Demo & Charge Entry
Accurate entry of all medical charges on the first attempt, with no errors, corrections, or rejections, ensuring the claim is ready for billing.
Our Experience Demo and Charges Team will work towards
- Reduces eligibility denials
- Prevents demographic-related rejections
- Increases clean claim rate
We initiate strong Front-End Eligibility Verification Before charges reach billing
- Active insurance
- Specialty coverage
- Copay and deductible
- Referral requirements
- Authorization requirements
Prevents “coverage terminated” denials and reduces rework by the billing team.
Usually our team works on frequent registration errors and insurance-specific mistakes for continuous process improvement and better staff training.
To reduce clearinghouse rejections and improve first-pass payment rate, our team will review:
Date of Service, CPT Codes, ICD-10 Codes, Modifiers, Units, Provider Information, Place of Service, NPI Details
Our Experience team will prioritize Specialty-Specific Charge Entry Checklists.
Different specialties have unique requirements
For example:
Radiology- Modifier verification
- Critical care time validation
- Global period review
- Assistant surgeon modifiers
Fewer coding-related denials for higher clean claim percentage
We review:
- Active eligibility
- Authorization on file
- Provider credentialing
- Correct CPT/ICD combinations
- NCCI edits
- Modifier usage
- Demographic accuracy
Top Rejection Reasons Focus
We analyze previous months’ rejections to create payer-specific prevention guides to improve the clean claims rate and reduce denials.
Example – Typical reasons:
- Invalid Member ID
- Missing rendering provider
- Missing modifier
- Invalid diagnosis pointer
- Authorization missing
Speed Up Claim Submission
Our team aims for zero TAT for charge entry and claim submissions (Same day charge entry).
Goal: Charges entered within 24 hours of DOS.
Track:
- DOS to Charge Entry
- Charge Entry to Claim Submission
Suggested KPI:
| Metric | Target |
|---|---|
| Charge Entry TAT | <24 Hours |
| Claim Submission TAT | <48 Hours |
Work Queue Prioritization
Submit claims in this order:
- High-dollar claims
- Timely filing risk claims
- Medicare claims
- Commercial claims
End-of-Day Reconciliation
Match:
- Encounters
- Charges
- Claims generated
No encounter should remain unbilled. We connect our team daily for team-level process improvements.
Daily Huddle (15 Minutes)
Review:
- Rejections from yesterday
- Missing charges
- Eligibility issues
- Authorization issues
Weekly Quality Audit
Audit 20–30% of claims per employee.
Measure:
- Data entry accuracy
- Coding accuracy
- Submission timeliness
Knowledge Repository
Maintain:
- Payer-specific billing requirements
- Modifier guidelines
- Common denial fixes
We will prioritize KPI:
| KPI | Target |
|---|---|
| Clean Claim Rate | >98% |
| First Pass Acceptance Rate | >98% |
| Demo Accuracy | >98% |
| Charge Entry Accuracy | >98% |
| Claim Submission TAT | <48 Hours |
| Registration Error Rate | <1% |
| Eligibility Error Rate | <1% |
High-Impact Process Optimization Ideas
- Mandatory eligibility verification before DOS.
- Dual quality check for new staff entries.
- Payer-specific billing cheat sheets.
- Daily missing charge reconciliation.
- Root cause analysis of every rejection category.
- Standardized Demo and Charge Entry checklists.
- Same-day charge posting.
- Weekly quality audits and feedback sessions.
- Common dashboard tracking errors and productivity.
- Cross-training between Demo Entry, Charge Entry, and Billing teams.
These improvements alone can typically increase First Pass Acceptance Rate from 90–93% to 97–99%, reduce rework, and speed claim submission.