I think what needs to happen is coding support for CPT4, HCPCS and their fees into the Native Data Loads module in OpenEMR. It shouldn’t be a very big project but developers like to be paid.
There are as many fee schedules as there are insurers. No easy way to have more than 1 working in the Fee Sheet.
There are multiple Medicare schedules within one state. Our state has 5.
CPT codes must be purchased from the AMA, which makes it tough to import via External Data Load.
Fee schedules change every year. Unlike Workmen’s Comp, which has a set of fixed values by which a multiple is increased or decreased annually; this does not exist for other carriers in a form that readily accessible. The RVU file is not used by most practices.
Physicians usually don’t need the schedule of other specialties.
If you are not in the mood to write the .sql file, the fee schedules are available either as .xml or .csv files. Even non-geeks can manage an import with a .csv file. There is a how-to in Code Types.
Insurers adjust off what they don’t cover. I believe the main reason to load a fee schedule is to make sure you don’t charge too little, and that you charge something sensible for the self-pays. Some of my clients have applied a multiplier to the Medicare rates in their area to get default fees.
The native data load would be programmed to accept whatever the provided file structures are. Even for purchased CPT4 data you will get a download to give it. Note for example the data load for RXCUI will accept a zip file and extract and decipher its contents automatically.
That is true that developers like to be paid. I like to get paid for the hacking I do. I will take a look at that and see what hacking I can do there if any. I will report back if I have any progress.
I am not sure how to answer you. I have imported the CPT codes that were purchased from the AMA into the codes table. Please review and let me know if this is correct at http://omp.openmedpractice.com/testdrive
I have loaded all 10,029 codes into the codes table. The codes are registered as CPT in the table.
The reason for importing the Medicare Fee Schedule is to spare the billing clerk the hassle of keying it each time.
Bear in mind that the Medicare approved/paid amounts are usually less than the reimbursement rates for commercial carriers such as Blue Shield. For example if we use the Medicare approved amount of $119.71 for 92014 in the Fee column & then we bill Blue Shield with this fee; Blue Shield will pay only $119.71 instead of their Usual & Customary Fee of $160.94. A needless haircut.
Our old PMS had a feature where the Medicare approved amount & the expected paid amount would pop up automatically when we posted Medicare payments. OpenEMR does not have this feature.
I should have asked this question at the outset. What is the purpose of importing a set of Medicare fee schedules?
I was only importing the fee schedule because it was originally apart of the program when I first started using it at version 2.x.
But if I am understanding what you are driving at is that it would be impractical to import the fee schedule because it varies so widely. Right?
Would it be best to let each practice add fees to the codes that they use most often because they should have the most accurate fee schedule rather than the generic one that can be downloaded from CMS?
