Charge Captured: A Case Study

Charges – This is the financial obligation made to a patient’s account for services rendered.

-The charge description master, or chargemaster, is an extensive list of items that's to be billed to a patient, payer or healthcare provider. Since the coders translate patient data to be input in the hospital or a facility's system, the billing staff would have to gather their information from the coders to be put into the care of the chargemaster so it can be translated into a list that will be provided for those who are providing the payment for the patient. So in all, the CDM staff, billing staff and coders are all interconnected for they need the data provided by one another to get their duties

Charge entry is one of the key areas in medical billing. In the medical billing charge entry process, created patient accounts are assigned with the appropriate $ value as per the coding and appropriate fee schedule. The charges entered will determine the reimbursements for physician's service. In this area, the electronic form 1500 is completed with its codes of services and procedures.

Patient Accounting and Practice Management systems are designed to help health care medical practices are to improve the quality of care, cut cost, reduce risk, and increase revenues. When it comes to the size of a medical practice from small, or to a large medical practice, multi-location group this will feather the system to allow in creating and maintaining a patient billing information much faster and more efficiently then it was ever before. Medical Assistants are able to enter a patient information and post any changes much faster and more accurately with the use of a simplified medical billing software that promotes physician acceptance and much greater investment protection that provides faster insurance reimbursement and to improve

HIPAA requires two designate coding system to be used to report to private and public payers; this is HCPCS and ICD-10. This coding system is primarily used in the United States and it is used by healthcare providers, including physicians and hospitals. Icd-10 is useful for reporting inpatient and HCPCS is used for procedure reporting for outpatient service and they are both assigned to DRG group. Once the health service is performed, charge captures are slips that are posted to a patient’s account that is processed as a batch order system. The key to the ordering system and charge capture is the “charge code” which is then reflected each service, procedure, supply item or drugs in the chargemaster (CDM). Medical claims fall into one of two types: CMS

Training front office staff is one of the most crucial aspects of the billing process. The front staff is usually responsible for obtaining the correct demographic information as well as insurance information from the patient. Without the correct information the claims will never be paid. This is why training front staff on insurances, collecting co-pays and knowing when to collect for additional charges that may not be covered by the patient’s insurance is

The key elements to a healthy and successful medical practice are a reliable and properly trained staff and a sound revenue cycle that produces satisfactory reimbursement. Revenue cycle management starts at the front-end with pre-registration of the patient. Complete and accurate recording of patient insurance and billing information is imperative. Insurance verification plays a major role in the assurance of reimbursement. The front desk should counsel and confirm financial responsibility with the patient during the registration process. Patient encounter is equally as important. Correct coding of patient diagnosis and procedures minimizes the likelihood of claim rejection. The next step in the revenue cycle is claim submission. The claims process begins with the provider treating the patient then sending a bill to the designated payer. Before the bill is sent, a certified coding specialist or medical billing specialist prepares and reviews the claim for any inaccuracies. There are a few ways the claim is submitted, either manually or electronically. Once the claim is submitted, follow-up with third party payers is a necessary step in the

After years and years of studying, practicing, and preparing for a future in health care, physicians and other medical care providers mark their place in the industry by providing the best care for their patients. These professionals face challenges every day – from providing life-saving emergency treatment to investigating complex diseases – but there is another critical component of a successful medical practice: medical billing.

When a patient enters a facility ( Dr.office, Hospital, Clinic or other) a chart is created or updated containing demographic information needed to process a claim and a patient account is created or updated. The information collected is then shared ( data flow) through the proper channels needed to create a billing and reference point. Charge capture is a method of reporting every service rendered to a patient so that proper billing can be done as well as documenting all important information pertaining to individual patients.

Accounting is performed on a cash basis, and billing of patient’s insurance is offered as an extra, free service, where patients receive eligible reimbursements directly from their insurance providers.

Equip your staff to manage collections with every patient encounter. Payers provide online tools to estimate coverage for specific services and verify unmet deductible balances. Using these tools and a current patient account balance report together allows your staff to discuss financial obligations at registration or before the patient exits the office. Train designated team members how to discuss payment options with your patients. With the proper tools, technology and training, patients will be confident your care about their health and your team will improve past due ratios.

The accounts receivable is on part of the revenue cycle within a healthcare organization. Accounts receivable is defined as the revenue that patients and third parties owe the organization for services that have been provided (Nowicki, 2015). Obtaining demographic information, insurance data, verifying insurance coverage, acquiring deductibles and copayments, receiving authorizations, recording charges, printing and submitting bills, following up with patients about payment, and collecting payment are some of the activities within the accounts receivable cycle (Nowicki, 2015). The revenue cycle utilizes a multidisciplinary system to decrease amounts within accounts receivable by managing the payment cycles (Nowicki, 2015). Some of the management

Problems for patient care are poor communication between patient and staff, medication errors and diagnostic errors. Internal problems for data capture is that guidelines are not created appropriately for users such as patient and nurse staffs of EHR systems regarding the proper use of documentation techniques to ensure complete, accurate and quality documentation of admitting and transferring within the system. EHR issues such as the content standards should be well-defined, which would improve efficiency, decrease redundancy, relieve the documentation burden, and improve errors on patient care and data integrity. On the other hand, external reporting on the performance of quality measures is a different activity that possibly will lead to enhancements in care delivery, however, will not affect patients directly. hopefully the same measures of quality, proficiency, care, and outcomes should both guide and implement proper care-delivery processes internally and provide evidence or suggestions of the extent of those developments externally as part of a well-designed reporting process. Recommendations that one would make is to come up with proper strategies to use EHR data to improve identification of patients who were admitted to the emergency, know the important cause of imprecisions in quality measurements derived from administrative data and the incapability to recognize patient type within the electronic health

The relationship between patient’s accounts, data flow, and charge capture is simple, it’s everything starting from when the patient walks in to a hospital all way up until they are discharged. First the patient will come in request services, and provide there demo-graphic. Insurance and medical information. All this information is collected for the hospitals different departments to provide correct patient care and treatment as well as charge the patient properly once treatment is completed.

Medical billing and coding is the backbone of healthcare organizations and the core foundation on which the existence of healthcare organization is establish. Medical billing is a division of healthcare organization that focuses primarily on the day-to-day billing operation in an effort to collect the medical fees on behalf of the organization. Following the state and federal laws and regulations, billing department bills the third-party payers such as health insurance companies and the Medicaid & Medicare, for the service rendered to the patients. Without the billing department, healthcare organization’s operation would come to a halt as they would not able to collect an adequate capital in order to continue operating.