Objective :

Oversee the charge entry and auditing process to ensure that all services rendered are captured accurately, coded correctly, and billed promptly—supporting timely claims submission and reducing the risk of denials or revenue loss.

Key Responsibilities:

Charge Entry :

Purpose : Convert clinical documentation into billable claims using correct codes and charge data.

Tasks:

  • Review clinical documentation from providers for completeness and clarity.
  • Enter charges into the practice management system (PMS) or EHR based on CPT/HCPCS codes for procedures.
  • ICD-10 diagnosis codes
  • Modifiers (e.g., -25, -59) as needed
  • Place of service (POS) and rendering provider details
  • Match the DOS (Date of Service) with scheduling and documentation.
  • Validate that charges align with payer guidelines and LCD/NCD policies.

Inputs:

  • Superbill, encounter forms, EHR notes, coding sheets
  • Charge capture applications or dictation tools

Charge Audit & Quality Review :

Purpose : Ensure that all charges are complete, accurate, and compliant before claim submission.

Tasks:

  • Audit charge entries for correct coding (CPT, ICD-10, modifiers)
  • Accurate patient and insurance data
  • Missing or duplicate charges
  • Provider documentation support
  • Run pre-billing reports or work queues to identify issues.
  • Coordinate with coders or providers to resolve discrepancies or clarify unclear documentation.
  • Flag outliers for higher-level review (e.g., unusually high charges, questionable code combinations)..

Timely Claims Submission:

Pupose : Prevent delays in reimbursement by ensuring charges are processed and submitted quickly.

Tasks:

  • Submit claims daily or per scheduled cadence once charges are verified.
  • Monitor claim scrubber feedback (via clearinghouse or payer portal).
  • Track and resolve front-end rejections immediately to avoid delays.

Our Best Practices:

  • Use standardized charge entry templates and coding cheat sheets.
  • Implement a dual-check system for high-dollar or high-risk claims.
  • Keep current on payer-specific rules and billing updates (e.g., bundling edits, modifier use).
  • Conduct regular training for charge entry staff on CPT/ICD coding changes.
  • Perform random charge audits weekly or monthly to ensure ongoing compliance.

Charge Entry & Audit Workflow:

  • Review clinical documentation
  • Enter charges and codes
  • Audit for accuracy and compliance
  • Submit claims or route to billing queue
  • Monitor rejections and address errors
  • Document completion in system for tracking

Why It’s Important :

Accurate charge entry is the foundation of clean claims. Errors at this stage lead to rejections, denials, delayed payments, or even compliance risks. A strong audit process protects revenue and ensures adherence to payer and regulatory requirements.