How do others handle billing with the fee sheet when a patient has multiple encounters with different providers on the same date of service at the same facility? For example, let’s say the patient has a physician’s follow up visit, then has therapy with a physical therapist, and then sees a massage therapist on the same day at the same facility. Currently the billing person is creating a separate fee sheet for each encounter (3 in this case) which can be tedious especially when the fee sheet has one item (i.e. massage therapy). Could one “master” fee sheet be created for the patient for that date of service and then add the appropriate providers and services ( the doctor visit, the therapy session and massage therapy session)? Or is it still best to just keep it one fee sheet per encounter? I was just wondering if there is a more efficient way to handle this scenario.
Hi Mike, the Fee Sheet supports multiple services and you can assign providers at the service line level. I guess you’d only need separate encounters if they need to be billed in different ways.
Do you see that either one of these methods is a “best practice” for any particular reason, either systemically or clinically? I know that there is a session user related to who created the encounter, and that can restrict (via ACL and user settings) some folks to even see the encounter if they did not create it. Part of my curiosity is base on the behavior of multi-provider event scheduling, and if that actually has any affect later down the line.
With the following variables, what might be the relevant results?:
1. Front desk with standard Front Desk/scheduler ACL group sets status to “Arrived”. Presumably, the appointment is scheduled for the physician…perhaps in this case the multi-provider events must be enabled and the appointment should be scheduled that way? Does that have any effect on the variables in the form_encounter entry?
2. The physician sees the person, then does his own note form, and actually enters the services and diagnosis himself (yes, this is a completely hypothetical situation).
3. The two therapists each see the patient. At which point might the therapists have an issue with viewing the encounter if they do not have full physician access and they did not start the encounter/have a multi-provider event?
I understand what you are saying about the Fee Sheet supporting multiple providers and services at the line level. I was just curious how important it was to create a Fee Sheet for each “billable” encounter in a one to one relationship. I wasn’t sure how this would impact payments allocation. Right now it looks like on the payments side it does not mater if a Fee Sheet was not generated for each “billable” encounter of a patient’s same day multi-encounter/provider visit.
I’ll let someone with a medical background speak for best practice in a clinical sense. It will be up to the providers or perhaps clinic policy whether they want to share the same OpenEMR encounter. Specifying a provider at the service line level does not have any effect on access control or appointments, it’s mainly a billing thing.
It would be cool to be able to automatically (or at selectable at generation time) chose to create separate claims by ‘rendering provider’. This is the norm for integrative medical clinics where the Same provider has to submit separate claims depending on whether the encounter was them being and “Naturopath” or them being an “Acupuncturist”. This would apply to diff providers in the same clinic as well.
Tony www.mi-squared.com / @tonymi2 oemr.org / @OEMR_org
Main thing to keep in mind the way things are now is that encounters map 1-to-1 with claims. It would be nice to eventually have smarter insurance billing logic that can combine them or perhaps even split them.
"3. The two therapists each see the patient. At which point might the therapists have an issue with viewing the encounter if they do not have full physician access and they did not start the encounter/have a multi-provider event? "
Do you mean the provider being allowed to view the other provider’s encounters in addition to their own encounter?
In my scenario above, each provider (physician, physical therapist, massage therapist) is creating their own encounter on the same day patient visit. I was not sure if creating one “master” encounter for the given date of service and having the other providers add to that encounter was a good idea. Thoughts?
"Main thing to keep in mind the way things are now is that encounters map 1-to-1 with claims. It would be nice to eventually have smarter insurance billing logic that can combine them or perhaps even split them."
So then the billing personal does indeed have to create a Fee Sheet for each billable encounter in order to maintain the one to one relationship with claims to encounter?
If the first encounter contained the Fee Sheet with the services for that encounter in addition to the services of the other two encounters, then the remaining two encounters would not be tied to that claim. That’s not good then, right?
As Rod said, if you need to have 3 separate claims you need three encounters with their own fee sheet charge entries. No way around that right now.
-Tony
Yeah Mike,
My concern with everyone using the same encounter and just add their encounter forms and billing to it is that I believe the encounter is flagged to creating user (you see this if you print a report anyway). You can’t typically designate different forms to different providers, and when there are different levels of access involved, some “add-on” providers working with the same encounter who have “mine only” authorization will not be able to even view the encounter…so they cannot add their forms or fees to the same fee sheet. This is likely the case with the therapist. This is a bit of a disconnect in those situations, making the nifty line-item provider box in the fee sheet just a pain, if you are not sure who the “Default” provider is going to be (and if it even matters). I really need to look at (or ask here) if the line-item provider in the billing sheet overrides the Rendering/billing provider for the line item in the 837, or not……??? I asked these things long ago, but the context of the question was never really understood, or the answers were really never known. Providing supervisor was another big question for me, but thankfully, I never actually needed any of that, and was just able to re-write the fee sheet a bit after figuring out which box resulted in the actual billing provider box. I created other boxes for non-billing supervised providers, reviewers, and clinical supervisors to track their performance, units, RVU’s, travel, and pay. Those basic questions are still out there, though I am sure I now have the skills to track down the answers myself…If I needed to for myself…
Art,
Yes, gen837 is supposed to compare the line-item provider, and if the provider is different than the one specified in loop 2310B, it adds the procedure specific provider.
I think that’s the answer to your question.
// Loop 2420A, Rendering Provider (service-specific).
// Used if the rendering provider for this service line is different
// from that in loop 2310B.
//
if ($claim->providerNPI() != $claim->providerNPI($prockey)) {
++$edicount;
$out .= "NM1" . // Loop 2310B Rendering Provider
"*82" .
"*1" .
"*" . $claim->providerLastName($prockey) .
"*" . $claim->providerFirstName($prockey) .
"*" . $claim->providerMiddleName($prockey) .
"*" .
"*";
if ($CMS_5010 || $claim->providerNPI($prockey)) { $out .=
"*XX" .
"*" . $claim->providerNPI($prockey);
} else { $out .=
"*34" . // Not allowed for 5010
"*" . $claim->providerSSN($prockey);
}
if (!$claim->providerNPI($prockey)) {
$log .= "*** Rendering provider has no NPI.\n";
}
$out .= "~\n";
if ($claim->providerTaxonomy($prockey)) {
++$edicount;
$out .= "PRV" .
"*PE" . // PErforming provider
"*" . ($CMS_5010 ? "PXC" : "ZZ") .
"*" . $claim->providerTaxonomy($prockey) .
"~\n";
}
I think I got that piece of the mechanics of what happens, and certainly that is easy to see for the per-line-item billing table, but what (in vanillaEMR) the provider that pops up as “default”
It SEEMS to me, that when you set the billing provider name, “default” provider for the line items will be saved as whatever the $encounter_provid, the form encounter provider gets updated to that, and the whole chain reaction is started by picking a billing provider.
Not sure though. Between $main_provid, $encounter_provid, Provider_ID, and all the other dozen or so variables, I haven’t come to the absolute conclusion what the end result is (Who is the form_encounter provider that shows up in CCR, etc…), and if a non-billing provider starts a fee sheet, enters just the billing provider’s name (id), and leaves the line items as “default”. I can answer this with a little experimentation, but it seems like something important enough for the manual to leave no doubts about.
The post above is another victim of a tiny textbox interface, and no editing ability. Sorry for what reads like mad ravening, when I wasn’t even actually insane at the time.
Art - I agree that things could get messy with multiple providers sharing the same encounter. Right now it seems best to just have each provider create a separate encounter. Not sure if there could be a better way to organize that down the road given that all the providers are treating that patient for the same diagnosis. Thanks for your input and also bringing up the question on the 837.