Add-on software to practice management systems that can reduce the time it takes to build or review insurance claims before batch transmission to the carrier. It takes codes entered by a coder, and by using a series of built-in prompts it enables him or her to code more accurately and specifically. The encoder bases its code selection on clinical documentation and can generate diagnostic and/or procedural codes. The prompts perform such tasks as resequencing codes by priority, verifying the relationship between grouped codes, and suggesting additional related codes not originally entered by the coder. Two types of encoder systems exist: logic based and dictionary driven.

Method used in encoder software in which a coder enters a keyword that brings up a menu of either diagnostic or procedural codes from which a coder can choose.

Method used in encoder software in which a coder enters a keyword that generates a series of prompts or questions that ends with a suggested diagnostic or procedural code.

1. Face-to-face meeting and communication of a provider and a patient for the diagnosis and treatment of a disease or injury. This may occur in an office, home, or hospital facility setting. 2. One contact or episode of service to a patient. Also known as a visit .

Detailed information about individual medical services, regarding how a patient was treated, that are provided to a capitated managed care plan by the provider. The level of detail about each medical service reported is similar to that of a standard insurance claim form. Encounter data are also sometimes referred to as shadow claims .

Dollar amount that is charged to a managed care plan member by a provider when medical service is provided in a preferred provider hospital emergency department or in the office of the preferred provider. A schedule of benefits or fee schedule in the managed care contract lists the amount of the fee for each type of medical service along with the procedural code.

All-encompassing billing form personalized to the practice of the physician. It is considered a financial record source document that is used to record the patient’s diagnosis, any services given to the patient during the current visit, and related service fees. It may be used when a patient submits an insurance claim; also called charge slip, cheat sheet, communicator, fee ticket, multipurpose billing form, patient service slip, routing form, superbill , and transaction slip . See multipurpose billing form and cheat sheet .

At one time considered a buzz word for “claim.”

In managed care plans, a report of capitated services, submitted for statistical purposes only. No reimbursement is made from this information.