This department is responsible for entering all information received from the Physician’s office. It gets the information from the Client file, the Patient demographic file and the Charge ticket/ sheet. The process of capturing this information onto the billing software is called charge creation.

Process details:

Listed below are the different steps involved in creating a Demographic detail of a patient in the system.

1. Patient details

1. Patient id #: (If applicable)
2. Patient name
3. Date of Birth
4. Sex
5. Marital status
6. Social security number
7. Address (physical and mailing address)
8. Home Telephone number
9. Employer name and address
10. Work Telephone number

2. Guarantor/Account details

1. Guarantor name
2. Date of Birth
3. Sex
4. Marital status
5. Social security number
6. Address (physical and mailing address)
7. Home Telephone number
8. Employer name and address
9. Work Telephone number

3. Insurance details

This includes the primary, secondary and tertiary (if any) insurance coverages of the patient.  Insurance is of two types: –

(a) Health plans and (b) Liability plans.

Insurance details include:-

1. Insurance name and address
2. Insurance identification number
3. Group name/Group number
4. Validity of the policy
5. Name of the insured (subscriber)
6. Relationship of the insured to the patient/guarantor.
7. Financial Class (FC)

 

The charge entry dept is responsible for entering any information received from the physician’s office onto the medical billing software’s database.

1. Patient Medical record number
   This is a unique identification number given to the patient at the time of visit to the hospital. According to client/hospital specifications the names for medical record number varies such as Unit number, Account number, Hospital number etc.
2. Patient name
   The following fields are involved when a patient name is entered. They are: Patient last name, first name, Suffix, Title.
3. Date of Birth
   This should be entered in the format of Month/Date/Year. (MM/DD/YY)
4. Sex
   The patient sex as to female and male are entered.
5. Patient Status
   This gives the patient marital status and the status as to whether the patient is employed or a student.
   Includes
   Marital Status - Single, Married, Other
                           Employed, student.
6. Social security number
   A Social Security Number (SSN) consists of nine digits, commonly written as three fields separated by hyphens:
   AAA-GG-SSSS. The first three-digit field is called the "area number". The central, two-digit field is called the "group number". The last, four-digit field is called the "serial number".
7. Address (physical and mailing address)
   Physical address refers to the patient resident address or where the patient lives. Mailing address refers to the post box address of the patient.
8. Home Telephone number
   A 10-digit number including the area code and a 7-digit number excluding the area code is entered.
9. Employer name and address
10. Work Telephone number

1. Name of the guarantor (if the patient is not the responsible party)
2. Address (physical and mailing address)
3. Telephone number

(1) Health plans and (2) Liability plans.

1. Health plans are those coverages, which are subscribed to meet any health care costs/expenses.
2. Liability plans are taken against any particular risk/accident. They are broadly classified as Auto accident plans and Workman’s compensation plans.
   If the visit is for any accident (motor vehicle accident/auto accident or workman’s compensation) then the Date of accident/injury is included in the charge entry process.

1. Date of service:
   The date of service is the date that describes the procedure/service performed in the charge sheet/charge ticket. According to the hospital(s), it is termed as Exam date or Service date or Ordering date on the reports.
2. Billing provider:
   The rendering physician who actually performs the services will be listed on the reports. The rendering physicians will be entered into the billing software according to the client specifications. The client specifications will have an associate of doctors who works in the hospital with their specialties.
3. Place of service:
   This is the place/facility where the services are actually performed by the rendering physicians. These are broadly classified as Outpatient Hospital services, Inpatient Hospital services and Emergency Hospital services. Every hospital will have a list of codes to specify the place of services where the services are performed.
4. Admission date:
   Date of hospital admission is necessary in case of all inpatient charges. The date of admission must be before the date of service.
5. Referring physician:
   This physician is the one who refers the patient(s) to the rendering physicians for the services performed.
   The field on the charge sheet/ticket will have the following list as referring physicians according to client specifications.
   They are:-
   (a) Ordering physician
   (b) Attending physician
   (c) Admitting physician
   (d) Family physician or Primary care physician (PCP)
   (e) Copy for or Additional physician
6. Referral #:
   Referral number/Pre-certification number given on the reports will be entered along with the primary care physician name.
7. Procedure code (CPT) and the number of units performed:
   Current procedural terminology (CPT) is a standardized system of five-digit codes and descriptive terms used to report the medical services and procedures performed by physicians. These will be coded on the charge sheets or checked off on the charge tickets. If the procedure is performed more than once then it will also be specified as units on the charge sheets/charge tickets as per client specifications.
8. Modifiers:
   This is an extension of the procedure code, which further Explains treatment performed.
   
   Modifiers can indicate:
   (1) A service or procedure has both a professional and a technical component.
   (2) A service or procedure was performed by more than one physician
   (3) Only part of a service was performed
   (4) An adjunctive service was performed.
   (5) A bilateral procedure was performed
   (6) A service or procedure was provided more than once
   (7) Unusual events occurred
9. Diagnosis code:
   The signs and symptoms for the visit are denoted as diagnosis codes. These are termed as International Classification of Diseases (ICD codes). The symptoms can be found in the History, Clinical data, Clinical history, Reason for exam, Reason for visit etc on the charge sheets/charge tickets according to the hospitals.

When all the above information is entered into the client billing software then the charge entry process is complete.