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Billing Service : Custom Created Forms

Encouter Forms
This form will be created specifically to cater to your practice’s needs.  The document will be used to collect the data necessary from a patient’s visit to the office (or similar site) that will become part of a patient record and/or be used for claim management purposes.

Demographic Forms
Obtaining patient demographics is standard practice.  By supplementing a customized Demographic Form, you will only collect the information that you want.

Insurance Waivers (ABN)
Waiver of Insurance Coverage & Insurance Waiver Form – By signing a Waiver of Insurance Coverage, a patient may choose to decline medical coverage for a specified visit, diagnosis, etc.  In addition, by having patients sign an Insurance Waiver Form, if the insurance carrier denies a claim the patient will be liable for the service and the chance of a non-payment will decrease.

Insurance Waivers (ABN)
As a convenience to all, we offer a Credit Card on File Waiver form.  This form authorizes the office to charge any outstanding balances to the particular credit card indicated.  This saves money on mailing supplies, as well as the time spent trying to contact non-paying patients. In addition, by implementing this form, it helps decrease your patient A/R.