Physical Therapy Encounter

This menu option is used to post additional claim information needed to process a patient claim.

Medicare Part B covers outpatient physical therapy services provided by a qualified therapist in private practice when furnished in the therapist’s office or the patient’s home. Private practitioners are individuals who work in an unincorporated solo practice, partnership, or group practice, or a professional corporation or other incorporated physical therapy practice. Regardless of the business structure of the therapy practice, Medicare requires the practice to meet all State and local licensure laws.

Physical therapists must enroll in the Medicare program to be eligible to render medical services to Medicare beneficiaries and submit claims for the services rendered. To enroll in Medicare, a physical therapist must complete a form and be qualified to obtain a provider identification number that identifies him or her as the person who provided the service on the Medicare claim form. If a physical therapist plans to provide services as part of a group or organization, the group practice must enroll in Medicare. Each individual therapist who plans to reassign his or her benefits to a group or organization must complete and submit a separate form to its Medicare carrier.

In prior versions, for the Internal Control Number (ICN) to be included in the Electronic Claims, the ICN had to be entered in the <Internal Control> field. Effective this version, Intellect now pulls the ICN number from the charge. This is handled by Intellect when auto-posting is used to post payments from the payers. This modification is NOT retroactive. Additionally, this ICN now also prints on the printer EOB from Intellect.

When Intellect looks for a Referring Provider (a.k.a. ordering physician), Intellect first looks at the encounter screen for either an <Ordering Provider> or <Supervising Provider> and, when either is blank, Intellect looks at the Utility--►Set Up--►Parameter <Referring> setting and pulls the referring provider based on the setting.

Effective Version 9.12.27
For clients who complete most of the Encounter screen fields with the same values for each patient, version 9.12.27 allows a 'default' record to be set up with the value to be carried over to all new Encounters.

To set up a default screen, go to Charges--►Encounter. Select the type of Encounter screen the office uses (the sample below is for Generic Encounter), then select Modify. At the <Patient Account No> field, enter 0 (zero). At the <Encounter #> field, enter 0 (zero).

Setting up the default encounter screen does NOT affect any encounters already entered.

1. To add encounter information to a patient’s account in Intellect, go to Charges --► Encounter --►Physical Therapy --►Add

This screen, like many in Intellect has several optional fields. The graphics in this documentation may vary slightly from actual clinics. See the options on this screen and/or the documentation on adding/removing fields.

2.2 Enter the patient account number, OR type up to 6 characters of the last name and press the [F2] key. To select the code from the list, either highlight the record and press the [Enter] key, OR double-click on the record.

3.1 The patient’s name is displayed. This is a read-only field and may not be modified.

6.1 Type the beginning effective date authorized by the insurer for this treatment.

7.2 When posting charges linked to this encounter (in Charges--►Charge) and the date of service is not within this date range, a warning displays:

8.2 Intellect completes Box 23 of the CMS 1500 form with this number for paper claims.

9.1 This is a required field. Enter the total visits as authorized by the insurer.

9.2 It is used for electronic claim submission Loop 2305 CR703 "Total visits projected, home health".

10.1 Enter the <Total Authorized Visits> minus the number of visits that have taken place.

10.3 Intellect uses this amount to calculate Electronic claims submission Loop 2305 CR702 "Total Visits Rendered Count"; i.e., the amount of actual charged visits.

11.2 Effective version 13.12.12: Information is pulled from this field to complete Box 15 on the CMS 1500 with the date and qualifier 455.

12.1 Type the date the patient was last seen by the attending physician or therapist for the qualifying condition related to the services performed.

12.2 This is a required field when services involve an independent PT, an occupational therapist, or a physician involving routine foot care.

12.3 Intellect completes Box 14 on the CMS 1500 form with the date and qualifier 304.

Or, when used for electronic claim submission, this date goes in Loop 2300 DTP*304*D8

13.2 It is REQUIRED in Loop 2305 CR701 Code indicating disciplines ordered by a physician.

13.3 To view the list of codes with descriptions, press the [F2] key. To view the list of only the codes either click on the arrow, OR press the → (right arrow) on the keyboard. To select, double-click on the correct code, OR use the ↑ (up) and ↓ (down) arrows to highlight the correct code, and then press the [Enter] key to select.

14.2 This code pulls information from Utility --►Referring <Referring Code>.

14.3 Effective version 13.10.29: For the CMS 1500 form, Intellect completes the Supervising Provider’s name in Box 17 with qualifier DQ (for Supervising Provider) and the provider’s NPI in Box 17b.

15.1 The name of the <Supervising Provider> is displayed. This is a read-only field and may not be accessed.

15.2 The provider name completes Box 17 on the CMS 1500 form and the electronic equivalent Loop 2310D NM1*DQ.

16.1 This field is used to designate a supplemental report type that will be forwarded separately. It works with the <Report Transmission Code> and <Identification Code> fields. It is included in electronic claims submission Loop 2300 PWK01.

16.2 To view the list of codes with descriptions press the [F2] key. To view the list of only the codes either click on the arrow, OR press the → (right arrow) on the keyboard. To select, double-click on the correct code, OR use the ↑ (up) and ↓ (down) arrows to highlight the correct code, and then press the [Enter] key to select.

17.1 This field is used to designate a supplemental report type that will be forwarded separately. It works with the <Report Type Code> and <Identification Code> fields. It is included in electronic claims submission Loop 2300 PWK02.

17.2 To view the list of codes with descriptions press the [F2] key. To view the list of only the codes either click on the arrow, OR press the → (right arrow) on ther keyboard. To select, double-click on the correct code, OR use the ↑ (up) and ↓ (down) arrows to highlight the correct code, and then press the [Enter] key to select.

18.2 Enter the Attachment Control Number from the pre-printed MEDI-CAL CLAIM Attachment Control Form. The form must accompany the supporting documentation.

NOTE: When completing the encounter record, it is recommended to include the ATTACHMENT CONTROL NUMBER as part of the Encounter Description.

18.3.1 With the focus in this field, press the [F2] key twice to display a list of document files pulled from the Progress Notes in PCM (the list does NOT include files generated in Intellect or manually saved to the /home/staff/EB_ATTACHMENT folder).

18.3.2 To display only a certain type of file, enter the beginning letters of the file and then press [F2].

18.3.3 Click on the appropriate file to select it. Multiple files may be selected by holding down the [Ctrl] and [Shift] keys while clicking on the desired files. The file's Document Id displays.

19.1 The Claim Frequency Code is used only for electronic claims submission Loop 2300 CLM05 - 3, and indicates what type of claim it is. For example, an original submission, corrected claim which is being resubmitted, a replacement claim, or a voided claim. The default is set to ‘1' Original Submission. Prior to adding this field on the Encounter screen, the system submitted all claims with Claim Frequency Code 1.

19.2 To view the list of codes with descriptions press the [F2] key. To view the list of only the codes either click on the arrow, OR press the → (right arrow) on the keyboard. To select, double-click on the correct code, OR use the ↑ (up) and ↓ (down) arrows to highlight the correct code, and then press the [Enter] key to select.

19.4 Effective version 18.08.31: When this field is set greater than 1 and the <Internal Control> field is blank, the ICN # that comes with the ERA file is printed in Box 22 on the HCFA 1500 and also sent electronically.

20.1 Enter the unique identification number assigned by the pharmacy or supplier to the prescription. It uses Loop 2410 REF02 with the Qualifier XZ.

21.1 EDS assigns each claim an Internal Control Number (ICN) systematically when it is received electronically or by mail. Processing or returning the claim constitutes EDS’ final action on that claim. A resubmission of the same service is considered a new claim. Each claim sent to EDS is assigned an ICN automatically, which is used to track the claim. The ICN is made up of 13 digits in a specific format. The format of the ICN enables the determination of when the EDS actually received the claim.

21.2. This field is used when rebilling a corrected claim to provide the insurance for the original claim control number on a denied claim.

21.3 This number is included in the electronic transmission for all claims. It is a number assigned by the payer to identify a claim. The number is usually referred to as an Internal Control Number (ICN), Claim Control Number (CCN), or a Document Control Number (DCN). CLM, 2300 REF02 is the Loop and segment:

21.5 Effective version 18.08.31: When this field is blank and the <Claim Frequency Code> field is set greater than 1, the ICN # that comes with the ERA file is printed in Box 22 on the HCFA 1500 and also sent electronically.

23.1 If there is documentation that needs to be sent to the insurance company, enter the file name of the documentation.

23.3.1 Create and save Appeal Document(s) files in the /home/staff/EB_ATTACHMENT folder. SBRs may also be saved as a .pdf to the /home/staff/EB_ATTACHMENT folder and attached as appeal documents.

23.3.2 Type the exact file name in this field. Note: This field is case-sensitive.

23.3.3 With the focus in this field, press the [F2] key twice to display a list of document files pulled from the Progress Notes in PCM (the list does NOT include files generated in Intellect or manually saved to the /home/staff/EB_ATTACHMENT folder).

23.3.4 To display only a certain type of file, enter the beginning letters of the file and then press [F2].

23.3.5 Click on the appropriate file to select it. Multiple files may be selected by holding down the [Ctrl] and [Shift] keys while clicking on the desired files. The file's Document Id displays.

24.1 Click [Add] to clear the screen and return the focus to <Patient Account No>, saving the new encounter.

24.2.1 Click [Yes] to clear the screen and return the focus to <Patient Account No>, saving the new encounter.

24.2.2 Click [No] to clear the screen and return the focus to <Patient Account No> without saving.

24.3.1 Click [Yes] to clear the screen and return the focus to the main Intellect screen, saving the new encounter.

24.3.2 Click [No] to clear the screen and return the focus to the main Intellect screen without saving.