At a Glance
The Encounter Details page enables you to document new encounters with patients. It also allows you to view and edit information on existing encounters. This page is commonly used to update a patient’s primary, secondary, and tertiary insurance for an encounter.
Note that in order to update a patient’s insurance information on their profile for all of their future encounters, you will need to update it in your EHR first. Insights updates itself with information from your EHR each night.
✍️ Editing an Existing Encounter
Upon opening the Encounter Details page, you’ll see a list of all encounters.
When you click into an encounter, an editing modal will appear.
You may click into any section and edit it, then review and resubmit. See the new encounter creation walkthrough below for more details.
If you simply want to view the information about the patient, insurance, providers, etc., you may of course do so and then simply click the X in the upper right corner to close the editing modal.
Once you manually edit an encounter, that encounter will no longer automatically receive updates from your EHR.
🚶Walkthrough Encounter Creation
Let’s create a new encounter as an example case. Note that the same process would apply if you were editing an encounter, but many fields would already be filled in with existing information.
Click Create Encounter.
A modal will appear, inviting you to Create Blank Encounter or start from a template based on an existing patient’s previous encounter.
For this demonstration, we’ll click Create Blank Encounter.
An editing modal will pop up with informational sections organized as shown below.
Encounter Information
Patient
This section allows you to use existing patient information, or to Create Patient. We’ll choose Create Patient.
Next, we’ll fill in the patient’s basic information and click Save.
Now we’ll see the new patient’s information populate the Patient section.
Click Next Step when everything looks correct.
Insurance
Add, create, or update primary, secondary, and tertiary insurance information in this section.
When an insurance is selected, you can click the pencil icon next to it to edit that insurance in Insights.
For this walkthrough, choose Create Insurance.
Note that editing or creating new insurance information in Insights will not write back to your EHR (unless you use Athelas EHR). Please be sure to enter this information in your EHR as well.
Fill in the new insurance information and click Create Insurance.
Now, you can select that insurance from any of the primary, secondary, or tertiary menus.
Keep in mind that, apart from the insurance we’ve just entered, the options that pre-populate these lists come directly from information that Athelas has extracted from your EHR.
Once all insurances have been added, click Next Step.
Facility
Select the facility at which the encounter took place.
To add a new facility, go to the My Practice page.
Pro Tip: You can set a default Place of Service (POS) code option for each of your facilities from the My Practice page, either upon creation or when you edit them, shown below.
Click Next Step.
Service Lines
This section allows you to add or update ICD-10 codes, associated procedures, service lines, claim information, and authorizations.
As with previous sections, the options populating these fields come from information extracted from your EHR.
Diagnosis Codes
Start typing to find the diagnosis code you want to add, then click to select it.
Service Lines
When you click Add Service Line, a modal will appear.
Fill in the details of the service line here, including procedure code, diagnosis code pointers, modifiers, and so forth.
You can also check the box to indicate if the procedure was performed as an emergency (which will update section 24c on the CMS-1500 form).
Once everything looks correct, click Create Service Line.
Notes About Service Lines
- Procedures from your practice’s self-pay fee schedule will appear here only if the patient is self-pay
- Charges for CPT codes that auto-populate are based on insurance information and your practice’s fee schedule, but you can overwrite them if necessary.
Claim Information
Enter the place of service code, admission and discharge dates here. The claim charge amount will be automatically calculated as the total of the service line charges.
Authorizations
This is where you add any prior authorizations. For this example, we’ll click Add Authorization. This will bring up a popup in which we can create and edit either a pre-certified authorization or a referral.
Note that you can switch between viewing the list of Pre-Certifications and Referrals by clicking the corresponding button in the top left corner.
For this example, we’ll create a new pre-certified authorization.
Click Create.
A new window will appear. Fill in the information and click Create.
You’ll see your new prior authorization in the list on the previous modal. Check the box to select it and then click Save.
Note that if a referral is specified as a prior authorization, you will be unable to edit the referring provider in the following Providers section.
Providers
Input a rendering provider for this encounter as well as referring or supervising providers, if applicable.
You can either visit the My Practice page to create new providers, or you can simply type a provider’s NPI number into the search field and their information will populate, as shown below. Note that we source this information directly from the NPI registry.
Supporting Documentation
Upload any supporting documentation here.
Note that previously submitted documentation for this encounter is not visible here. Follow the steps below to view previously submitted documentation.
From the Claim Details page, click into the encounter in question, then click the Submissions tab.
You will see both the claim submissions and any additional documents.
Click View at the right end of the corresponding row to view that documentation, as shown in this screenshot.
Configurations
Configure rules for this encounter.
‘Billing Type’ is the kind of claim you want to produce — Professional, Workers’ Comp, or Auto.
The ‘Category’ section will be available for modification if you’re submitting multiple encounters for the same patient on the same date of service. This extra level of distinction helps reduce the chance of rejection, as many payers assume that claims are duplicates in these situations.
Finally, you can add any Tags you like to the encounter. Tags can be used to informally categorize encounters so that you can filter for them later.
To create a new tag, simply type it in and then select +Create.
To edit or delete tags, click Manage Tags.
If you’ve reached a stopping point, you can choose to save your work in one of the following ways.
Note that these save statuses are for your team’s own flow and understanding, so feel free to use them as you see fit. Generally, this is what each status is intended to indicate:
- Open
- No one has touched this encounter yet. Go ahead and get it started so your practice can get paid!
- In Progress
- Someone is working on this encounter.
- Blocked
- Someone is working on this encounter but has run into an obstacle that may require more time, or Athelas’ help. For example, perhaps the claim can’t be submitted because a prior authorization needs to be updated, or the provider’s notes are incomplete.
- Archived
- This encounter is not currently being prepared for submission.
Once everything looks good, click Begin Review.
🏆 Review / Submit
After clicking Begin Review in the Configurations section, Insights will ensure that the encounter details are free of technical errors that could lead to claim rejection or denial.
If all is well and no pre-submission errors are found, click Close & Submit Encounter.
If errors are found, they will appear with explanations, along with a link to Jump to section so that you can address the issue quickly.
The ‘Suggested Edits’ tab offers even more actionable direction in avoiding potential denials. The information provided here comes directly from CMS’ National Corrective Coding Initiative (NCCI). We can see in the example below that certain CPT codes cannot be billed together, and only one of the listed modifiers should be used on a given CPT code instead of multiple.
Keep in mind that the ‘Suggested Edits’ are just that — suggestions, based on CMS guidelines, but suggestions nonetheless. You may find cases such as the example below, in which some codes were flagged by the system, but they are indeed payable by the payer. In this case, it is fine to go ahead and submit without making those suggested further changes.
After all errors have been addressed, click Re-Review to find out whether more corrections are required, or if the encounter is now ready for submission.
If it can be submitted successfully, click Close & Submit Encounter. This will set your encounter status to ‘Closed.’ Then, when you hover the status on the Encounter Details page, a tooltip will indicate when it will be submitted.
📢 Further Assistance
We’re here to help! Please get in touch with support@getathelas.com if you’d like some hands-on assistance.
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