HCFA 1500 form fields

girish_a wrote on Wednesday, April 22, 2009:

Hi,
    How or where can we enter units ( BOX 24G ) , Place of Service ( BOX 24B ) , Type of Service ( 24C ), Referring Provider Name ( 17 ) and Referring Provide Identification ( 17a ) and a customised Patient Account Number in OpenEMR.

Thanks,
Girish

ideaman911 wrote on Thursday, April 23, 2009:

Girish;

Please let us know what version and what platform you are using in future.  That can help diagnose issues.

Assuming you have OpenEMR operating, the place of service will be the code which you have defaulted in selecting your facility.  If you provide from multiple locations, there are two ways to do things; create multiple facilities, which I believe to be a problem with billing because of distinguishing them in selection, but mis-match at the payer vs IRS info; or you can do as i suggest which is to create different visit types in the Calendar Categories setup under Admin, then make the changes I detailed elsewhere in the forums.  If you want the latter, simply click my website below and tell me your version in an email, and I’ll send you explicit directions and the file to substitute which will then override the facility default if you select a different service.  The service selection is done in an encounter.  The rest of the info is also in an encounter, but you select the Fee Sheet and enter the ICD codes and service codes and units via that.  The referring provider is actually entered in the patient demographics, I believe in the CHOICES section, and they must be pre-defined as a user (they need not be authorized to enter data) with their NPI.  The 17A section will use their UPIN.

To use a customized Patient Account number you would have to NOT use the auto numbering at the initial patient create where you first enter their last and first names and salutation.

Hope that helps.

Joe Holzer    Idea Man
http://www.holzerent.com

girish_a wrote on Friday, April 24, 2009:

Thanks Joe,
           I am using OpenEMR version 3.0.1

           I think the Facility where service is rendered should be in Misc. Billing Options and there should be a Form to enter the place of service.

           Here is why:- Hospital as Place of Service can have POS as 21,22,23 and so on and so forth.

           Let me have a look and evaluate at what you are suggesting to see if it will fit our scenario.

Regards,
Girish

ideaman911 wrote on Friday, April 24, 2009:

Girish;

The notes below are mine from that development.

Appended  1/4/09  To add House Call and other service locations to calendar and to encounter drop-down to allow substitution of POS in claims, add them as New Categories in Admin - Calendar as House Call color #FFFF99 duration 1 Hr (3600) or as desired and change Office Visit to 1 Hr if desired (3600), and add TC Conference color Red IN THAT ORDER and verify (do not change here) with BROWSE in openemr_postcalendar_categories database in Admin to verify House Call has pc_catid = 12 also - these will display in Encounter view/new as drop-down selections.  To have them show at top of list, precede them with a period “.” as they list alphabetically (by ASCII order).  Then add conditionals in …/library/claim.class.php at Function for POS near line 527, and do same for SNF, or other service locations as appropriate to enter correct code override.  Logic shown allows select substitution for claim of whatever form_encounter[‘pc_catid’] is in table with whatever POS code is required for proper claim submission, to replace POS code defined for facility as default.  Codes listing can be found in …/library/classes/POSRef.class.php and details are available at CMS website.

I would think you would simply create the names you wish to use to distinguish 22, 23, 24 etc. as Calendar Categories like:

.Hospital 22
.hospital 23
.Hospital 24

and then set the substitution codes per those.  If done per my notes, your users would select the appropriate .Hospital service in the encounter, and that will cause the correct POS to display in the X12 or CMS 1500.

Let me know how you make out.  Thanks.

Joe Holzer    Idea Man
http://www.holzerent.com

ideaman911 wrote on Friday, April 24, 2009:

Girish;  a note of warning:

Do this first to prove it works with a development setup.  You can then copy the revised files to your production configuration.

Joe Holzer    Idea Man
http://www.holzerent.com

jerry42 wrote on Monday, May 18, 2009:

Thanks for explaining how to fill in Box 17 and 17b for the referring providers.

Now how do I fill in box 19 ?  In a podiatric practice this is where I’m supposed to put the Last Seen Date from the primary care doctor.

I’m also struggling to understand your “Then add conditionals in …/library/claim.class.php at Function for POS near line 527, and do same for SNF, or other service locations as appropriate to enter correct code override.”  for adding other POS’s.  Do you have a howto for novices somewhere?

xiaoanri wrote on Monday, May 18, 2009:

jerry,

as far as I understand, the box 19 infomation can be entered at "misc billing options for hcfa-1500", in the additional note box.  problem is it is not included in the billing file if you generate x12, or it is not included properly so that it serves the function.  It does show up when you generate HCFA 1500 as pdf.

Hui

xiaoanri wrote on Monday, May 18, 2009:

To Joe,

the referring physician is entered in the address book, the "AB" tab, and it will show up in a drop down as a choice at patient demographics.  this will be carried over to hcfa 1500, item 17.  Also I am confused somewhat about your proposal to deal with different service locations, could you please explain what would be the advantage? 

Thnak you,
Hui

jerry42 wrote on Tuesday, May 19, 2009:

Hui,

Using version 3.0.0.1 on Debian,  box 19 isn’t  one of the choices available on the Misc Billing Options HFCA list.
Does your version have it?  Or can you point me to directions for adding it?

jerry

xiaoanri wrote on Tuesday, May 19, 2009:

Jerry,

In the Misc Billing Option there is an additional note/comment or something like  that, it is the LAST box on the list.  Try to put a couple of words and generate a hcfa 1500 pdf file, see if it goes to box 19.  Let me know how it goes.

Hui

jerry42 wrote on Tuesday, May 19, 2009:

Hui,

Thank you,  box19 filled in. that’s exactly what I needed.

jerry

ideaman911 wrote on Wednesday, May 20, 2009:

Folks;

Sorry to confuse, and for the delay in response.

The code below is my revision from claim.class.php near line 527, and uses the pc_catid values created with Admin - Calendar - Categories and verified in the Admin - Databases - Openemr-postcalendar_categories - Browse :

  function facilityPOS() {
        //  All JCH by Joe Holzer (C) 1/8/09 <im@holzerent.com>  JCH
    //  For providers with multiple facilities, need multiple POS, especially for medicare & Medicaid  JCH
    //  We need the pos_code for this encounter if it is a 12 (or other select) to override the facility[pos_code]  JCH
  //  Codes as shown are House, TC Conf, Non-Skilled Nurse Facility and Fayetteville (converts to Office)  JCH
    //  After entry as added categories for Admin - Calendar and verify pc_catid values to make $enc_catid  JCH
    //  Values for $pos_code are available from CMS and are in …/classes/POSRef.class.php  JCH
    //  This replaces function facilityPOS() as originally by Rod Roark  JCH
       
      $enc_catid = x12clean(trim($this->encounter[‘pc_catid’]));     // Needed value for POS overwrite JCH
    $pos_code = ‘’;                      //  Set $pos_code blank by default  JCH
        if ($enc_catid==‘12’) {
              $pos_code = ‘12’; }            //  If House Call then code is 12  JCH
            else if ($enc_catid==‘13’) {
                  $pos_code = ‘99’;  }         //  If TC Conf then code is 99  JCH
            else if ($enc_catid==‘14’) {
                  $pos_code = ‘32’;  }         //  If Non SNF then code is 32  JCH
            else if ($enc_catid==‘15’) {
                  $pos_code = ‘11’;  }         //  If Fayetteville then code is 11 - could have been omitted  JCH
                       
          if ($pos_code != ‘’) {             //  Only replace if there is a valid code per tests  JCH
            return $pos_code;  }
          else return x12clean(trim($this->facility[‘pos_code’]));
  }

Those changes will create drop-down additions to your Visit Category choices in the Encounter form.  Since they list alphabetically (ASCII), you can "fool" it by preceeding the ones you wish to be at top of the list with a period or other character with a lower ASCII value than A.

And obviously, you will want to use some label which distinguishes one from another to help in that selection.

Hope that helps.  I am certain these work with Windows, and am unaware of any reason they will not in Linux.

Joe Holzer    Idea Man
http://www.holzerent.com

sraj49 wrote on Saturday, February 06, 2010:

The client deals with workmens compensation almost 50% of the cases and the filed 14 has to be populated in HCFA 1500 and similarly for hospital patients. The files refers " Date of current injury". Can anyone help me with this. I do not find this field in the MISC Billing options also.

Thanks

Raj

sraj49 wrote on Saturday, February 06, 2010:

Can anyone help me with this please….