One of the most significant stages of medical billing is correct charge entry – it is during this step that the whole reimbursement process begins. Any mistake at this point may result in late payments, rejections and disruptions in healthcare practice cash flows. At A2Z Billing, we are aware that charge entry stability and accuracy affect such variables as revenue cycle performance and provider satisfaction.
Now, we are going to discuss the issue of charge entry in medical billing, its processing, and its further course of action.
The concept of Charge Entry on Medical Billing
Charge entry refers to the process of keying in all the medical services, procedures and treatments of a patient into the billing system to make claims to be submitted to the insurance. In less complicated words, it is the process of transforming the services of the provider into billable forms.
Each visit, procedure, or test a patient undergoes produces a certain code of codes CPT (Current Procedural Terminology) codes of procedures and ICD-10 codes of diagnoses. The charge entry specialist receives these codes and checks their validity after which he/she enters them into the medical billing program.
Why It Matters
Entry of charges might pass off as a simple data entry process, but it is the key to providers receiving the correct and prompt payment. Any minor error, like a wrong code, the omission of modifiers, or the input of the wrong amount can result in claim rejection or underpayment.
A good charge entry process ensures:
- Clean claims submission
- Accurate patient billing
- Faster reimbursements
- Lower denial rates
- Better financial control for healthcare practices
What Is Charge Entry in Medical Billing ?
Let’s look at an example to make it clear:
Example:
A patient visits a cardiologist for a follow-up on hypertension. During the visit, the doctor performs an EKG and reviews medication.
Here’s what happens next:
- The provider documents the visit details in the patient’s medical record.
- The coder assigns:
CPT Code: 93000 (Electrocardiogram)
ICD-10 Code: I10 (Essential Hypertension)
- The charge entry team reviews the documentation and enters:
- Patient and insurance details
- Date of service
- Provider name and NP
- CPT and ICD codes
- Fee for each service
- Once verified, the charges are saved and forwarded for claim submission to the payer.
If everything is accurate, the claim moves smoothly through the insurance system and payment is released. If there’s an error (say, a missing modifier), the claim could be rejected — delaying payment by weeks.
What Is the Charge Entry Process in Medical Billing?
The charge entry process involves several checkpoints to ensure that all patient encounters are billed accurately. Here’s how it typically works:
1. Gathering Patient, Encounter Information
The workflow originates with the review of patient demographic information, patient insurance information, and the encounter form or superbill. All information must be current and complete.
2. Verify Provider Documentation
The charge entry specialists review the clinical documentation to ensure the procedures and diagnoses are congruent with what was provided. Any discrepancies would be caught prior to the coding.
3. Assign Appropriate Codes
Utilizing the information in the provider’s notes, coders assign appropriate CPT, ICD-10, and HCPCS codes to describe the medical services provided. The codes assigned must be compliant with payer-specific guidelines and meet the requirement for medical necessity.
4. Enter Charges into the Billing System
The verified codes and service details are entered into the medical billing software, along with the provider and facility identifiers. Every charge must reflect accurate dates, quantities, and fees.
5. Double-Check for Errors
Before submitting claims, the entry is reviewed by a second team member or automated system to catch issues like:
- Missing modifiers
- Duplicate entries
- Invalid codes
- Incorrect insurance information
6. Submit Claims
Once verified, the claim is ready for electronic submission to insurance payers through a clearinghouse. Clean claims are typically processed faster and paid sooner.
What Comes After Charge Entry?
After charge entry, the process doesn’t end. The next steps ensure that the provider gets paid:
1. Claim Scrubbing
The claim is checked through automated scrubbing tools to detect coding or formatting issues. Any errors are corrected before submission.
2. Claims Submission
The clean claim is submitted electronically to the insurance payer. Timely filing is critical to avoid denials due to missed deadlines.
3. Payment Posting
Once the payer processes the claim, payments or adjustments are posted to the patient’s account.
4. Denial Management
If a claim is denied or partially paid, the denial management team investigates the reason, corrects any issues, and resubmits the claim.
5. Patient Billing
After insurance payments are applied, any remaining balance is billed to the patient. This ensures transparency and full revenue capture.
Why Accuracy in Charge Entry Is Crucial
Errors at this stage can have a ripple effect throughout the billing cycle. Here’s what can go wrong — and why accuracy matters:
| Error Type | Result |
| Wrong CPT or ICD Code | Claim denial or underpayment |
| Missing Provider Info | Rejected claim |
| Incorrect Fee Entry | Revenue loss |
| Incomplete Documentation | Delayed payment |
| Duplicate Charge | Overbilling and compliance risk |
A single unchecked mistake could cost hundreds or even thousands in delayed or lost revenue. That’s why experienced charge entry specialists are worth their weight in gold — they keep the system running clean and compliant.
The Value of Professional Charge Entry Services
Outsourcing charge entry to trained billing experts brings significant advantages:
- Reduced administrative burden for in-house staff
- Consistent accuracy across high-volume claims
- Fewer rejections and denials
- Reliable compliance with payer rules
- Faster turnaround times
Practices that invest in professional charge entry support often report 20–30% fewer claim denials and significantly improved cash flow within months.
Real-World Insight: How Charge Entry Boosts Reimbursement
A mid-sized family practice processing around 5,000 claims a month noticed increasing payment delays. After auditing their process, it turned out that 12% of their denials came from incorrect or missing charge entries.
By tightening their review workflow and assigning a dedicated charge entry specialist, their denial rate dropped to under 3%, improving monthly revenue by nearly $40,000.
That’s the power of accurate charge entry — it’s not just data entry; it’s financial control.
Conclusion: Precision Today, Profit Tomorrow
Entering charges in medical billing does not simply entail entering codes, it is about receiving premium compensation for the service provided to maintain your medical practice for the medical team or provide competitive wages for what your competitor would pay. What gets entered into the charge is the service time of the medical provider and another commitment/obligation for that time at a fair market salary.
When you use professional billing experts, you know that each line is correct, with the code, each dollar, and order tied to that activity, so you can protect your practice. With accurate charges, you will experience fewer headaches, get paid faster, and be more financially healthy.
If you would like to make it easier for your practice to negotiate billing, or you would like assistance to get your billing done in a timely manner, A2Z Billing is ready to help. Our experts have years of experience in the billing process of even complex claims so that you can focus on the more important part of your practice: the patient.
FAQs About Charge Entry in Medical Billing
- What is charge entry in medical billing?
It’s the process of entering all services, procedures, and charges for a patient encounter into the billing system to prepare claims for submission.
- Who performs charge entry?
Usually, trained billing specialists or medical billers handle charge entry, ensuring all data and codes are accurate before claim submission.
- What comes before charge entry?
Coding and documentation review occur first. Providers document the services, and coders assign CPT and ICD codes before charge entry takes place.
- What happens after charge entry?
Claims are scrubbed, submitted to payers, and followed up for payments. Afterward, payments are posted, and patients are billed for remaining balances.
- How long does charge entry take?
It depends on the practice size and software used, but typically, charge entry for a single encounter takes about 2–5 minutes.
- What tools are used for charge entry?
Medical billing software like Kareo, AdvancedMD, or NextGen is commonly used, often integrated with EHR systems.
- What are common errors in charge entry?
Common mistakes include missing modifiers, duplicate charges, incorrect CPT or ICD codes, and mismatched provider information.
- Can charge entry be automated?
Automation can assist, but human review remains essential. Even AI-driven systems require oversight for complex cases.
- How does charge entry affect revenue?
Accurate charge entry ensures correct claims submission, which reduces denials and accelerates reimbursements — directly impacting cash flow.
- Why should practices outsource charge entry?
Outsourcing reduces errors, improves turnaround time, and ensures compliance, allowing providers to focus on patient care instead of paperwork.