Charge Posting
Charge posting is a critical step in the medical billing process where patient services, procedures, and treatments are entered into the billing system to generate claims for reimbursement. It directly impacts cash flow, claim acceptance rates, and revenue cycle efficiency.
Errors in charge posting can lead to claim denials, payment delays, and financial losses for healthcare providers. This guide provides an in-depth look at charge posting, its importance, step-by-step processes, common errors, and best practices to ensure accurate and compliant billing.
At RCM4U, we ensure accurate and timely charge entry, reducing claim denials and optimizing reimbursement for healthcare providers. Our expert team meticulously enters, verifies, and audits charge data to maintain billing accuracy and compliance with industry standards.
Step-by-Step Process of Charge Posting
1. Patient Demographics and Insurance Verification
Before entering charges, it is crucial to verify and confirm the accuracy of patient demographic details:
✅ Patient Name, Date of Birth (DOB), and Address – Matches insurance records to avoid denials.
✅ Insurance Provider & Policy Number – Verifying active coverage, network eligibility, and claim submission details.
✅ Subscriber/Guarantor Information – If the patient is a dependent, the correct subscriber details must be listed.
✅ Copay, Deductibles, and Coverage Limits – Ensuring the patient understands their out-of-pocket expenses.
✅ Preauthorization & Referral Requirements – Ensuring required approvals from the insurance provider.
❗ Any discrepancies in patient or insurance details may result in claim rejections or delays.
2. Entry of Procedure & Diagnosis Codes (CPT, HCPCS, ICD-10)
Charge posting involves recording the services provided to the patient using standardized coding systems:
✅ CPT (Current Procedural Terminology) Codes – Represents the procedures, surgeries, and medical services performed.
✅ ICD-10 (International Classification of Diseases) Codes – Specifies the diagnosis or reason for the procedure.
✅ HCPCS (Healthcare Common Procedure Coding System) Codes – Used for Medicare, Medicaid, and durable medical equipment (DME) claims.
✅ Modifiers – Adjustments to CPT codes that indicate specific circumstances (e.g., multiple procedures, bilateral services).
✅ Units of Service – Specifies the quantity of procedures or time spent on patient care.
🔎 Example:
- CPT Code 99213 → Office Visit (Level 3)
- ICD-10 Code J02.9 → Acute Pharyngitis (Sore Throat)
- Modifier 25 → Significant, separately identifiable evaluation & management (E/M) service
Correct coding ensures that the claim is processed without rejection for medical necessity mismatches.
3. Charge Capture and Entry of Fees
Once the correct codes are assigned, the charge capture process records the associated charges. This includes:
✅ Provider’s Fee Schedule – Each CPT code has a pre-determined charge set by the provider.
✅ Contractual Adjustments – If the provider has an agreement with an insurance payer, certain discounts apply.
✅ Bundled vs. Unbundled Services – Ensuring compliance with payer guidelines to avoid incorrect billing.
✅ Procedure-to-Diagnosis Linkage – Justifying the procedure with the appropriate diagnosis code.
💡 Using automated charge capture systems reduces manual errors and improves charge entry efficiency.
4. Provider & Payer Information Selection
To ensure the claim is processed correctly, charge posting includes:
✅ Rendering Provider Name & NPI (National Provider Identifier) – The actual provider who performed the service.
✅ Billing Provider Information – The entity (clinic/hospital) submitting the claim.
✅ Referring Provider Details – If the patient was referred, the referring provider’s details are included.
✅ Correct Insurance Payer Selection – Ensuring the claim is routed to the correct insurance provider.
⚠️ Incorrect provider or payer details may lead to claim denials or payment misrouting.
5. Review and Quality Assurance
Before finalizing charge posting, a thorough review is performed to prevent errors:
✅ Charge Reconciliation – Matching charges with medical records and provider documentation.
✅ Duplicate Charge Verification – Identifying and removing duplicate charge entries.
✅ Medical Necessity Checks – Ensuring procedures are justified by the diagnosis code.
✅ Coding Compliance Audits – Verifying adherence to CMS, HIPAA, and insurance policies.
📌 An automated billing system with built-in claim scrubbing tools helps minimize errors before submission.
6. Claim Submission for Processing
After charge posting is completed, the claim is prepared for submission:
✅ Electronic Claim Submission (EDI 837P or 837I) – Sent via a clearinghouse or directly to the payer.
✅ Paper Claim Submission (CMS-1500 or UB-04) – Used when electronic submission is not available.
✅ Timely Filing Compliance – Ensuring claims are submitted within the payer’s deadline (e.g., 90–365 days).
💡 Best practice: Monitor claims daily to identify & resolve rejections quickly.
Common Errors in Charge Posting & How to
Avoid Them
| Error Type | Impact | Prevention |
|---|---|---|
| Incorrect CPT or ICD-10 Code | Claim denial for incorrect coding | Use coding software & updated codebooks |
| Missing or Incorrect Modifiers | Payment reduction or denial | Educate billers on modifier usage |
| Duplicate Charges | Overbilling & compliance risk | Perform charge reconciliation before submission |
| Incorrect Provider or Payer Info | Claim rejection or delay | Validate provider NPI & insurance details |
| Underbilling or Overbilling | Revenue loss or compliance issues | Conduct periodic internal audits |
📌 Regular training, software validation, and manual audits help maintain charge posting accuracy.
Best Practices for Charge Posting
✔ Automate Charge Entry – Reduce manual errors using EHR-integrated billing software.
✔ Ensure Timely Entry – Post charges within 24–48 hours to avoid delays in claim submission.
✔ Perform Quality Audits – Regularly audit 5–10% of claims to identify discrepancies.
✔ Stay Updated on Coding Guidelines – Train staff on ICD-10, CPT, and payer-specific updates.
✔ Monitor Denial Trends – Analyze denial reports to address common charge posting errors.
Charge posting plays a vital role in medical billing and revenue cycle management. Accurate and efficient charge entry ensures:
✅ Faster claim processing
✅ Reduced denials and rejections
✅ Reduced denials and rejections
✅ Optimized cash flow for healthcare providers
Implementing best practices, automation, and regular quality checks will help providers maximize revenue efficiency and compliance.
Why Choose RCM4U for Charge Posting?
✅ Accuracy & Efficiency – Our team ensures precise charge entry to minimize denials and delays.
✅ Expertise in Multiple Specialties – We handle charge posting for various medical specialties, including cardiology, dermatology, orthopedics, and more.
✅ Compliance-Driven Approach – We stay updated with the latest payer policies and medical coding regulations.
✅ HIPAA-Compliant & Secure – Data confidentiality and security are our top priorities.
✅ Seamless Integration – We work with all major EHR and practice management systems.