A medical encounter form is a document used by medical providers to bill patients in a consistent manner. To release payment, all insurance carriers demand a scanned medical encounter form.
The appearance of these forms may vary depending on the medical provider a patient visits. However, they must include 13 fields, including patient name, patient medical record number, date of birth, date of service, place of service, CPT-4 procedural code and description of service, modifier information, resident involvement, diagnosis code, billing instruction, space for documenting special billing instruction, provider name and signature, and date.
