration (collecting patient information and verifying insurance), charge capture (documenting and coding services), claim submission (sending claims to insurers), and payment processing (handling payments and following up on unpaid balances). Each step is crucial for effective healthcare revenue management.
An example of revenue cycle management (RCM) involves a healthcare facility collecting patient information at registration, coding services after appointments, submitting claims to insurers, and processing payments while following up on any unpaid balances to ensure timely reimbursement and optimize revenue.

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