In Revenue Cycle Management (RCM), every step matters. Two of the most critical stages are Charge Entry and Claim Submission. While they are closely connected, they serve very different purposes in the billing cycle.
Understanding the difference can significantly impact clean claim rates, reimbursement timelines, and overall cash flow.
🧾 What is Charge Entry?
Charge Entry is the first financial step in the billing process.
It involves:
✔ Entering CPT, ICD-10, and HCPCS codes into the billing system
✔ Verifying patient demographics and insurance details
✔ Ensuring procedures, diagnoses, and provider information are accurate
✔ Reviewing documentation before claims are created
This stage ensures the claim is built correctly from the start.
💡 Why it matters:
Errors at the charge entry stage often lead to denials, rejections, and delayed reimbursements.
📤 What is Claim Submission?
Once charges are accurately entered and reviewed, the next step is Claim Submission.
It involves:
✔ Finalizing the claim
✔ Sending it through a clearinghouse or directly to the payer
✔ Ensuring compliance with payer-specific requirements
✔ Monitoring for acceptance or rejection
This is the step where reimbursement officially begins.
💡 Why it matters:
Even a perfectly coded claim can fail if submission protocols aren’t followed correctly.
🔁 The Key Difference
👉 Charge Entry builds the claim.
👉 Claim Submission sends the claim.
Charge entry comes first. Claim submission follows.
Both stages must work together to maintain:
• High first-pass acceptance rates
• Reduced AR > 90 days
• Lower denial percentages
• Faster revenue realization
🚀 Why This Matters for Healthcare Practices
Inaccurate charge entry or poorly managed claim submission can result in:
❌ Increased denials
❌ Revenue leakage
❌ Delayed payments
❌ Higher administrative workload
At HMBS (Healthcare Medical Billing Services), we focus on structured SOP-driven workflows that optimize both stages to improve claim accuracy and reimbursement predictability.
📈 Want to Improve Your Clean Claim Rate?
If your practice is experiencing delays or rising denials, it may not be the payer — it may be the process.
Let’s evaluate your revenue cycle structure.
📩 DM us to learn how structured RCM execution can strengthen your financial performance.