Best Practices in Charge Entry for Healthcare Organizations

One wrong code. One missed modifier. That’s all it takes for thousands of dollars to slip through the cracks in healthcare billing. And with rising denial rates and stricter regulations, there's zero room for error.

Charge entry in healthcare isn’t just another back-office task—it’s crucial for the revenue cycle. A mistake can snowball into claim rejections, compliance headaches, and revenue loss.

In fact, medical claims with inaccurate codes can lead to delays or outright denials. That’s part of why nearly 25% of U.S. healthcare spending is considered wasteful.

But here’s the good news: a solid charge entry strategy can flip the script. When done right, it boosts claim approvals, ensures accurate reimbursements, keeps your organization compliant—and yes, it even improves patient satisfaction.

In this blog, we’ll walk through the best practices in charge entry, the charge entry process steps, and how healthcare organizations can streamline operations.

5 Best Practices for Charge Entry in Healthcare

Below are the most effective strategies for charge entry that align with the current healthcare industry:

1. Ensure Complete and Accurate Data Collection

The foundation of an effective charge entry in healthcare is determined by your organization’s ability to gather and document patient information. 

Here’s what you can do:

• Implement forensic-level clinical documentation protocols
• Create multi-layered verification checkpoints
• Develop comprehensive coding compliance frameworks

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2. Focus on Regulatory Compliance

Compliance isn’t just about avoiding fines—it’s a strategic advantage that ensures consistent, accurate revenue flow and protects you from financial and legal risks. Therefore, you should: 

• Develop a Proactive Compliance Intelligence Unit: Establish a team or system that continuously monitors and updates the charge entry process steps based on the latest regulatory changes.
• Establish Transparent, Auditable Charge Entry Protocols:  Maintain clear documentation and reporting structures so charge entry can be quickly reviewed, verified, and defended during revenue cycle audits.

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3. Rely on Technology

Process automation and cloud computing have proven their worth in the healthcare industry. Here’s how you can use AI-driven software to improve your revenue cycle management and reduce inefficiency:

• Deploy AI-powered Charge Capture Intelligence: Automate code selection, reduce manual errors, and ensure accurate charge capture.
• Integrate Machine Learning for Real-Time Error Detection: Identify inconsistencies and flag potential errors before claims are submitted. Minimizes denials and reworks.
• Develop Intelligent Reconciliation Algorithms: Match charges with clinical documentation to prevent missed or duplicate entries.

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4. Conduct Regular Training for Staff

While technology evolves, human expertise remains paramount. Since charge entry requires diligence and up-to-date knowledge, training your staff in the following focus areas regularly can help optimize reimbursement:

• Changes in payer rules and regulations, such as updates in policies, reimbursement criteria, and documentation requirements
• New coding updates, like ICD (International Classification of Diseases) revisions, CPT (Current Procedural Terminologies), and HCPCS (Healthcare Common Procedure Coding System) changes
• Performance analytics and quality improvement methodologies
• Cross-functional training to improve communication between clinical and billing departments

5. Consider Strategic Outsourcing Partnerships

One of the emerging best practices in healthcare revenue management is the strategic outsourcing of the charge entry process steps. 

Market research shows that the global medical billing outsourcing market, valued at $14.9 billion in 2023, is set to reach $44 billion by 2033 at an 11.5% CAGR. 

This underlines the increasing dependence on specialized service providers to streamline operations.

Given the complexity of modern healthcare billing, partnering with dedicated RCM service providers offers several advantages:

• Reduces common errors such as upcoding, unbundling, incorrect diagnosis codes, modifier issues, insufficient documentation, and duplicate billing
• Helps you bridge the gap between CPT codes and diagnoses to improve coding accuracy
• Allows you to stay compliant with constantly evolving healthcare regulations
• Gives you instant access to top-notch RCM experts in healthcare billing, coding, and compliance
• Helps you reduce overhead costs associated with hiring, training, and retaining experts
• Gives you access to the latest technological infrastructure, including analytics for financial reporting and decision-making, reducing your need to invest in software
• Enables you to handle fluctuations in billing volume and scale operations quickly and proactively
• Mitigate the risks of data breaches with outsourced partners' top-tier cybersecurity protocols, creating a resilient healthcare ecosystem.

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Why Healthcare Providers Should Prioritize Charge Entry Best Practices

Accurate charge entry in healthcare guarantees:

• Regulatory Compliance: Following HIPAA, ICD-10 coding standards, and payer-specific guidelines helps prevent penalties and legal liability.
• Reduced Claim Denials: Insurance plans under the Affordable Care Act (ACA) marketplace deny an average of 20% of claims, with some insurers rejecting up to 35%. Reduced data entry and coding errors can accelerate claim processing and significantly reduce this financial burden.
• Operational Efficiency: Streamlined charge entry processes improve workflow, allowing medical staff to focus on patient care rather than billing issues.
• Revenue Optimization: Incorrect charge entry can lead to underbilling, which affects cash flow, or overbilling, which risks audits and penalties.
• Improved Patient Experience: Accurate billing leads to fewer patient complaints and builds trust in your organization.

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Key Takeaway

By tightening your charge entry process, training your team, staying aligned with compliance standards, and leveraging technology, you're not just protecting revenue—you're setting your healthcare organization up for long-term growth and stability.

And when internal bandwidth is limited or billing complexity grows, outsourcing to a trusted RCM partner like HOM can make all the difference. 

With proven expertise, a combination of AI and human intervention, and a 97%+ adjudication quality rate, HOM doesn’t just support your revenue cycle—it strengthens it.

Ready to minimize claim denials and improve your bottom line? 

Let us perform a free audit and show you exactly where your revenue is leaking—and how to get it back.