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
Source Article

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
Source Article

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
Source Article

Claim Correction Form

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

FPM Superbill

A superbill to capture the codes most common in office-based outpatient practice
Excel PDF
Source Article

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
Source Article

Want to use this article elsewhere? Get Permissions


Information From Industry