CHARGE ENTRY & CHARGE AUDIT

CHARGE ENTRY & CHARGE AUDIT :

Failure to effectively document care information can often lead to revenue leakage – amounting of millions of dollars of lost revenue. While deploying effective charge capture, workflow solutions can help reduce instances of lost revenue. Also, effective collaboration between coding and charge entry teams leads to a sustainable improvement in the overall process.

With expertise in multiple specialties and Revenue Cycle Platforms, our charge entry experts process high volume of charge entry transactions with exceptional accuracy. CPJ’s client portal enables a smooth communication between our teams, for a seamless end-to-end process.

CHARGE ENTRY :

Our charge entry transactions remain consistent throughout :

  • Receive documents in the form of superbills, charge tickets, source document etc. through FTP or document management system or client’s system.
  • Capture the date of service, billing provider, referring provider, POS, admission date, CPT/procedure codes, ICD-10, number of units and modifiers.
  • Using our proprietary tool ARC.flow, provide real-time reporting to the customer by escalating pending issues for clarification which results in faster turnaround time .
  • Import charges directly from the EMR. These charges are reviewed for accuracy before being sent for billing.

CHARGE AUDIT :

Leverage CPJ’s Charge Audit services to identify missed charges, instances of over-billing, and coding errors that led to revenue loss.

We take an analytical approach to:

  • Validate written orders for level of care, and all treatments rendered .
  • Necessary modifiers are appended, and exact number of units are billed .
  • Comparing charges by patient’s accounts.
  • Verifying charges against updated fee schedule.
  • Identifying undercharges, duplicate posting, and overcharges.
  • Verifying the charges with various department billers and coders.

Charge Audits help reveal causes for variances including problems with charge entry, provider absences, failure of providers to report timely charges, a change in coding patterns, services not billed for, and other reasons for claim denials. Ideally, charges should be consistent from month-to-month; barring changes in physician productivity due to unavailability.

CPJ’s Value Proposition for Charge Entry and Charge Audit services

  • Improve productivity and accuracy.
  • Competency across specialties
  • Timely filing of claims and benchmarking of fee schedules as well as denial patterns
  • Review of charge entry processes to arrest revenue leakage
  • Ensure appropriate reimbursement obtained
  • Optimize revenue and identify missed revenue using Charge Audit
  • Identify and fix compliance issues for charge overages
  • Recover lost charges and avoid delay in processing AR
  • Real-time collaboration and reporting through our client portals

MEDICAL BILLING SPECIALIST

CPJ offers and provides Medical Billing solutions and the process being worked on behalf of the Providers in US. In simple term, Medical Billing is the process of submitting and following upon on all the claims with the health insurances in order to receive payments for services rendered by the healthcare provider. The Providers outsource their billing process to a third party billing companies in US and outside US due to its complexity and difficulties in coding, understanding insurance specific rules and AR follow-up on outstanding claims.This also includes resolving the Patient AR by sending Statements and follow up with patients .

  • Collecting,posting and managing account payments, submitting claims and following up with insurance companies.
  • Review account information to identify trends and opportunities to improve the revenue cycle process .
  • Research unresolved and old AR, claim denials, and coding issues (traditionally issues such as these are forwarded to the client to resolve) .
  • Act as client liaison, provide status updates and detailed reporting on a weekly basis

MEDICAL CODING SERVICES

We at CPJ provide Medical Coding services and the process is about transforming the healthcare diagnosis, procedures, medical services, and equipment into universal medical alphanumeric codes. The diagnosis and procedure codes are taken from documentation (Medical Records) produced by the providers, such as transcription of physician’s notes, laboratory and radiology results, etc. AAPC – American Academy of Professional Coding (regulatory authority of complete medical coding in the United States) certified Medical Coding Professionals in CPJ Techno Solutions Team help ensure the codes are applied accurately during the medical billing process, which includes abstracting the information from documentation, assigning the appropriate codes, and creating a claim to be paid by insurance carriers. The major task of the Medical Coder is to review the Medical Records and assign standard codes using CPT, ICD 10, HCPCS Level II classification systems defined by AAPC .

  • Ensure ICD-10 compliance.
  • Reduce AR backlogs
  • Decrease in DNFB
  • Improve quality of care
  • Improve provider documentation
  • Reduce turnaround times
  • Enjoy more reliable data reporting