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Business

In: Business and Management

Submitted By jarcher1
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The Purpose of the Encounter Form
The critical form that links services provided to the information system and the billing process on a patient-by-patient, day-by-day basis is the encounter form. Also called a charge slip or superbill, it is generated for each patient visit and serves to communicate information about the number and type of services provided, by whom, to the system that generates bills. The provider signature on the encounter form makes this a legal billing document and attests to the fact that services were performed and may be billed for (Maines).

Most encounter forms use "Progress" codes that are non-billable until the procedure is completed (i.e. root canals and prosthetics). Commonly these are CDT codes with "P" appended, while completed procedures have "C" appended, or have no prefix/ suffix.
Depending on coverage, some procedures may need to be 'prior approved' by the third party carrier to be paid after completion. Terms for this are usually spelled out in the third party contracts. After the dentist formulates a treatment plan, it is submitted for Prior Approval, and approved services/ amounts are assigned some kind of code for billing upon completion (often called a PA number.

Superbills & encounter forms help you save time and capture all charges from your patient visits. You can configure a custom Superbill for each provider in your practice, print Superbills with prepopulated patient information from the appointment scheduler, and use those Superbills to document the charges for your patient visits. By using forms customized to your unique needs, you can save time while capturing all charges.

Superbills & Encounter Forms
Superbills, also known as "Encounter Forms", "Charge Slips", or "Fee Tickets", are pre-printed forms that are used to document the charges, via procedure codes, associated with a patient visit along with supporting information, such as diagnosis codes, that are required to bill insurance companies. There are thousands of procedure and diagnosis codes used to document medical services, but most medical providers use only a small subset of these codes based on their practice. So Superbills save time for providers by providing a predefined list of codes for their practice that they can use to simply "check off" the services associated with a patient visit. Superbills are then handed off to a medical biller where the charges are entered into medical billing software so they can be billed to insurance companies and patients (Maines).
Once your Superbills have been created, you'll be able to print the forms from the appointment scheduler. You can print Superbills for individual appointments or you can print daily or weekly batches of Superbills by physician and/or location. Your Superbills will include the patient and appointment information for each appointment. There is also a unique ticket number printed on each Superbill that you can later optionally use during charge entry to automatically carry over all information from the corresponding appointment.
Capture Charges Using Your Custom Superbills & Encounter Forms
You can use printed Superbills to quickly capture charges for each patient visit. Simply circle the procedure codes that correspond with the services and other charges provided to the patient during the visit. You can also code the visit by circling the diagnosis codes that correspond with the patient's condition and link them by number to the associated procedure code they support. After completing the Superbill, many providers will deliver physical copies of the forms to their medical biller for charge entry or scan the forms using the Kareo document management system and then electronically route your Superbills through Kareo to your medical biller or billing service for data entry.

Some practices say they can't afford to take the time on the phone when the patient calls for an appointment to collect insurance information. That means that the practice doesn't get to verify the patient's insurance coverage before the appointment.
If you don't verify coverage before the patient presents, you have to hold up rooming the patient to verify the insurance when they check in. That's inefficient for everyone in the practice and often puts the whole schedule behind for the day.
Pre-visit eligibility verification is a best practice that every physician office should strive to accomplish. If you find out that the patient is not covered for the visit a couple of days before the scheduled appointment, you can contact the patient to either get corrected information, or maybe even reschedule the patient if necessary.
You can submit all patients on a day's schedule in an electronic file and send it to a clearing house to verify eligibility for all appointed services (it's called "batching"). Doing so will reduce the volume of denied claims (Jameson,2012).
Aging are claims that show unpaid typically after 30 days. Most billing systems will allow you to pull Aging Reports that show claims unpaid after 30 days, 60 Days, 90 Days, etc. If you have claims that are more than 30 days old, this usually indicates there is a problem and specific actions need to be taken to address the issues so you can get paid. Sometimes it’s simply just making a phone call. Other times it’s because you missed a billing code. There are many reasons that claims get rejected, but the reality is unless you work the claim (and in a timely manner) you will never get paid.
While it may sound basic, many physicians and medical providers are missing the key ingredient to increasing their revenue or staying out of the red. They provide excellent care and bill for their work, however they fail to implement a strategy to deal with rejected claims and allow the aging on these claims to get out of hand.

Some physicians have told us that it is just too depressing to look at unpaid claims. Many feel helpless in doing anything about this. What medical providers fail to understand is billing is easy, but working rejected claims is not (Jameson,2012).

Aging in and of itself is a major part of billing that most offices just don’t put a lot of effort into.

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