Claimocity Claims
Understanding RCM:
The Charge Entry Process
Getting paid for the care you provide shouldn’t be complicated, but for many healthcare providers, the billing process feels like navigating a maze. One wrong turn in charge entry and you could be looking at denied claims, delayed payments, or even lost revenue that can’t be recovered.
Charge entry might not be the most exciting part of running a practice, but it’s one of the most important. This critical step in your revenue cycle determines whether you get paid correctly and on time for every service you provide. Let’s explore what charge entry involves, where it falls in the revenue cycle, and how you can optimize this process to capture every dollar you earn.
What is Charge Entry in Medical Billing?
Charge entry is the process of converting the medical services you provide into billable charges that can be submitted to insurance companies for reimbursement. Think of it as translating your clinical work into a language that payers understand and will pay for.
During charge entry, billing specialists review patient encounters, assign appropriate medical codes (CPT, ICD-10, or HCPCS), determine pricing based on your fee schedule, and enter this information into your practice management system. It’s the bridge between the care you deliver and the payment you receive.
Where Charge Entry Fits in Your Revenue Cycle
Charge entry sits at a crucial point in your revenue cycle that determines whether you get paid quickly or deal with billing headaches down the line. It happens after you’ve provided care but before claims submission. Here’s how it connects to the bigger picture:
- Pre-Service: Patient registration, insurance verification, and authorization
- Patient Care: Clinical care and documentation
- Charge Entry: Converting services into billable charges
- Claims Submission: Sending claims to payers
- Payment Processing: Receiving and posting payments
- Denial Management: Handling rejected claims
- Patient Collections: Collecting remaining balances
Get charge entry right the first time, and you’ll minimize revenue leakage, optimize cash flow, and reduce claim denials that can delay payments for weeks or months. The reality is that over 25% of denied claims come from charge entry mistakes that could have been avoided from the start.
The Charge Entry Process: Step-by-Step
Understanding each step of the charge entry process helps you spot where problems might occur and how to prevent them.
Review Medical Records
Examine clinical documentation, including physician notes, procedures performed, and supplies used to capture all billable services.
Assign Medical Codes
Apply appropriate CPT and ICD-10 codes for procedures and diagnoses, following current coding guidelines and payer requirements.
Double-Check Pricing and Patient Details
Link each charge to the correct fee schedule, confirm insurance info, and make sure patient data is clean and current.
Enter Charges and Verify
Input all information into your system and review for accuracy. Incorrect data at this stage can trigger rework or lead to denials down the line.
Submit for Reimbursement
Generate and submit claims to insurance companies for payment.
The Cost of Inaccurate Charge Entry
When charge entry goes wrong, it hits your practice where it hurts most–your bottom line. With the cost to rework a denied claim averaging $25, these errors add up fast. Here’s what poor charge entry can cost you:
- Delayed and Denied Reimbursements: Coding errors and missing information trigger claim denials that delay your payments and create extra work.
- Lost Revenue from Missed Charges: When you don’t capture services properly or code them too low, you’re literally leaving money on the table.
- Compliance Problems: Wrong codes or inaccurate documentation can trigger audits or penalties that nobody wants to deal with.
Best Practices for Charge Entry
If you’re looking to tighten up your revenue cycle, start with the basics. These best practices help you catch mistakes early, streamline workflows, and keep cash flowing in the right direction:
Ensure Accurate Documentation
Get your whole team on the same page with documentation guidelines and what’s needed for accurate charges.
Audit Often
Regular audits help identify trends, catch recurring issues, and prevent future denials.
Monitor RCM KPIs
Track metrics like clean claim rates, denial rates, and days in A/R to help you spot trends and address issues quickly.
Leverage Technology
Innovative solutions can reduce manual entry, catch errors before claims go out, and speed up your entire charge entry process.
For more ways to improve your billing workflow, check out our guide on revenue cycle optimization.
Streamline Your Charge Entry with Claimocity
If charge entry mistakes are costing you time and money, it’s time to partner with Claimocity. Manual processes slow you down. Our AI-powered solutions work alongside a team of RCM experts with over 20 years of inpatient billing experience to take billing off your plate and help you get paid faster.
Our integrated system allows providers to document care in their preferred EHR while we do the backend billing. That means fewer delays, fewer denials, and a lot less time wasted on paperwork.
Ready to see why so many practices are outsourcing their revenue cycle management? Schedule a demo today to see how Claimocity can help you capture more revenue, reduce denials, and make billing hassles a thing of the past.
