Definition
Any direct contact between a patient and a provider for evaluation, diagnosis, or treatment counts as an encounter. Each encounter should produce documentation and either a charge or a recorded no-charge reason. Under capitated contracts, providers still submit encounter data to report the services delivered.
Why it matters
The encounter is the unit that billing reconciles against. An encounter with no charge is missed revenue that no denial report will catch. In capitated and managed care arrangements, missing encounter data can understate risk scores and future payments.
Example
A practice compares 120 encounters on the schedule to 116 charged visits. The 4 gaps trace to telehealth visits that were documented but never billed.