Are charge entry errors costing your practice thousands monthly? Charge entry mistakes cause 25% of claim denials. Wrong procedure codes get rejected. Missing modifiers reduce payment. Incorrect units underpay services. Each error costs $100 to $300 to fix. Meanwhile, payment delays for weeks. This guide reveals the most common charge entry errors in Athenahealth. You’ll discover why each error happens. We explain prevention strategies using Athenahealth tools.
Understanding Charge Entry
Charge entry records services in Athenahealth. It converts clinical services to billing codes. Proper charge entry ensures accurate claims. Errors cause denials and lost revenue.
Error 1: Wrong Procedure Codes
Using incorrect CPT or HCPCS codes. This is the most common charge entry error.
Why This Happens
Staff don’t know the correct codes. Codes change annually. Similar codes get confused. No reference materials available. Guessing at codes.
How to Prevent
Create charge templates for common services. Load the correct codes in templates. Update codes annually each January. Provide coding reference guides. Use dropdown menus, not free text.
Fix Current Errors
Review rejected claims for code errors. Correct codes and resubmit. Train staff on proper codes. Update templates with corrections.
Error 2: Missing Modifiers
Required modifiers not applied. This reduces payment or causes denials.
Common Missing Modifiers
Modifier 25 on E/M with procedure. Modifier 59 for multiple procedures. Modifier 26 for professional component. Modifier GP for physical therapy. Each missing modifier has a financial impact.
Prevent with Configuration
Configure the auto-modifier application. Set rules applying modifiers automatically. When specific codes appear together, add required modifiers. This eliminates forgetting modifiers.
Train on Modifier Use
Explain what each modifier means. Show when each applies. Provide a modifier quick reference. Quiz staff on modifier scenarios.
Error 3: Incorrect Unit Billing
Wrong number of units billed. This underpays or overpays for services.
Unit Calculation Errors
Time-based codes need unit calculation. Every 15 minutes equals one unit. Staff miscalculates frequently. Some codes have different unit rules.
Use Athenahealth Tools
Configure automatic unit calculation. The system calculates based on the time documented. Staff enter minutes, and the system calculates units. This eliminates calculation errors.
Document Time Properly
Providers must document the exact time. Start and stop times needed. Total time must support units. Without time documentation, you can’t bill time-based codes.
Common Charge Entry Errors
| Error Type | Impact | Prevention Method |
| Wrong procedure code | Claim rejection | Use charge templates |
| Missing modifiers | Reduced payment | Auto-modifier rules |
| Incorrect units | Under/overpayment | Automatic calculation |
| Wrong diagnosis link | Medical necessity denial | Diagnosis validation |
| Missing charges | Lost revenue | Charge capture system |
| Duplicate charges | Overpayment recovery | Duplicate detection |
Error 4: Diagnosis Linking Mistakes
Procedure not linked to supporting diagnosis. This causes medical necessity denials.
Linking Problems
No diagnosis selected. A wrong diagnosis doesn’t support the procedure. Multiple diagnoses, wrong one linked. Diagnosis order incorrect.
Configure Validation
Set up diagnosis-procedure validation rules. System checks if the diagnosis supports the procedure. Blocks submission if a mismatch is found. Forces correct linking.
Create Smart Templates
Templates with procedure-diagnosis pairs. The system automatically links to the correct diagnosis. Staff can’t select the wrong diagnosis. This prevents most linking errors.
Error 5: Unbilled Services
Services provided but never entered. This loses revenue completely.
Why Services Go Unbilled
Provider doesn’t communicate services. The nurse forgets to document. Lab work not entered. Supply charges missed. Each unbilled service loses money.
Implement Charge Capture
Use encounter-based charge capture. System prompts for expected charges. Compare scheduled services to entered charges. Flag missing charges before the day ends.
Reconcile Daily
Review all appointments versus charges. Identify appointments without charges. Follow up the same day. Don’t let unbilled services accumulate.
Error 6: Wrong Place of Service
Incorrect location code. This affects payment rates.
Place of Service Codes
Office visits use code 11. Hospital inpatient uses 21. Emergency room uses 23. Telehealth uses 02. Each location pays differently.
Set Default Locations
Configure the default place of service by location. Office location defaults to 11. Hospital location defaults to 21. This prevents manual selection errors.
Verify for Special Services
Some services override the default location. Telehealth needs a place of service 02. Verify special services have the correct location. Train staff on location-specific services.
Error 7: Charge Entry Timing Issues
Charges entered too late. This delays claims and payment.
Late Entry Problems
Charges entered days after service. This delays claim submission. Some staff batch charges weekly. Late charges miss filing deadlines. Payment was delayed unnecessarily.
Establish Entry Deadlines
Require same-day charge entry. Providers finalize notes by day’s end. Charges entered within 24 hours. Set alerts for unfinalized encounters.
Monitor Entry Compliance
Track charge entry timing. Report on delayed entries. Address staff not meeting deadlines. This improves cash flow significantly.
Error 8: Incorrect Patient Selection
Charge posted to the wrong patient account. This creates billing nightmares.
How This Happens
Similar patient names. Staff are rushing during busy times. Not verifying the patient before entry. Multiple charts open simultaneously.
Prevent Wrong Patient Charges
Verify the patient before every charge entry. Check the date of birth matches. Confirm the correct appointment. Use patient photos if available.
Fix When It Happens
Delete the charge from the wrong account immediately. Enter the charge on the correct account. Document the correction. Notify supervisor of error.
Error 9: Using Outdated Codes
Billing codes from previous years. This causes automatic rejections.
Code Update Problems
CPT codes change every January 1st. Staff use memorized old codes. Templates not updated annually. Fee schedules still have old codes.
Annual Code Updates
Update all templates each January. Review fee schedules for new codes. Train staff on code changes. Provide new code references.
Subscribe to Updates
Use coding update services. Receive annual change notifications. Athenahealth provides code updates. Enable automatic updates when available.
Error 10: Missing Required Documentation
Billing without supporting documentation. This fails audits even if claim pays.
Documentation Gaps
Time is not documented for time-based codes. Medical necessity not explained. Procedure details missing. Modifier justification absent.
Link Charges to Notes
Ensure charge links to the encounter note. Review note supports the codes selected. Verify documentation completeness. Don’t bill services not documented.
Create Documentation Prompts
Templates prompt for required elements. Time-based services require time entry. Procedures require site and details. This ensures documentation supports billing.
Conclusion
The most common charge entry errors in Athenahealth include wrong procedure codes and missing modifiers. Incorrect unit billing and diagnosis linking mistakes cause denials. Unbilled services and the wrong place of service reduce revenue. Late charge entry and wrong patient selection create problems. Outdated codes and missing documentation cause rejections. Prevent these errors through charge templates, auto-modifier rules, validation edits, and charge capture systems. Train staff properly and update codes annually. Daily monitoring catches errors before claim submission.
FAQs
What is the most common charge entry error?
Wrong procedure codes are most common. Missing modifiers are second. Together, these account for 50% of charge entry errors.
How can I prevent missing modifiers?
Configure the auto-modifier application in Athenahealth. Set rules that automatically add required modifiers. This eliminates forgetting modifiers.
What if charges are entered late?
Late charges delay claim submission and payment. Establish a same-day charge entry requirement. Monitor compliance. This improves cash flow significantly.
How do I fix wrong patient charges?
Delete the charge from the wrong account immediately. Enter the correct patient account. Document the correction. Train staff to verify patients before entry.
Should the charge entry happen daily?
Yes, charges should be entered within 24 hours of service. This allows faster claim submission. Claims submitted quickly pay faster.
