CMS Form 1500 2/12 Item Number 17

nursejeff wrote on Wednesday, March 26, 2014:

Box 17 now requires a qualifier be applied to identify which provider is being reported.

DN  Referring Provider
DK  Ordering Provider
DQ  Supervising Provider

This allows for 2 characters to the left of the dotted line and 24 characters to the right

For example: DK|Jeff Guillory RN FNP

Does OpenEMR allow for this Qualifier?

Jeff Guillory Jr
NP Health Clinic

fsgl wrote on Wednesday, March 26, 2014:

Page 11 of this CMS guide gives details about these qualifiers.

Because Kevin reworked the CMS 1500 form, we need his input.

fsgl wrote on Wednesday, March 26, 2014:

Just looked in the 4.1.2 (5) Demo. There are no provisions in Misc Billing Options HCFA when Global/Features setting changed to 02/12.

Would suggest filing 837’s in the interim.

yehster wrote on Thursday, March 27, 2014:

Seems like an oversight on my part. Out of town right now, but will look at it early next week.

cmswest wrote on Friday, April 11, 2014:

if you need a quick patch just for your DK add this to line 375

put_hcfa(34, 1, 3, "DK");

and change line 379 to this:

put_hcfa(34, 4, 25, $tmp);

fsgl wrote on Friday, April 11, 2014:

Thank you, Stephen.

I presume that the gen_hcfa_1500_02_12.inc.php will grab the new data for Box 17 from the old inc.php file.

Are the insertions correct?

nursejeff wrote on Tuesday, April 15, 2014:

The issue I have is that my Supervising Provider is not populating in Box 17 at all.

My billing specialist is telling me that only the “referring provider” is showing up in box 17. In my case, these two are not the same person.

I need the “Supervising” physician, selected on the Fee Sheet, to show up in box 17 on my CMS1500 with the proper qualifier preceding it.

Jeff Guillory Jr.
NP Health Clinic

cmswest wrote on Tuesday, April 15, 2014:

oh, this can get tricky, following the above referenced pdf, thanks to fsgl’s link to the cms guide, you will need 2 hcfas if there’s a referring provider and a rendering provider!

there’s no easy way to handle this in openemr right now so my advice is to electronically bill it!

but if you can’t first generate the claim for the referring physician and then go back in and change the fee sheet to indicate a supervising phys and then generate that claim

to do this you’ll have to add this code:
if ($claim->supervisorNPI()) {
$tmp = $claim->supervisorLastName() . ', ’ . $claim->supervisorFirstName();
put_hcfa(34, 1, 3, “DQ”);
put_hcfa(34, 4, 25, $tmp);
put_hcfa(34,33,15, $claim->supervisorNPI());
}

here

fsgl wrote on Wednesday, April 16, 2014:

Very difficult indeed.

Because there are only 3 boxes for 6 entries, how would the Billing Manager “know” whether to insert the info for referring or for supervising or to generate a CMS 1500 for referring and then for supervising?

If the CPT codes are the same for both referring and supervising on the same claim form, it would be a lot simpler to use one or the other. If the practice is not going to get paid more for using both, then there appears to be no reason to use both.

The only time that I think of using supervising is when attending physicians in a residency program are the supervisors and the residents are the renderers.

Jeff, why do you need both and why is it not possible to send 837’s? If we understand your situation better, we can come up with a better solution.

jkshla wrote on Wednesday, June 18, 2014:

I need to make these insertions as well. I was hoping patch 6 would give an option in Misc billing for this. Can someone walk me through the process of making these changes? I am comfortable doing it but need a little guidance. Thanks

fsgl wrote on Wednesday, June 18, 2014:

Hi James,

This should have been fixed with patch 6.

Go to Administration/Globals/Features, then to the bottom of the screen to choose the 02/12 version of the CMS 1500 form.

You can experiment in the 2099 Demo before printing up your real claims.

Bear in mind there is no way to have both DN and DQ on the same form. The CMS guide cited above instructs the submitter to send two paper claims, because there is physically no place for the second qualifer. If you don’t want to submit two forms for the same claim, try sending the claim electronically. I think that the 837P should be able to accommodate both.

fsgl wrote on Wednesday, June 18, 2014:

The DN should appear in the claim form if a referring physician had been selected in the Demographics/Choices. See attachment 1.

DQ should appear if designated in the Fee Sheet. See attachment 2.

Referring and Supervising physicians must be in the Address Book first in order for this to work on 2 claim forms.

jkshla wrote on Saturday, June 21, 2014:

fsgl. I have everything configured properly. I have updated to patch 7 now and still can’t get it to work. I need DN only. I am listed in the address book and as the referring provider in choices. Claim form is still not generating the DN in box 17. It only shows my name as it did prior. I have had it set on claim forms 02/12 in features for some time and just verified that it is in place as well. Any ideas? Thanks

cmswest wrote on Saturday, June 21, 2014:

right, the DN hasn’t been added to the code base yet

follow my post above from 04-11, you’ll be editing the box 17 section of

library/gen_hcfa_1500.inc.php

jkshla wrote on Saturday, June 21, 2014:

can you give me a quick tutorial of how to edit that on the server. I plenty compenent to do it if you can get me to the right file. I’ll need commands. I’m new to Linux. Thanks!

fsgl wrote on Saturday, June 21, 2014:

The path in Linux is var/www/openemr/library/gen_hcfa_1500.inc.php and open as Administrator.

See the screenshot in my 4/11 post.

Add line 375, use DN, not DK.

Change line 379.

Install Bluefish if you cannot get the line numbers in Scite.

fsgl wrote on Saturday, June 21, 2014:

Any reason to submit paper claims?

One does not have to fool around with these qualifiers with the 837P.

Turnaround time for payment is about 2 weeks for e-claims while our Medicare carrier takes about 6-7 weeks to pay on paper claims.

jkshla wrote on Saturday, June 21, 2014:

Paper claims are for secondary insurance. We have to send primary EOBs with them.

jkshla wrote on Saturday, June 21, 2014:

Also, what command should precede the path to open. As administrator I assume you are referring to sudo?

fsgl wrote on Saturday, June 21, 2014:

EOB’s from the primary insurances are sent as part of the 837P file. Occasionally the EOB’s are not transmitted as a result of an error. In those unusual circumstances, we would just fax a copy of the missing EOB to the secondary. This saves us from having to resubmit to the secondary again.