Encounter Summary

The Encounter Summary dialog is useful for several reasons. The dialog provides:

• mechanisms for entering related details like procedures, claims and patient payments
• display summaries of the detail that have already been entered (i.e. procedure list, claim list, payer payment list and patient account history)
• display totals of amounts in the lists
• indicates if the encounter is balanced (balanced means all procedures of all claims have been paid by the payers and the remainder of the charges has been debited from the patient account.)
• mechanism for patient to pay for the encounter
• mechanism for generating a report of all the information related to the encounter

The Encounter Summary dialog contains information about the entire encounter and documented in the following sections:

Encounter Section

The top section(above), titled Encounter, displays the patient, the date and the provider of the encounter. These fields are only editable in the Encounter Edit dialog that can be accessed by selecting the Detail button found in this section. The last piece of information shown here for reference only is the patients required co-pay.

Procedure Table

The next section of the Encounter dialog, titled Procedures, is a table that has some procedure information for this encounter. Every encounter must have at least one procedure.

The Procedure table has five fields:

1. CPT code - the Current Procedural Terminology code
2. Charge - the amount your office charges for this procedure
3. Quantity - how many of the specific CPT codes
4. Total Charge - the total charge which is the quantity multiplied by the Charge. This is the amount your office charges for this quantity of this procedure.
5. ICD-9 codes - up to five diagnosis codes for the procedure

There are three buttons associated with this section

1. New - select this button to create a new procedure for this encounter. Selecting the button will cause the Edit Procedure dialog to appear to allow the procedure to be defined. There is a red star next to it to remind you that a procedure is required.
2. From Previous - Quite often patients see a provider for the same reason over and over (therapy, massage, etc.). The identical procedure codes, ICD-9 codes and procedure modifiers are repeated each time. For convenience when entering new procedures for an encounter, all this information from a previous encounter can be reused. This button will allow the user to select a previous encounter for the patient. When selected, all procedure codes, ICD-9 codes and procedure modifiers will be entered for the new encounter.
3. Modify Charge - if for some special reason you would like to modify the charge of any or all of the procedures, select this button and the Modify Charge dialog will appear.

Another action associated with the procedure table is to double-click the mouse over a procedure name in the table causes the Procedure Detail dialog to appear. In the Procedure Detail dialog you will be able to edit or delete procedures and create a PDF document summarizing the procedures.

NOTE: More information about Procedures can be found in the next chapter.

Claim Table

The next section of the Encounter, titled Claims, display a summary of the claim information associated with this encounter. You would create a claim for each payer that will pay for some or all of the procedure chares. If the patient has no insurance coverage then there would be NO claims created.

There are four fields in this table that should uniquely identify a claim.

1. Date - the date the claim was created
2. Name - the name of the payer of the patients coverage
3. Level - TFM provides for three levels of coverage to be identified
1. Primary - the first payer of claims for the patient
2. Secondary - the second payer of claims for the patient
3. Tertiary - the other payers of claims for the patient
4. Biller - the name of the biller that filed the claim

There are two buttons associated with this section:

1. New - select this button to create a new claim for this encounter. Selecting the button will cause the Edit Claim dialog to appear to allow the claim details to be defined.
2. Delete - button allows you to delete the selected claim. If there is no claim or if no claim is selected then the delete button is not selectable. When not selectable the button is not highlighted, as shown in the image.

Another action associated with the claim table is the double-click with the mouse of a claim in the table will cause the Claim Edit dialog to appear. In the Claim Edit dialog you will be able to take several actions:

• edit a claim
• create a HCFA PDF document for this claim
• setup a the claim for EDI

Note: More information about Claims can be found in the Claims chapter.

Patient Account Table

The Patient Account tracks all of the patient financial transactions. The Patient Account table is displayed as part of the Encounter dialog mainly for operational convenience. When an encounter is created and procedures are recorded, it is likely that a patient also will pay their co-pay. The New button attached to this table provides the means to record a payment. For a more detailed description of the Patient Account information look at that previous chapter.

Payer Payment Table

The payer Payments listed in this table contain all the payments that have been received from payers for this encounter and any debits applied to the encounter from the patient account. Three other pieces of information are also displayed:

1. the Balanced indicator that shows when all allowed charges have been paid and the patient account has been Debited for the patient responsibilities.
2. the Total Paid amount is the amount of money that has been paid for the encounter.
3. the Total Allowed amount is the amount of money the payer has indicated that the provider should receive for the encounter.

The Payments table displays the following details about the payments that have been received for the encounter:

Notes Field

The Notes field is a field that contains free form text information that might be entered for this encounter.

Buttons

At the bottom of the dialog is a group of four buttons that control the interactions with this dialog.