FPM Toolbox

Billing, Collections and Claims Processing

Advance Beneficiary Notice (ABN) - English

A form required for billing Medicare patients for a service when Medicare will not pay because it determines the service is not medically necessary
Download Format : PDF
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Advance Beneficiary Notice (ABN) - Spanish

A form required for billing Medicare patients for a service when Medicare will not pay because it determines the service is not medically necessary
Download Format : PDF
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Charge Capture Tool

An Excel spreadsheet that helps a practice conduct a chart audit to determine whether it is billing and getting paid for the appropriate services.
Download Format : Excel
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Claim Correction Form

A one-page form that can help make the process of filing corrected claims more efficient
Download Format : Word PDF
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FPM Superbill

A superbill to capture the codes most common in office-based outpatient practice
Excel PDF
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Sample Financial Agreement

A patient agreement outlining a practice's payment policies, including how to handle co-pays, insurance deductibles, payments plans, and overdue payments.
Download Format : PDF
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Sample Patient Financial Hardship Application

An application for patients facing financial hardships and seeking assistance from their doctor's office to pay their medical bills
Download Format : Word PDF
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