What is the relationship between patient accounts, data flow and charge capture?

by Anonymous

What is the relationship between patient accounts, data flow and charge capture?

Charge Capture is the process of capturing the information needed for a medical claim. This is basically the information needed to complete a CMS-1500 form.

Charge capture is basically the creation of a superbill. It can be done via paper or electronically. There are many software applications that allow capturing charges using a laptop, tablet, or smart phone. Electronic charge capture is popular now as a means of increasing the efficiency of the reimbursement process – it eliminates lost charges due to inefficiencies when using the paper process. This is usually done using a mobile device.

The obvious importance of charge capture is that its the basis for the providers income.

With regard to data flow this captured charge information can then be sent electronically to a billing specialist or billing office. This billing office could be an in-house service or an outsourced billing service to manage the submission of claims as well as the reimbursement process. The data would include point of care treatment and diagnosis codes as well as patient demographics.

However the importance of data flow is the patient data must be entered and maintained by someone on the providers staff to insure it is current. This includes fundamental info like the patients name, insurance info, address, up to date CPT and ICD medical billing codes, etc. This information – or data flow – must be seamless between all the parties for reimbursement process to be successful.

This requires the people entering and maintaining the patient accounts, the provider accessing and entering encounter information, and the person processing the claims and managing the patient accounts must be well coordinated. Otherwise the advantages of using a charge capture system are lost and you would be better off going back to the paper system.

I would envision this working as follows:

The patient shows up for an office visit. Their name, demographics, insurance information, medications, etc. would be entered into the charge capture system. When the patient sees the provider, the treatment and diagnosis are entered when administering care. This information is then communicated to the billing department or person to submit the claim.

So the data flows from the patient to the provider to the claim processing and billing to the insurance company. The patient account is updated with insurance payment information once the claim is processed. Any remaining patient responsibility would be billed to the patient.

Hope this answers your question.