AMC report - Inconsistent Demoninator

anonymous wrote on Thursday, July 05, 2012:

Hi,

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

Thanks
DD

bradymiller wrote on Friday, July 06, 2012:

Hi,

Just to clarify, isn’t there only one AMC measure that counts encounters:
http://www.open-emr.org/wiki/index.php/Description_AMC

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)

Here’s text regarding this measure taken from the following AMC MEasures pdf:
http://healthcare.nist.gov/docs/170.302.n_AutomateMeasureCalc_v1.1.pdf

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.”

-brady
OpenEMR

anonymous wrote on Friday, July 06, 2012:

Thanks brady.  i mean, if suppose, i have created 2 encounters for a DOS. Assume, in the second encounter, we provide ‘clinical summaries’.

In this case, the denominator is 2 and numerator is 1 and whose % is 50% only.  But logically the measure is 100%.

So if i have considered the encounter which involves the measure, then i may get more accurate report.

View please…

bradymiller wrote on Saturday, July 07, 2012:

Hi,

The AMC measures wording (all one sentence worth :slight_smile: ) 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.

-brady
OpenEMR

anonymous wrote on Saturday, July 07, 2012:

Hi,

The reason for separate encounters is to be able to bill out for more than 4 CPT codes.

Thanks
DD

bradymiller wrote on Sunday, July 08, 2012:

Hi (also specific question towards Rod below),

Rather than muck up the AMC calculations to support this, wouldn’t the best place to attack that issue be by getting OpenEMR to support multi-page claims (the code that writes the claims is straightforward and guessing it should not be too tough to get this supported)? Pertinent code is here:
http://github.com/openemr/openemr/blob/master/library/gen_hcfa_1500.inc.php
http://github.com/openemr/openemr/blob/master/library/gen_x12_837.inc.php
http://github.com/openemr/openemr/blob/master/library/Claim.class.php

I guess the first question is if there is a limit also in the X12 claims?

Rod, how tough do you think it would be to modify the code to support this?

-brady
OpenEMR

tmccormi wrote on Sunday, July 08, 2012:

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.

-Tony

tmccormi wrote on Sunday, July 08, 2012:

errata …  only accept 4 DIAGNOSIS …

sriniemr wrote on Saturday, November 09, 2013:

Brady /Tony

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.

Source : http://www.mneconnect.org/CMS1500_faq.html

Please share your views

Thanks
Nathan

yehster wrote on Saturday, November 09, 2013:

Nathan, are you offering to modify gen_hcfa_1500.inc.php to split a claim with more than 6 procedure codes into multiple pages?

That would be very helpful.

sriniemr wrote on Saturday, November 09, 2013:

But kevin

It seems if we customize the claims to accept more than 6 CPT codes at multiple pages,that will not accept by payers…

Payers asking to send more than one claim in the case of more than six CPT codes

Share Your thoughts on how to manage this

yehster wrote on Saturday, November 09, 2013:

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.

sriniemr wrote on Sunday, November 10, 2013:

Thanks Kevin

I will look into it

sriniemr wrote on Tuesday, November 19, 2013:

Kevin

FYI : It seems the option of printing multi pages CMS 1500 claims are already done.

Please check attached test claim and share your thoughts

Also brady please let us know

-Nathan

yehster wrote on Tuesday, November 19, 2013:

Can you verify if your batch is from just one encounter?

sriniemr wrote on Tuesday, November 19, 2013:

Yes…Its generated from one encounter.generated on 4.1.3 dev version of code base.

Please let me know

sriniemr wrote on Tuesday, November 19, 2013:

Kevin

Generating one more claims from openemr demo instance

Patient : Test Test (6-21)

See attached claim

yehster wrote on Tuesday, November 19, 2013:

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.

sriniemr wrote on Tuesday, November 19, 2013:

Ok kevin.

brady Please review this thread and remove multi page paper claims from Active projects,If necessary

Thanks
Nathan

bradymiller wrote on Wednesday, November 20, 2013:

Hi Nathan,

Thanks for clarifying this. I have removed the item from the Active projects page.

-brady
OpenEMR