Demo and Charge entry
Demo and Charge entry
100% HIPAA Compliance
Scalability & Flexibility
Customized Reporting
Expertise & Certification
The page positions Demo and Charge Entry as the foundational and most critical stage of the entire Revenue Cycle Management (RCM) process. The core message is that absolute accuracy at this initial stage is non-negotiable for a healthy revenue cycle.
Demographics Entry
This is the process of creating or updating a patient’s account within the billing software. It is described as the “identity” of the claim. The key data points captured include:
- Patient Information: Full Name, Date of Birth (DOB), Gender, Social Security Number (SSN).
- Contact & Address Information: Mailing Address, Phone Number.
- Insurance Information: Payer Name, Member ID, Group ID, Policy Holder’s Information.
The stated goal: To ensure every piece of patient information is 100% accurate and matches the insurance payer’s records to prevent immediate rejections due to simple data mismatches.
Charge Entry
This is the process of translating medical services rendered into billable financial charges. It involves converting clinical documentation into a standardized format that insurance companies can process. Key tasks include:
Receiving Source Documents: The process begins with documents like superbills, charge tickets, or electronic data from the provider’s Electronic Health Record (EHR).
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Unmatched Accuracy
Emphasis on their “zero-error” goal. Their multi-level auditing process is designed to catch and correct errors before they become costly problems, leading to a high first-pass claim acceptance rate.
Faster Reimbursement Cycles
Clean claims are processed faster by payers. By eliminating the back-and-forth of denials and resubmissions, clients get paid more quickly, improving cash flow.
Increased Revenue
Proper coding and modifier usage ensure that providers are not under-billing for services rendered. They capture every billable component to maximize revenue.
Significant Cost Reduction
By outsourcing, practices can reduce overhead associated with hiring, training, and managing an in-house billing team, including salaries, benefits, and software costs.
Expertise and Certification
Their team is staffed by AAPC (American Academy of Professional Coders) certified professionals who are experts in multiple specialties and stay current with constantly changing coding regulations.
Scalability and Flexibility
Their services can scale up or down based on the client’s patient volume, making it an ideal solution for both small practices and large, growing healthcare systems.
100% HIPAA Compliance
They stress their commitment to data security with secure data centers, encrypted file transfers, and strict internal protocols to protect all Protected Health Information (PHI).
Customized Reporting
Emerge RCM provides detailed reports on the charges entered, allowing clients to have full transparency and visibility into their practice’s financial front-end.
The first step in Emerge RCM’s charge entry process begins with the secure receipt of essential documents from the client. These include patient demographic forms, copies of insurance cards (both front and back), and superbills or charge sheets that detail the services provided. Clients can transmit this data using secure methods such as SFTP (Secure File Transfer Protocol), encrypted emails, or by granting direct access to their EMR (Electronic Medical Records) or PM (Practice Management) systems.
This step sets the foundation for all subsequent billing actions. Maintaining the integrity and confidentiality of patient data is paramount, and Emerge RCM ensures HIPAA-compliant handling at every touchpoint. By leveraging automation and robust data security protocols, this stage ensures the accurate transfer of necessary information—minimizing delays and paving the way for faster claim processing and reimbursements. It’s the critical first link in a seamless, streamlined revenue cycle process.
Once documents are received, Emerge RCM’s experienced billing team meticulously verifies every piece of demographic and insurance information. This step is vital in preventing downstream claim rejections and payment delays. If a patient is new to the system, a complete account is created with all necessary fields including date of birth, insurance policy details, and provider information. For returning patients, all existing data is reviewed and updated if required. Additionally, a preliminary insurance eligibility check is often conducted at this stage to confirm that the patient’s coverage is active and valid on the date of service.
This proactive approach helps in reducing claim denials due to inactive or incorrect insurance details. By focusing on front-end accuracy, Emerge RCM ensures smoother downstream processes, fewer billing errors, and faster revenue realization. This step plays a crucial role in building a clean and audit-ready foundation for successful claims submission.
In this step, Emerge RCM’s team of AAPC-certified coders access the client’s system to review the clinical documentation and accurately enter medical charges. Each service provided is meticulously translated into its respective CPT (Current Procedural Terminology), ICD-10 (Diagnosis), and HCPCS (Healthcare Common Procedure Coding System) codes. If applicable, correct modifiers are also assigned to support medical necessity and meet payer-specific billing guidelines. The coders work in close alignment with the documentation provided, ensuring that every procedure is properly represented, and no revenue is left unaccounted for.
This step not only supports accurate reimbursement but also minimizes the chances of denials due to incorrect or incomplete coding. Emerge RCM stays current with ever-changing coding rules and payer policies to ensure compliance. The precision in this phase ensures the integrity of claims and significantly enhances the financial health of the practice by optimizing revenue capture.
Emerge RCM sets itself apart through its dedicated, multi-layered Quality Assurance (QA) process. Before any claim reaches the payer, it undergoes a thorough audit by a separate QA team that operates independently from the charge entry staff. This step is designed to catch and correct errors proactively, ensuring the highest levels of accuracy. The QA process includes validation of demographic accuracy, verification of all CPT, ICD-10, and HCPCS codes, appropriate use of modifiers, and precise linking of diagnosis codes to corresponding procedures.
The team also cross-checks the claim for compliance with payer-specific guidelines and regulatory standards. Any discrepancies or inconsistencies are flagged and resolved before final claim submission. This rigorous QA not only reduces the risk of denials but also strengthens the audit trail for future reference. By prioritizing quality control, Emerge RCM helps healthcare providers maximize reimbursement and maintain a reputation for billing integrity and compliance.
Once all charges have been reviewed and approved through the QA process, the next step is claim batching and submission. Emerge RCM carefully compiles approved charges into batches according to payer requirements, specialty type, or submission timelines. These batches are reviewed one final time for any outstanding errors or omissions before being electronically submitted through secure, HIPAA-compliant clearinghouses or directly to the insurance payers. The focus during this step is speed, accuracy, and traceability.
Emerge RCM ensures that each claim is transmitted with the correct payer details, provider credentials, and all necessary attachments or supporting documentation, if applicable. Timely claim submission not only accelerates payment turnaround but also supports optimal cash flow. Additionally, Emerge RCM tracks each submission, ensuring confirmation receipts are received and logged. This transparent and controlled submission process helps providers avoid lost claims, delays, or rejections—ultimately leading to faster reimbursements and improved revenue cycle performance.
