What Is an Encounter in Medical Billing?
Healthcare providers across the nation receive collection services, management counseling, server support, credentialing services, and medical billing and coding services from PracticeForces. Their team believes in helping healthcare providers streamline their services for better patient experiences in their offices.
Here, they explain the definition of an encounter in medical billing and other related terms.
An encounter is when a user has contact with a provider and when the provider gives services to that user. For a visit to be an encounter, the provider must document any services that happened.
Providers should not count some services as an encounter, such as:
- X-Rays
- Drawing blood
- Lab tests
- Renewing prescriptions or writing new ones
- Collecting urine samples
- Vaccinations
What Is a User?
The user is a patient who has an encounter with the provider at least once a year. A patient is still a user if they receive multiple services throughout the year. Still, data systems only count them as users once, no matter the number of services they receive.
What Is a Provider?
The provider is the person that assesses the patient or notes any services rendered on the patient's records. Nurses, physicians, assistants, dentists, mental health care providers, and rehabilitation counselors are all providers.
What Services Constitute an Encounter?
Many varied and broad services determine if a visit is an encounter. Any form of patient care other than those listed above counts as an encounter in medical billing. These forms of care include:
- Inpatient hospital care
- Physical therapy
- Emergency room visits
- Occupational therapy appointments
- Remote appointments where providers render additional services
What Is the Difference Between an Encounter and a Claim?
An encounter is an event that transpires between the provider and the user (or patient). This visit must include certain services that define the visit as an encounter.
A claim is a bill for services rendered that the provider sends to a user's health insurance provider. This bill details the diagnosis, the treatments given during a visit, and all the other pertinent information that the provider and the insurer need. The provider and the insurer use a system of well-defined medical codes representing the diagnoses and treatments used.
What Is an Encounter Form?
An encounter form, or an encounter record, is the detailed record of the services provided by the physician to the user or patient. These often use the same medical codes used in medical billing.
Professional Medical Billing and Coding Services
PracticeForces hopes that the definition of an encounter in medical billing, as well as all the other related terms and services, is more apparent. They offer many different services to doctors' offices and other healthcare providers to improve workflow and support patient satisfaction and experiences.
Healthcare providers can reach PracticeForces at (727) 732-2831 to go over the various services available for those providers. Patients with questions about their billing statements can contact them at (727) 771-1300.
If you’re interested in what CPT codes mean, you can learn more about them here!
