Overview:
In an ideal world, the documentation of an encounter is accurate when it is first entered by the pharmacy team, however at times errors are made. Our ‘encounter editing’ function allows pharmacy teams to make necessary edits to historic encounters. All changes will need to be attested to for accuracy.
For encounters which resulted in a medical claim, modifications to the encounter will have a downstream impact on the claim, which will also be modified and therefore must be resubmitted and readjudicated. This means that the claim status is important to understand prior to making modifications to the encounter, as claims that have been submitted cannot be adjusted unless they are reversed.
Before modifying an encounter for the first time, we recommend reaching out to support@imagemovermd.com to schedule a screenshare so we can support your first edit and ensure you understand all the necessary steps and impacts. Following that initial use case, the instructions below provide the guidance needed to modify encounters (and potentially claims).
Words to Understand:
Encounter: An encounter is what gets generated any time a workflow is completed. It represents all the clinical documentation and notes associated with the patient visit.
Claim: A claim is generated in our system to handle payment. A claim gets created for each encounter whether it is billed to insurance or if it's cash pay. A claim will be created even for a $0.00 transaction. These claims will automatically move to Archived status.
How To:
Review the claims dashboard from the Claims page of the web portal to confirm the claim status.
All PHI shown below is fake data from our testing environment. No PHI is being exposed in this guide.
Claim Statuses that cannot be modified:
Completed - If the claim is in ‘completed’ status this means payment has already been made, either by the patient or their payor, and the claim cannot be adjusted. If the encounter you need to modify is in this status and the elements you need to modify are associated with claim creation, you will need to reach out to support@imagemovermd.com to discuss, as we will need to reverse the claim.
Submitted - Claims that have been submitted cannot be adjusted. While you will be able to modify things like adverse reactions or other clinical details within the encounter, you will not be able to modify anything associated with the claim itself. This is why the ‘Resubmit claim…’ option in the screenshot below is greyed out. In order to modify the claim elements of an encounter in this status, you will need to reach out to support@imagemovermd.com to discuss, as we will need to reverse the claim.
Archived - Archived claims are claims that never had any dollar amount associated with the encounter. Once a claim moves to "Archived" status, the encounter (clinical information) can still be edited but the claim (billing information) cannot.
How to modify an encounter:
1.Find Patient - In the web portal, search for the patient, hover over their name and click ‘Edit’ (the pencil icon) on the far right to open their patient record.
2. Find the Encounter - Scroll to the bottom of the patient record and look for the encounter you’d like to modify in the ‘Test Results & Encounters’ section. Click ‘Edit’. This will launch our desktop workflows, which houses the encounter editor.
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The system will log your email as the person editing the encounter as well as the date and time at which you’re making the modification.
3. Edit the encounter - Before making your encounter edits, select which downstream actions you would like the system to take.
- Resubmit claim and/or manage patient payment info will allow us to resubmit the claim on your behalf and/or charge the patient for their responsibility. If you do not select this item, you will not be able to modify the ‘Billing’ or ‘Counseling’ portions of the encounter.
- Resend patient notification will resend the AVS to the patient based on their preferences.
- Resend CCD (Continuity of Care Documents) to HIE (Health Information Exchange) will update the data we provide to the HIE on your behalf.
- Resend report to PMS will refax the AVS to your PMS (if you have that feature configured).
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Next, use the navigation bars (usually near the bottom of the screen) to find the field(s) that need to be modified. Modify any responses that need to be changed by either directly updating them or clicking the ‘Edit’ icon as needed..
Editing/Adding Vaccine Adverse Reactions: If you learn your patient suffered an adverse reaction from a vaccine you provided, you can update that information easily via the editor using the same steps as above and using the navigation bars to access Adverse Reactions.
Save Edits: Once all edits have been made, navigate to the Summary or Finalize page (depending on the type of encounter and edits you’re making) and click ‘Save and Exit Session’.
- If at any point you determine a change should not be made, simply ‘Cancel without saving’ and the encounter will revert back to its original state.
Once you’ve finalized your changes, please notify support@imagemovermd.com as to the change(s) you made so we can ensure the claim/payment steps are managed appropriately.