Different providers accept or do not accept assignment for same patient/insuance

Hello!

We are excited to add on a new provider in our office running OEMR. The only issue is that I do not accept assignment from most insurances (including Medicare, as I’m non-par) BUT our new provider accepts assignment from practically every insurance.

Since the only accept assignment field is in the patients demographics (other than the facility), does anyone know a trick around this?

Ideally we’d like to be able to set assignment based on care provider (which is a field in demographics).

This is a huge issue for us because copays are different, even Medicare rates are different.

Please help :pray::pray:

Thanks in advance dear OEMR colleagues!!

Hi @Sarah_Graff
Sorry to see nobody has responded to your plea!
I do not consider this an authoritative idea, but the sound of crickets was getting loud, and this may be a starting point for investigations.

The only option for accepting assignment is in the Facility settings, right?
What do you think about creating a facility with a different name that does accept assignment and have the provider work with that facility as their default?

Bear with me here.
A new facility would be added to the list for a provider who has different assignment settings.
I’m fairly sure clearinghouses/ ins cos don’t really care what this facility NAME is, just its identifiers in the facility listing (but I could be wrong).

image

In the facility info, make it so that it does or does not accept assignment (oval at bottom)
image

And in the provider’s user profile, you select the default facility as whichever one matches the provider’s assignment preference…

Screenshot at 2024-09-10 12-45-03

The rendering provider would have to be correctly entered in the fee sheet, but the only problem I can think of with this is if somebody somewhere has a problem with 2 different- named facilities having the same identifiers, like taxonomy and facil NPI.

What do you think?
Good luck!

  • Harley
1 Like

Thank you @htuck!

We have used that option in the past however it becomes tedious for the billing team to keep changed the facility. Let me explain a little further our workflow:

  1. Patient arrives at office and the flow board patient status is changed to arrived.
  2. System settings are in place to auto create an encounter when patient is set to arrived.
  3. The encounter defaults to values that we cannot define in settings, e.g., facility, appointment type, and reason for visit.*
  4. When the fee sheet is created and the patient is checked out, billing has to go to the billing manager to filter out claims by provider.
  5. The biller then has to manually change every Encounter Form to correct the billing facility.

*There is a way to set the default reason for visit in settings, but there is only one value you can use universally for all visits.

I will add screenshots later to explain a little further.

The workflow was tedious before but manageable, now the friction points in the system are leading to unnecessary issues and delayed claims processing.

We are a very small team with minimal margins, so we don’t have the ability to hire additional staff to help with this unfortunately.

It would be nice if I could modify some of the codebase myself, but alas I’m busy being the doctor :sweat_smile::wink:

Thank you again @htuck!

Hi @Sarah_Graff - Good to hear back from you.
I know the feeling- I used to have a lot of fun doing (comparatively) simple coding back in the day so I know the principles and logic. But these days I do not have the time to learn the whole universe of what software development has grown into just to hack together a cool feature on OpenEMR.

From your description maybe creating the facilities that take assignment as previously described, then when the appointment is made the front desk person selects in the appointment event dialog the billing facility that takes assignment? You could choose the right facility right in the beginning when the appointment is made and it seems like it’d go into the encounter information wherever that gets used throughout the encounter, on to the billing workflows without needing to be changed.
Screenshot at 2024-09-25 10-11-06

Just thinking…
Good luck!

  • Harley
1 Like

Hi Harley,

Seems like we have a lot in common – including our reasoning skills. :slight_smile:

I agree with your recommendation and think this would be a great addition to the wiki for workflow support for those looking to adopt the platform. I have tried to sign up for the wiki as a contributor, but the links to join are all broken. Any thoughts?

Thanks again for all your help, you’re greatly appriciated!

Hi @Sarah_Graff
Thanks for the compliment, I hope the idea works! I’m concerned that some aspect of having the same facility taking assignment for some claims but not for others might confuse the insurance companies. If you do this please let me know how it goes.

Yes, I saw the dead links, too, and come to find out that because of recent increases in bot and miscreant user activity @brady.miller asks people to email or DM him to ask for a wiki editor account. He’s pretty responsive, though so it shouldn’t take too long before you can get in there and start publishing.

Best- HT