How to create charges?

Creating treatment details: (Charge Creation)

(i) Medical Record Number: This is the number allotted by the physician’s office to track the patient records after his visit.

(ii) Date of Service: The date(s) on which the provider has rendered the service to the patient. It should be entered in the software.

(iii) Provider: Person who provides the healthcare services is known as Provider and his name should be entered in the same software.

(iv) Type of service: It refers the type of treatment has done for the patient. (For e.g., Radiology, Cardiology)

(vi) Name of Clinic/ Facility: It is the place where services are furnished. i.e., in a hospital, clinic, laboratory etc.,

(vii) Referral Authorization Number: This number is issued by the PCP (Primary care Physician) while referring the patient to a specialist or another doctor. managed care plans require such referrals, without which payment may be denied for the services done by the specialist. This referral acts as a kind of a second opinion on the patient’s medical condition. It also helps in keeping the insurance co.’s costs down by filtering the number of patients who really require a specialist’s supervision

(vii) Referring Physician: The doctor who referred the patient to the rendering doctor. referring doctor information is very important if services require referral information, such as in managed care, consults, lab services etc., for diagnostic services such as Radiology (X-Rays), referring doctor is called the ordering
doctor who orders tests.

(viii) Admit Date and Discharge date: if the patient has been admitted to a hospital for treatment then the date on which the patient was admitted and date on which the patient was discharged need to be recorded and communicated to the payer.

(ix) Injury Date: The date on which the first symptoms began for the current illness, injury. This information is used in determining benefits or exclusions for pre- existing condition. In such cases, we need to mention is the injury is work related or due to accident.

(x) Prior Authorization Number: Insurance issues prior authorization number, authorizing the services to be provided if services require prior authorization, the charge sheet will indicate the prior authorization #, Services may not be paid without this number in the claim. This number is an important data element for claim processing.

(xii) Procedure Codes: These are the five digit alphanumeric codes (Common procedural Terminology), which represents the treatment performed for the patient. This might also include the services and supplies.

(xiii) Diagnosis Codes: These are the five digits alphanumeric decimal codes (ICD9CM- International Classification for Diseases-Version- 9 -Clinical modification), which represents the patient illness or condition or disease for which the treatment was rendered or diagnosed as result of the treatment. for e.g.. 486, 719.7, 728.87, v04.89

(xiv) Billed Amount: This is the amount charged by the physician for the particular service rendered to the patient.

(xv) Co payment : Amount that is paid by the patient at the front office before getting treatment. This amount is specific to the type of policy.

(xvi) Units: if the provider performs the same procedure for multiple times, then units should denote it whether it has been done for single time or double time or more.

(xvii) Modifier: Modifiers are the two digits alphanumeric codes that are adopted by the physician to reaffirm to the carrier that the procedure performed was altered or modified due to certain unavoidable circumstances. Below is the list modifiers