For the AMC measure - specifically for encounter based measures, i see inconsistent Denominator with multiple encounter for a DOS -
In the denominator calculation, will all the encounter created on a particular day taken into account? If so, i doubt the calculation of denominator is invalid
My guess is we need to consider only the encounter that involves measures.
As per OpenEMR architecture, all the encounters between the given date range is selected, irrespective of # of encounters created on a particular DOS
15. Provide clinical summaries for patients for each office visit. 170.304(h)
Category Counted: encounters
Denominator criteria: none (total number of encounters)
Numerator criteria: Patient summary provided within 3 business days of encounter (total number of encounters that a patient summary was provided/sent within 3 business days)
Clinical summaries provided to
patients for more than 50% of all office
visits within 3 business days
In code, it does appear to cumulate all encounters for the denominator and whether they each fulfilled criteria for the numerator. So, it does appear (I haven’t tested, just by looking at code), that if you have multiple encounters on the same day. they will be treated separately in the calculation.
Can you further describe what you mean by this:
“My guess is we need to consider only the encounter that involves measures.”
The AMC measures wording (all one sentence worth ) do seem to point towards counting Office Visits, which does seem odd to have more in one day from the same physician. Just to give me a better idea of what is going on(and why one encounter would involve the measure and one wouldn’t), can you provide in more detail what each of the multiple daily encounters are for. For example, what is happening in encounter 1 that is different than encounter 2 and why need separate encounters.
The X12 does not have those limits, some insurance carriers on accept 4 DIAGNOSIS codes on a claim, but the X12 sends them all and as many lines of Services as there are.
CMS 1500 paper claims handle up to 6 lines of CPT per page. I’m not sure where DD is getting 4 from.
This thread is placed as OpenEMR Active projects,So i Would like to contribute this feature to OpenEMR.
Here is my initial analyses
CMS -1500 Paper Claims has six boxes to enter CPT codes…
If the practice/clinic has more than six CPT,they have to send a another CMS 1500 claim.
Here are some reference…
More than 6 CPT
Can we submit more than 6 line items on a 1500 claim form?
Currently, users can’t submit more than six line items on a 1500 claim form. If you are submitting a claim that requires more than six lines, then you must submit these items over multiple claims.
I’m suggesting that it would be possible to modify gen_hcfa_1500.inc.php to address the problem that the original poster works around by creating two separate encounters.
“Multiple Pages” in this context means two or more separate fully filled out CMS 1500 forms, which is what you get when you create multiple encounters, which seems to work for the original poster for billing purposes, but it messes up AMC denominators.
Had to try it myself too, and indeed if there are 7 or more different codes, the claim does in fact get split onto separate pages. I was confused in my earlier testing, because it seems that if procedures are duplicated, it’s only put on the HCFA 1500 form once. My original cases had duplicates.
However, if there are more than 4 Diagnoses (justifications/ICD codes) on the encounter, the diagnoses beyond 4 are ignored without warning in the diagnosis list section and invalid “pointers” (numbers beyond 4) are included on the form. This must be the issue that the original poster was having.
The “fix” to this separate issue will be to use the new 02-12 format for the HCFA 1500 form that will be accepted starting in January. I think there might still be some weirdness as there is the potential for diagnoses being listed on a given page that aren’t referenced at all as justification when there are more than 6 procedures on a given claim, but
Nathan, thanks for looking into this.
For reference:
These are the code segments that implement splitting a given claim into multiple pages.
The original poster hasn’t weighed in with any additional feedback/comments, so I don’t really think there is anything additional that needs to be addressed related to this thread.