I think that as I get used to the system (if I go with AC) I will be able to use all this smoothly. However, as a CAM doc, trust me that at least initially I won't have enough time to complete my note before the patient leaves. The way I work now at my main office, I hand the superbill to the staff and they input the info from the sheet into our practice management software, collect payment, give the patient a receipt and schedule the follow-up. Meanwhile, I am completing my note before I see the next patient. So, I asked the sales person at AC the question about unsigned superbills and he suggested to look at the following link:

http://www.amazingcharts.com/wiki/index.php?title=Create_a_Superbill

I tried this and it does work. I can generate a receipt for my patient with all the necessary info for reimbursement before I sign the note. I call also print a HCFA 1500 this way as well. So I have my answer. As far as I can tell by my experiment, I can then go back to the chart, finish importing items and finish my note after the patient has left and before seeing the next patient. In my solo satelite office, I can perform all these steps and since I don't accept insurance, I am done and actually don't need any other PM software on a link. In the main office we are using Medisoft v 7.0. So thanks to John Gregal in sales!!!