Are there the equivilent of Medisoft cases

biller wrote on Thursday, May 14, 2009:

We are a small practice and are currently using Medisoft as our practice management software.  I would like to switch to oemr, everything so far is going well.  I do have one question though.  Medisoft uses cases to track or keep together insurance information, authorization numbers as well as a start and a stop date for this set of data.  An example would be if a patient has Medicare and is also involved in a motor vehicle accident, is it possible to keep track of them separately?  The work-around I found was to create a different patient for each new set of data, but that isn’t really going to work for us.  Any insight into resolving this hurdle would be greatly appreciated.

Thanks in advance

John

tmccormi wrote on Friday, May 15, 2009:

A form could easily be created or modified to track that information at the encounter level. 

Info on creating your own forms can be found in the installation at openemr/Documentation/3rd_Party_Form_API.txt

If you are not the developer type, you could hire one of the commercial vendors to create that form.  It’s one of the ways we survive to keep this product viable and it would not be costly…  See oemr.org Commercial Vendors.

–Tony

biller wrote on Tuesday, May 26, 2009:

Tony thanks much for the reply.  I may very well have to look into solving this with forms.  My original thought was that OEMR may already have such a feature since it is a common occurance in billing to have one person with multiple insurance companies at the same time.  I was just wondering how OEMR handles that situation. 

Thanks in advance

John

markthepharaoh wrote on Wednesday, May 27, 2009:

John

I used Medisoft before, what medisoft shows under the case is achieved in the OEMR under demographics; there you enter the different additional insurance policies that the patient has and  you connect the patient to the doctor or treating professional with all its PINs.  Further at the encounter you connect the patient to the facility.  In OEMR you will need again also to connect the patient to the treating professional at the fee sheet so that the treating professional info will show up on the billing.  I that helps.

Mark

biller wrote on Wednesday, May 27, 2009:

Mark, thank you very much for the quick response.  I will take a look at it and hopefully get it going.  I will ask another question if I get stuck down the road.

Thanks again for you help it is greatly appreciated.

John

biller wrote on Wednesday, May 27, 2009:

Mark, quick question before I go experimenting.  Does OEMR allow the equivalent of multiple cases in medisoft?  For example suppose John Doe has Blue Cross as a primary insurance for his medical needs.  Then at some point is in an auto accident and has GEICO as a primary insurance company.  I would want to associate some transactions only with Blue Cross as the primary insurance company for the Medical issues such as flu-like symptoms and then when he comes in and is treated with manipulations and e-stem and other procedures I would like to link those to GEICO as the primary insurance company.  I hope that makes sense.

Thanks again for your help in assisting me to understand OEMR better.

John

markthepharaoh wrote on Thursday, May 28, 2009:

John,

This is not a complete answer, but a starting point, there is a form called (Misc Billing Options for HCFA-1500)  it has some options for you to enter the information you want about auto accidents  however, it does not have a way for you to choose which insurance to use for this purpose.  I will look into it during this weekend and see if I can find a way to select an insurance for a specific purpose as u intend. 

Mark

biller wrote on Thursday, May 28, 2009:

Mark, thank you very much for helping me find a solution, it is greatly appreciated.  I was just thinking that OEMR would have something in place to handle people with different insurance companies for different situations.  I’m looking forward to what you are able to find out.

Thanks in advance

John

markthepharaoh wrote on Sunday, May 31, 2009:

John,

I had a second look at the Medisoft and OEMR.  Unfortunately  oemr as it stands now will not do what medisoft do.  I am going to make this suggestion on the forums for our developers and hopefully it will find an acceptance.  I am not a programmer so I don’t know how easy or difficult this task, but I am sure you can get an estimate from the commercial vendors of what is involved.

Basically, if the insurance portion is moved from the demographics to the encounters this will allow the choice of which insurance can be used with which injury or illness depending on that particular encounter.  This means that if the patient comes with an injury accident in this particular encounter the specific insurance can be selected as the primary for this accident.  Or it can be added under charges where you can have an option to make the insurance selection.  It also can be added at the fee sheet where the transaction is being constructed.  

Alternatively, you can change the insurance in the demographics and save it for a particular encounter and after billing you can change it again which is confusing and time consuming and I don’t know how this will effect previously create claims, I assume it will not as long as there are not re-opened or refreshed.  

I am sorry that I couldn’t come up with a better solution for you. 

Mark

ideaman911 wrote on Sunday, May 31, 2009:

Hi;

I think there is a "kludge" way to do this, but it will require some awareness.

First, all insurers must be defined in the Admin - Practice - Add Insurance area, so are not patient unique.  But there are a few possible ways to note the differences.  My suggestion would be to start for the "accident" case by assigning that as the "Tertiary", as it is the least likely to be used previously.  Then, make certain to add an "Issue" for that patient as "Auto Accident - Bill Geico" for example, and select THAT issue only for those encounters where services are related to the accident. 

For example, a clinic might treat an open sore from the accident but treat the patient’s diabetes at the same time.  However, that should be shown as two separate encounters, one for each insurer case, albeit with the same DOS.  You would  select the Accident related issue for the Geico wound care, but would instead select the Diabetes issue for the BCBS, for example.

Then at Billing there will be two encounters shown for the same day.  Unfortunately, a change I submitted for CVS has nit yet been loaded which would show the DOS in the Billing, so you must click on the encounter number to actually view the encounter details from there.  But doing so will show the encounter (your billing person must have view authority), and then (s)he can select the tertiary insurance for that bill in the Billing, click the checkbox, and print the CMS 1500 or produce the X12 as appropriate for that (if the X12, there should be an X12 partner associated with the Geico in this case).

As I indicated, it is a little "kludgy", but it does work.

Note: In testing this, I noticed that the selection of "Accident" fields in the "Misc Billing Options HCFA" did not properly print the Yes and NY when I entered Auto Accident there.  I will add that to the "Bug" list and will ask developers if an "Accident" override can be added to the 2nd & Tertiary which would disable the "Other Ins" from field 11d.  You might have to, in the interim, repair those on the CMS 1500 form.

Joe Holzer    Idea Man
http://www.holzerent.com

markthepharaoh wrote on Wednesday, June 03, 2009:

Joe,

I am glad that u were able to make it work, it is good to know!

Mark