Encounter Rate Billing is an option for payers such as Medicare (FQHC and RHC) and Medicaid that have very unique and specific billing and claim requirements, and that reimburse at a flat encounter rate.
Encounter Rate Billing provides the ability to automatically adjust charges so that the balance reflects the payer’s expected encounter reimbursement rate or amount. In addition, an encounter rate code required by the payer on claims can be automatically inserted onto each encounter. For example, a 0521 Revenue Code line item may be required on Medicare UB/837I claims, and a T1015 CPT4 Code line item may be required on Medicaid 1500/837P claims. The setup and configuration of the
Encounter Rate Billing library also defines which of the original charge line items on an encounter are included on the claim.
Note: FQHC practices must use encounter rate billing for Medicare. It is the only option available that meets CMS’s complex requirements and guidelines for claims.
The encounter rate billing considerations are as follows:
- Claims are configurable within the setup of the Encounter Rate Billing library.
- The Encounter Rate Billing library is easy to maintain for various payers and SIM codes.
- Works well with Electronic Remittance Advice (ERA).
