Encounter
An encounter is a single contact between a patient and a provider for the delivery of care — the visit, service, or stay that a claim reports.
Updated
An encounter is a single contact between a patient and a healthcare provider for the delivery of care. It can be an office visit, a hospital stay, an emergency department visit, a telehealth session, a diagnostic test, or any other discrete service event. The encounter is the unit of care delivery, and the claim that follows is the bill for it.
Each encounter generates one or more billable charges, which become a claim when they are coded and submitted. Because the claim is built from the encounter, the encounter's documentation — what was done, why, and where — is what the codes and the medical-necessity support are derived from.
In practice
Encounter documentation is the source for everything downstream: the codes reported, the medical-necessity support, and the modifiers that reflect the circumstances of the service. A claim that is clean on its face can still be denied if the encounter documentation does not support what was billed, which is why documentation completeness at the point of the encounter is a front-end prevention control.
Commonly confused with
- Claim: An encounter is the care event; a claim is the bill for it. One encounter produces one or more billable charges that become the claim, so the claim is downstream of the encounter, not the same thing.