Several serious factors can interrupt the revenue stream of any practices. This includes things like persistent claim denials, a patient contesting charges, improper security protocols for HIPPA compliance, and medical coding errors.
While some of these might be honest mistakes, they are often the result of an overtaxed or undertrained administrative task. The truth is most medical administrative support staff are better off handling other tasks within the practice rather than losing precious man-hours to medical coding and chasing down medical billing errors. Many times these issues persist until an audit of some type is performed.
The reality is that charge entry and audit services are critical components of the medical billing process. They help to ensure a consistent revenue flow, via fewer delays in payments, decreased problems with claim denials, and improved compliance with regulatory and ethical frameworks.
To really understand how charge entry and third-party audit services can help your practice, we are going to have to take an in-depth look at the medical billing process.
What Does Charge Entry Do In The Medical Billing Process?
When it comes to the medical billing process charge entry involves entering the diagnosis (DX) and medical treatment codes (PX) in line with the bill. This includes entering other relevant information like the date of service, the units of service, and authorization numbers, as well as any applicable CPT modifiers. The specific details of the healthcare provider and the total amount billed is also factored in.
Most healthcare providers are required to seek approval from the insurance provider in advance of treating the patient before submitting the claim for reimbursement. This includes the billed amount or the charge. This information is then incorporated into a “Super Bill” which serves as a comprehensive constitution of services, including diagnostic bills for each visit. Correct entry is critical
How Does Auditing Services Affect The Medical Billing Process?
Inaccuracies in the medical billing process can do more than just interrupt your practice’s revenue flow with claim denials and contested charges. When allowed to persist you can lose a significant amount of time in man-hours and materials making corrections. All of these things not only eat away at your bottom-line profitability, but they also make it nearly impossible to expand the scope of your services, or as well as limit the number of patients you can serve.
Worse still, a lot of these issues are related to persistent problems or simply bad habits that infuse human error into the medical billing process. Tracking them down can cost further time and man-hours. Then you might also incur further costs and time lost to effective retraining or implementing a new medical billing protocol.
A third-party audit from a highly experienced firm like Operant Billing Solutions can quickly and effectively comb through every aspect of your medical billing process. Trained eyes can help spot incongruities in your medical billing system.
We can then red flag any issues, as well as identify recurring habits that compound the effect of errors, and lead to persistent loss of time for your administrative staff.
Though one of the primary values of medical auditing services is that essentially creates a fool-proof charge entry service, to ensure correct claims are being submitted to insurance providers. This also helps identify and flag coding malpractices, which could inadvertently trigger federal watchdog agencies that target abusive healthcare practices.
Third-party, professional medical auditing incorporates thorough scrutiny and review of all pertinent medical records and documents to promote accuracy and ensuring compliance to all the medical regulations.
The Charge Entry & Medical Auditing Service In Action
Use in synergy charge entry and medical auditing services streamline the medical billing process through the following steps.
Step One
When the patient arrives their presence is entered into a logbook, that needs to be maintained throughout the care or services they receive. Its goal is to capture every important detail of the event. This includes the date, the condition requiring diagnostics, treatment, or follow up as well as the number of services performed. This also helps to catch any pre-existing conditions, and document them accordingly.
Step Two
Each medical department in a healthcare organization needs to maintain a charge sheet that specifically keeps an account of all chargeable supplies and treatments performed.
Step Three
The chargeable supplies and treatments from the medical departments are then justified with the patient logbook.
Step Four
Administrators conduct personal inquiries of the process throughout the specifically coded departments to assess the quality of processes regarding medical coding, documentation, and charge reconciliation.
A charge audit service also includes things like sample-based testing, data analysis, and a careful review of documents to ensure accurate charge entry throughout the medical billing process. It also helps to review clinical documents including things like multiple physician’s orders, nurse’s notes, and charge sheets prepared by clinicians or therapists. This meticulous accurate assignment of charges collates a clear picture of all medical services that have been provided to each patient.
This information can then be provided to the entity or department that is responsible for tracking revenue and collecting payment. The data is collated in such a way as to make it easy to identify errors or areas where errors are prone. This serves as a key tool for developing new policies for both making the practice more efficient, as well as compliant with all pertinent medical regulations.
What Are The Benefits Of Outsourcing Charge Entry & Audit Services?
Outsource your charge entry and audit services to a third party firm like Operant Billing Solutions comes with several benefits. Right off the bat, you will see an improvement in your revenue stream in the form of more consistent cash flow and the opportunity to treat a higher volume of patients. It also significantly reduces your risk of experiencing claim denials due to incorrect medical billing practices. You can also rest easy, knowing that your medical billing records will be compliant with all state and federal regulations.
It also helps free up your in-house administrative task to handle other important needs. This might include things like treating patients, expanding the scope of the practice, marketing, maintaining in-house treatment records, and payroll. Just to name a few.
