Billing : Mark as cleared

OpenEMR Development
1

nshim08 wrote on Wednesday, April 14, 2010:

OEMR allows to “Mark as Cleared” multiple times for same encounter, wouldn’t this generate multiple “BILL” sent to ins. company. Is this correct behavior ?

2

sunsetsystems wrote on Wednesday, April 14, 2010:

Mark as Cleared doesn’t generate any billing, rather just flags the encounter as billed.

Rod
www.sunsetsystems.com

3

nshim08 wrote on Wednesday, April 14, 2010:

Thankyou Rod.
Would you know how openEMR handles “cash” or partial payments? If you can direct me to some reading material about this
I appreicate your help. I looked at some user manual at hand and it has gerneral information about billing and not very clear about some aspects of billing.

thx

4

sunsetsystems wrote on Wednesday, April 14, 2010:

There’s a lot of info at http://www.openmedsoftware.org/ .  If you can’t find what you want to know there, feel free to ask specific questions in these forums.

Rod
www.sunsetsystems.com

5

nshim08 wrote on Wednesday, April 14, 2010:

Hi Rod,
  I am running openEMR demo on .org site with 3.1 user manual open .I was working with “Add New Patient” (I see your name Rod Roark as new patient example). In demo version there is no Isurance in patient demographic. Any idea how to add “Insurance” information in patient Demographic?

thanks
nshim

6

nshim08 wrote on Tuesday, April 20, 2010:

Hi Rod,
  would you know how “bills” are submitted automatically to insurance company.In billing, I can see reports/claims are generated
but I am not sure how it is “sent” to insurance company?  can you help on this.

thanks
nshim

7

sunsetsystems wrote on Tuesday, April 20, 2010:

Insurance is not billed automatically.  Generally you tell OpenEMR to generate a batch of claims as a file in X12 format, which you then transmit to a clearinghouse or payer according to their instructions.

Rod
www.sunsetsystems.com

8

nshim08 wrote on Tuesday, April 20, 2010:

So in “Billing” when we select “Insurance company” and “ClearingHouse” its all for show?
I created X12 files and saved it on hard drive.Then I went to “Transact” and selected “Billing”…allowed to put notes…!! doesn’t make sense…
again I am not sure where all these X12 files are submitted to ins or payer or clearhousing? I am looking for something says…“Send now” “Bill Now”…
interesting maze

thanks again for your help Rod…I am getting there

nshim

9

tmccormi wrote on Tuesday, April 20, 2010:

You need to make a contract with a clearinghouse, like Availity or Zirmed. Availity is free, not sure about Zirmed.  Once you have signed up with them they make you test 20 or so claims and then approve you.

After that, you work out with them how to send them files.  Availity has several options, the simple one is to login to your account on their portal and upload the generated X12 batch file.  They also support several secure FTP styles for transmission.

Different clearing houses and, indeed different insurance companies have different processes and rules.

Tony

10

nshim08 wrote on Tuesday, April 20, 2010:

Hi Tony,
  appreciate your help.
Sounds like lots of admin work at end of the day for any clinic or facility.openEMR has lots of screens that you input information but
I am not sure what they are good for or where it is used through whole process.Example of it is “Billing” allow selection of “Ins comapny and Clearhousing”, then I looked in X12 pdf file none of these selections were recorded in X12 pdf file….still do not know why we set these parameters when it is not used…!!

appreciate you help
nshim

11

visolveemr wrote on Wednesday, April 21, 2010:

Hi,

Are you talking about the CMS 1500 or X12 format? Clicking “Generate X12” will produce the insurance claims in the X12 format .  Please make sure to choose the appropriate insurance company details and the x12 partners before clicking “Generate X12” button.

Thanks
ViCarePlus Team
(www.vicareplus.com)

12

nshim08 wrote on Monday, April 26, 2010:

Hi ViCarePlus,
  you right I misspoke.The pdf file is CMS 1500.
  I am not sure why it allows us to “Mark as Clear” when all $$ amount is handled in EOB…seems to be it should set it to clear when balance is zero, rather allowing someone, set it to clear when $$$ outstanding?
  Is this “Mark as Clear” is for zero balance or there is another use for it….I couldn’t figure it out from the document.

thanks for info and help
nshim

13

visolveemr wrote on Tuesday, April 27, 2010:

Hi,

“Mark as Clear” change the status as “billed” and it is used to denote the  zero balance, thus further processing of the claims is  not required.

Hope this helps.

Thanks
ViCarePlus Team