Medicaid Invoice Question

billing
infrastructure
question

(Sherwin Gaddis) #1

Is there any way in the system to make it if a patient has an active Medicaid policy that OpenEMR cannot create a statement for them?


(Stephen Waite) #2

hi @juggernautsei, not currently. Dealing with recent cms update to QMB ?


(Sherwin Gaddis) #3

@stephenwaite, Ok, I guess I’ll crawl in there and make this happen.


(Stephen Waite) #4

cool, would be a nice feature under demographics for any person with charges to add a field like bill status - do not bill


(Sherwin Gaddis) #5

Here is a markup. Is this a good place for the feature?


(Stephen Waite) #6

that looks fine, now that you point that out it will be nice to add last bill date and other items to this available whitespace


(Jerry P) #7

Is this patient never going to get billed for anything or does it apply only to medicaid payments? What if show billing in demographics is turned off?(I think that’s an option). Wouldn’t this be more appropriate in insurance?


(Stephen Waite) #8

qmbs are dual eligible and can’t be balance billed per above link

also now receiving medicare adjustments that bring pt balance to zero after medicare electronic posting so if medicaid or a secondary insurance pays there has to be a credit adjustment posted to offset what appears to be a patient owed balance


(Sherwin Gaddis) #9

@sjpadgett Maybe better in the to put the check box in the insurance template.

@stephenwaite
Is this rule new from CMS? If so, anyone working on the logic to bring the software in line or should this be done by a human?


(Stephen Waite) #10

think it could be added as a separate script that would work in tandem with financial->reports->collections and credits dropdown

it would have to read the ar_activity table and look for Adjust code 209 from medicare payers in the memo field and add a negative adjustment record with a value equal to the credit balance.


(Sherwin Gaddis) #11

What would the script do after it finds that entry?


(Sherwin Gaddis) #12

@stephenwaite I just found that the new code has a feature in the Globals to Allos Statement Exclusions from Printing.

Someone already has done this so I don’t have to climb in there and do it. YEAH!!! :sunglasses:


(Stephen Waite) #13

nice but i thought that only sets a dollar amount so it’s not on a per patient basis?
could add a demographic field for qmb and then query that in the statement script


(Sherwin Gaddis) #14

@stephenwaite Thanks for pointing that out and saving me some time. I can get that done in short order. :star_struck:


(Sherwin Gaddis) #15

:face_with_raised_eyebrow:
The statement script3 does not work for what I am trying to accomplish. I have been working on this all afternoon and can’t get it to skip a medicare invoice. What this does is leave out a charge if it to be paid by Medicare.

I had to move my code over to the sl_eob_search.php file to interrupt the invoice being made.

I think it is working. I will have to test with the biller.


(Sherwin Gaddis) #16

In this post you mentioned per link above. Could you please post the link that is missing? Thank you

So, which is better, Skipping the invoice all together or removing any charges that are to be billed to Medicare and anything that is not Medicare goes on the invoice?


(Stephen Waite) #17

referred to this link

it’s better to both set up the patient for no bills and post adjustments to secondary payer credit balances


(Sherwin Gaddis) #18

Not going to pretend that I understand the rule. It is not clicking in my brain what they want. However, here is the PR for what I have so far. Should this have a Globals entry under billing to turn on or off? Also, this is a US thing anyway.


(Stephen Waite) #19

thanks for sharing, good idea to start by turning off bills, adjusting credit balances can be done later

think you’ll want a function to look at ar_activity for

and exclude on that basis


(Stephen Waite) #20

cms.gov is reverting to the previous ra, link