Scope of Purchase

Business & Clinical Management Services (BCMS) Intake Forms & Resources

Twenty-five (25) most commonly used and needed intake forms and resources for outpatient therapy providers. 

• All can easily be uploaded into the Prompt EMR system for seamless patient interaction. 
• All are fully customizable 
• All are vetted by industry experts 

Forms include:

1.  Patient intake form – Auto Accident
2.  Patient intake form – Commercial Insurance 
3.  Patient intake form – Medicare
4.  Patient intake form – Workers Comp
5.  Patient intake form – Payer Verification
6.  Patient intake form – Self Pay
7.  Informed Consent – Collaborative Decisions Making
8.  ABN
9.  ABN Instructions
10.  Personal Financial Disclosure
11.  HIPAA – Privacy Notice
12.  HIPAA – Authorization for Release of PHI
13.  Insurance Patient Payment Acknowledgement
14.  Cash Patient Payment Acknowledgement
15.  Medication/Surgery Flow sheet
16.  Notice to Medicare Patients (Home Health)
17.  Compliance Program Risk Assessment Checklist
18.  Telehealth Consent form
19.  Interpretive Services Poster-Handout

Resources:

1.  Delayed Plan of Care from MBPM
2.  Group Therapy
3.  HIPAA PHI Identifiers
4.  Medicare AMA Unit Counting
5.  Non-Enrolled Therapist under Supervision
6.  Technical Denial Due to Lack of Certification of POC

Client Responsibilities

License to Reprint/Copy/Distribute:

The Forms and Resources are licensed to the billed entity for its exclusive use and cannot be transferred. It may not be used, copied or shared in any way for goodwill or personal or financial gain without the expressed written permission of BCMS, Inc. As the licensee, you are responsible for safeguarding the distribution of your forms and resources. All materials maintained electronically must be password protected and in “read-only” format.

Disclaimer: BCMS, Inc. has taken great care to provide the most current and accurate information available as of the date of this license agreement; unless otherwise stipulated. Please note that the information provided should not be considered legal advice and is not a substitute for individual consultation with an attorney for legal guidance. Proper implementation of policies and procedures is the responsibility of the purchaser and is contingent upon a thorough review of the materials provided and compliance with the instructional material.