rmathieu wrote on Monday, September 21, 2009:
Is there any where I can setup the expected reimboursment medicare fee schedule provide me with for each CPT codes?
ideaman911 wrote on Friday, September 25, 2009:
Yes you can - In the Superbill (in Tree view I think it is called "Services") you can enter the fee. A word of caution; an individual CPT can have only one description and price. So if you use the Medicare rate, you will have NO possibility of getting paid more. A simple tool would be to take the medicare rate and increase it by a set factor, so you could then predict all during usage, but have the added benefit if it occurs. That’s what we do.
Joe Holzer Idea Man
http://www.holzerent.com
rmathieu wrote on Friday, September 25, 2009:
Then how do you know if for exemple you charge $100 for an individual CPT, the insurance owe you $60 and the rest is for the patient owe.
If you put the insurance expected reimbursment as a fee, you don’t know what the patient owe you.
How do you deal with that?
ideaman911 wrote on Wednesday, September 30, 2009:
Mathieu;
If you are using any OpenEMR version since 2.9.1, it includes the A/R function, which tracks payments via the EOB function. When you billed the 1st payer, say $300, you got back an EOB with their payment. Since it is almost impossible to be certain what will be the ultimate patient responsibility, since you must first bill all their insurers in order, your best hope is to read from their insurance card and collect whatever copay is defined there. But you may still have to eventually bill them if they have an annual out of pocket (OOP) obligation, such as the $120 for medicare, etc. You can never be certain whether you are first biller to access that at the insurer. Or any other.
But the primary payer EOB will show your billed and their "allowed", which becomes the max you can be paid if you are in-net with that payer. If you are not, then your patient should pay the full bill at the visit and seek reimbursement from their insurer. You will find in the EOB section of OpenEMR that the "Billed" is shown. You enter the "disallowed" as an "Ins Adjust" in the "W" box and select the adjust reason from the dropdown. That will show the remaining to be collected, from next insurer or patient as applicable.
Note that ADDED charges which can be collected above the "contracted" amount for in-net can be entered using that same place, but would be entered as a MINUS value, which will then show as the amount due properly. The drop-down list in the distribution does not include these, but you can add them. They must be hard coded in the PHP file itself prior to version 3.1.0, or in the Admin - Lists section from 3.1.0 on. We use, for example, "Late Pay Fee" which is required by NYS if clean claims are not paid within 45 days. We also collect interest on unpaid outstanding, perfectly appropriate so long as it is a stated policy in your "intake agreement". You can see there a bunch of other w/o (writeoff) and other choices listed as well.
So you should NOT put as your billing amount only the amount you expect from the insurer, but the amount you would charge the highest payer for the service. The A/R will handle the rest by the EOB functions, and you would use a w/o choice for the difference. In Mental health, for example, a patient might have Medicare as prime, another partial like Cigna as secondary, and Patient as final. Say for example the bill is $250, and Medicare allows $100. You enter the EOB which shows $250 as initial due, and input $150 as "Ins Adjust" or "Contract Adj" to bring the payable due to the $100. But the payment will be entered as the $50 Medicare will actually pay (they pay only 50% of Mental Health after all the deductibles are met). The remaining $50 must be billed to Cigna, which will often pay only 20% until the patient’s annual OOP is met, so you get their EOB for $10, which you enter as 2nd payer. So you must bill the patient for the $40 unless you somehow knew that would be the amount at their visit. If, however, they have Medicaid as tertiary, you must bill them on THEIR FORM for the remaining $40, of which they will pay only 20% of that, or $8, as final and you must take an Admin w/o (or Ins Adjust depending on your accounting desires) for the remaining $32).
See, isn’t the American Healthcare Funding System superior? It’s called the Clerical Full Employment Bill of 2009. But OpenEMR can handle it all internally. You can access the EOB from either the Billing module, or from the Collections Report by clicking on the "Invoice" link, which is comprised of the Pt ID dot Encounter ID.
Joe Holzer Idea Man
http://www.holzerent.com