Charge entry represents a critical component of medical billing. During the charge entry process, patient accounts are assigned a corresponding monetary value based on established coding and the relevant fee schedule. The charges recorded play a pivotal role in determining the reimbursements for the services rendered by physicians. Consequently, it is imperative for HANA HealthCare to exercise diligence in order to prevent any errors in charge entry that could result in claim denials. Furthermore, effective collaboration between the coding and charge entry teams is essential for achieving optimal outcomes.

HANA HealthCare Solutions offers charge entry services within its suite of healthcare revenue cycle management outsourcing solutions, as well as providing it as an independent service. The teams at HANA HealthCare possess extensive experience in managing the charge entry process across various medical billing systems and specialties. This expertise allows them to initiate the process promptly after a few discussions to grasp the specific requirements, thereby minimizing training time and effort. The teams utilize predefined, account-specific guidelines for charge entry tailored to different medical specialties, incorporating additional nuances for each client, which significantly reduces the potential for errors and enhances the likelihood of clean claims.

The charge entry process at HANA HealthCare Solutions includes the following steps:

• Charges are recorded in the client’s medical billing system according to account-specific guidelines.
• Any pending or held documents are forwarded to the client for clarification on a predetermined schedule.
• The Quality team conducts a final audit of the charges, and clean claims are subsequently prepared for transmission.

EDI Setup
HANA HealthCare offers comprehensive EDI setup services for both new practices and those transitioning from paper-based claims to electronic submissions. This process involves configuring the user and database on the EDI (Clearing House) platform, conducting tests with sample batches to verify the accurate processing of the 837 and 835 forms, and integrating the EDI system with the Billing software to facilitate seamless transmission of claim batches.

Electronic Submission
The submission of electronic claims is a pivotal aspect of the medical billing workflow. Healthcare claims encompass sensitive information, including patient and insurance details. Utilizing EDI for claims submission minimizes processing delays and enhances acceptance rates with payers. The HANA HealthCare teams possess the necessary skills and expertise to identify transmission-related errors at a granular level. This capability allows for the analysis and resolution of recurring issues, such as omitted line items, in collaboration with the support teams at the Clearing House.

For each client, HANA HealthCare designates a key team member to oversee EDI operations. This individual is tasked with:

• Managing daily EDI transmission of claim batches
• Monitoring EDI transmission reports on a daily basis
• Identifying rejections from EDI transmission reports
• Communicating rejections to the Billing team for error resolution
• Coordinating with the Clearing House to address any field mapping discrepancies

With EDI submissions, carrier confirmation reports are generated instantly, thereby eliminating delays caused by transmission errors. Additionally, tracking claims has become more straightforward, allowing for prompt corrections of rejected claims and their subsequent re-transmission.

Once established, the electronic transmission process is straightforward. However, many organizations and practices may overlook the significance of consistently monitoring reports and the potential impact on revenue flow when this is not done diligently. The teams at HANA HealthCare understand the critical nature of daily report tracking to ensure that EDI rejections are addressed promptly.