Forms

Forms to Help Run Your Practice

Here are some essential forms for running a practice and billing insurance. We will add more forms as we go along. An another essential element to a new practice is a Fee Schedule.

Insurance Forms

Assignment of Benefits

This is an important form for insurance billing. Without it, the insurance company has to send the payment to the patient. And good luck getting it after that. It is necessary in order to say yes to boxes 12 and 13.

New Patient Forms

Sample New Patient Checklist

This is one example of a form that is very helpful when shepherding new patients through the insurance system. By having a checklist, a practitioner makes sure that they or their staff are doing everything and doing it consistently.

New Patient Health History

This, or a form like it, is necessary for every new patient or we cannot adequately treat them. It may be considered malpractice to not have a new patient history.

Notice of Health Information Privacy Practices

This is the practice’s written privacy policies and procedures. It is manadated by HIPAA and all patients must be able to read it, though it does not necessarily need to be handed to each patient.

Personal Injury Forms

PI Acceptance

This is a sample form for new patients involved with a Personal Injury (PI) case. They should sign this, or something similar, stating that they accept the office policies for PI cases.

PI Verification

Just as the Insurance Verification Form, this is an absolutely necessary form for personal injury patients that should be filled out BEFORE the patient arrives for their first visit.

Verification Forms

Health Insurance Verification Form

This is our latest and greatest Insurance verification form. Forms are always changing and the Insurance Verification Form is the most frequently updated of the forms as insurance rules change and experience adds to the form. So this is the current fruit of our labors…

Insurance Verification No 1

An insurance verification form is the most important form when treating insurance patients. This form is used for all general insurance patients and should be filled out BEFORE a patient arrives for their first visit and repeated in regular intervals after that (e.g. annually or when benefits may have changed).

Insurance Verification No 2

Another example of General Insurance verification form.

Workers Comp Verification

Just as the Insurance Verification Form, this is an absolutely necessary form for workers comp patients that should be filled out BEFORE the patient arrives for their first visit.

PI Verification

Just as the Insurance Verification Form, this is an absolutely necessary form for personal injury patients that should be filled out BEFORE the patient arrives for their first visit.

 

1 Response to Forms

  1. Tracy Ye says:

    A couple came in my clinic and PI insurance issue. I read through the PI chapter in your book and downloaded PI verification forms. Thank you so much! Because of your book and website support, I talked with my new patients with great confidence about PI insurance stuff.

Leave a Reply