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The Charge Entry process is a vital link in the claims processing chain. Coded items for services rendered must be combined with the patient’s demographic and insurance data in a timely manner. Based on the codes, the correct charges must be applied. Only then can the claim be considered as complete and ready6for transmission to the payer.

What can disrupt the smooth flow of this process?

Common challenges:

  • Data captured or entered inaccurately by providers’ staff means rejected claims — typically more than 40% on first pass.
  • Unreconciled visits or appointments, as well as uncharged services, lost forms etc. can result in an overall lost charge error rate of 3—5%.
  • Unless found and corrected upfront, noncompliance with the rules of the Correct Coding Initiative (CCI), Local Medical Review Policy (LMRP) and National Coverage Determination (NCD) can drive denials as high as 15%.
  • About 20% of all claims rejected at the clearing house level are never corrected and resubmitted.
  • Lags of 14-21 days (each carrier has its own filing deadlines) between service delivery and charge entry may mean missed deadlines and consequently, lost revenue due to timely filing denials.

What NDS will do?
Our integrated services cover both Charge Entry and Claim Submission.
To ensure accurate and timely charge entry, we:

  • Obtain copies of:
    • Encounter forms or charge sheets.
    • Pre-authorization/pre-certification numbers.
    • Supporting documentation as necessary.
    • Daily reconciliation of scheduled appointments vs. charges.
  • Use operational tools to identify noncompliance with CCI, LMRP and NDC codes/edits.
  • Integrate with patient scheduling systems to identify missing charges or visits.
  • Enter charges into the billing system within 24 hours of services rendered.

To ensure speedy claims submission, we transmit completed claims to payers — also within 24 hours of the services having been rendered.
We do this by:

  • Adhering to carriers’ claim format requirements.
  • Carrying out frequent eClaims status updates through clearinghouse and payer reports as well as audit trails.
  • Reviewing clearinghouse accepted/rejected reports to ensure 100% accountability of claims billed.
  • Performing multi-tiered claims edit checks.
  • Ensuring resolution of all edits and payer rejections within 24 hours through appropriate research and edits.
  • Maintaining dedicated billing teams, whose work is regularly reviewed for quality. Cross-training ensures that staff holidays or absenteeism will never compromise throughput or accuracy.
  • Developing improved billing workflow processes, with full reporting.
  • Providing world-class data protection and privacy.

How you benefit?

  • Prompt and accurate charge capture and entry leading to fewer delays in billing.
  • 95% or better clean claims rate.
  • Reduced denials due to billing errors or late filing.
  • Administrative costs reduced by 30%.
  • Avoidance of costs associated with incorrect or late filings.
  • Optimized cash flow and reduced risk of payer audits.
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