The Encounter Form: Are you missing out on deserved reimbursement?

By Erica Schwalm, September 5, 2005


If you choose to use encounter forms to report information to your billing office, it is imperative that these forms are filled out correctly.  The encounter form (AKA superbill or charge ticket) is one of the most valuable tools used in the reimbursement process.  It serves as a communication device between you and your coders/billers.  If all necessary information is not recorded, delays or inaccuracies in the billing process will occur and you could be missing out on deserved reimbursement. 


In my experience, the most common problem areas are:



Avoiding Delays

One way to avoid delays is to assign someone in your office to review each encounter form before sending to the billing office.  Chances are your front desk staff has been trained to verify patient demographic and insurance information, referral and preauthorization requirements and collection of co-pays for each patient.  If they could also be trained to ensure each encounter form contains at least a DOS, provider name, level of service and diagnosis, this would surely reduce some of the delays.


Also, be sure that you provide your billers and coders with the information they need.  For example, when recording the diagnosis, do not use “Rule out” or “possible” diagnoses. Per ICD-9 coding guidelines, physician coders can not use these.  If a definitive diagnosis has not been made, record the patient’s signs or symptoms. 


Avoiding Loss of Revenue

One of the most important steps you can take to make sure you aren’t losing money is to write everything down, even if you don’t think it’s a billable service or item (when in doubt, write it down!).  


You, like many providers, might be under the false assumption that certain minor procedures done in the office cannot be billed and don’t indicate the service on the encounter form.  While it is true that some minor procedures, such as placement of an ear wick, are considered “bundled” into the office visit, many procedures can – and should be – billed.   


For example, you probably know that treating a minor wound with Steri-strips is not billed separately, that it is included in the E/M service, so you don’t bother writing it down.  You might be assuming that this rule also applies for wound closure with Dermabond, but that is not the case. Use of Dermabond can be reported with G0168 for Medicare patients, which has an allowable of about $100.00.  For non-Medicare patients, you can report this service with a simple repair code, 12001 for example, which reimburses about $150.00, more or less, depending on the payor.    If you had reported only a 99213, you could have lost between $50.00 and $100.00 (approximately).  If you do this once a week for a year, you could be losing over $5,000.  Now multiple this by the number of providers in your group. 




Another problem is that providers might think they are limited to codes pre-printed on the encounter form. For example, many providers have 90782, IM injection, on their encounter forms.  I have seen providers choosing this code for every type of injection they are giving, but this is not always accurate.  For example, if you are injecting a trigger point, this should be reported with code 20552 or 20553 if three or more muscles are injected.  20052 reimburses about $27.00 more than the 90782, and 20553 reimburses about $44.00 more than 90782.  And don’t forget about the drugs you injected.  If your practice purchased them, you can bill for them.  Be sure to indicate on the encounter form which drugs were used and how much was used.  Most injectables are reported with HCPCS codes, which can sometimes be billed with multiple units depending on the amount used.  One practice that uses Kenalog on a daily basis was reporting this with J3301.   This is the correct code, but the code descriptor is only for 10 mg.   They were usually giving 80 mg.  This one small error caused this 10-physician practice to lose about $150,000 in one year!  


Additional tips




The bottom line is, investing the extra time to completely fill out the encounter form will ensure you receive the reimbursement you deserve.