3 Must Haves on a Registration Form

A patient registration form is an important part of patient processing and key to “Getting Paid Right the First Time”.  Whether the patient completes a downloadable form on-line or fills one out on the first visit, it is very important for the patient coordinator to review the information with the patient making sure to check that every line is filled out completely and most important, that they can read everything written.

During the initial intake process, the information taken is used to verify benefits and to determine if a referral, authorization or other documentation is needed in order to see the patient.  Although you may have already completed an intake form, it is still important to have the patient complete the entire registration form to confirm the information they gave is accurate.

Over 85% of denials are due to data entry errors and many of these errors occur because the written information was not clear and a guess was made resulting in a misspelled name, wrong zip code, incorrect date of birth, claim and/or member number just to name a few.

Once the accuracy of the information has been verified, attention should be paid to the most important part of the registration form which is the 3 consents which need to be signed by the patient.

First is the Consent to Treatment.  The patient’s signature authorizes the professional staff to examine and treat the patient with physical therapy for the injury for which they are being seen.

Second is the Assignment and Instruction for Direct Payment to Health Provider.  By signing this, the patient is agreeing and instructing their insurance company to pay the clinic directly for professional medical services rendered.  It is a Direct Assignment of Rights and Benefits under the Policy.  It also states that the patient agrees to pay any balance of said professional fees for non-covered services or fees as required by their insurance policy.

And third, is a requirement under HIPAA regulations stating that the Physical Therapy company complies with HIPAA and will protect the patient’s Protected Health Information (PHI) and will use it as allowable by law in treatment and until full payment is received.  It also authorizes the release of information pertinent to their case to an insurance company, attorney, etc. for the purpose of securing payment under the HIPAA policy. 

Each of these consents should be signed separately in the presence of an employee, with a patient signature, patient printed name, and a staff witness signature.

By taking these steps you will be assured of fewer data entry errors and you will help patients to better understand their responsibilities, as well as yours, when it comes to consenting to treatment, assigning benefits to the practice and understanding HIPAA and their protected health information.


Diane McCutcheon, President
DM Business Management Consulting Services, Inc.
Account Matters – Billing & Collection Services
4 Charlesview Road, Suite 4
Hopedale, MA 01747
P: 508-422-0231  F:  508-422-0234
diane@dmbmcsi.com