We have been using another Patient Management Software to handle our Billing, but we would like to completely switch over to OPenEMR. One of the issues that has arisen is that there are specific procedures that our Podiatrist’s perform that requires a Primary Care Physician’s name as well as last time of visit to be entered on the claim. Has anyone encountered this issue? If so, how did you resolve. Any help would be greatly appreciated. I am also open to custom solutions. Thank you.
The referring physician’s information,including his NPI, needs to be in the Address Book first. Demographics->Choices->edit Referring Provider.
Date of last visit with the referring physician? I think it is Box 15, but I don’t have the HCFA 1500 manual in front of me to confirm. If it is Box 15, go to the encounter->Administative tab->Misc Billing Options HCFA, check box.
Print up a dummy claim form using present Practice Management software and check if it’s Box 15 in the interim.
fsgl, your instructions did print the Referring Physician’s NPI on the CMS form, so I’m assuming it will print in the X12 generator also. I still need to confirm though that box 15 is the correct box for the date of last pcp visit. In OPENeMR box 15 is identified as
“BOX 15. Date of same or similar illness (yyyy-mm-dd):” Thank you again.
The CMS 1500 provides the same information as the 837 x12 file. The CMS format is easier to read when checking.
My CMS 1500 manual is unclear whether to use Box 14, 15 or 19. I would suggest that you print up a CMS 1500 using the old software to determine where the date goes. If it is not box 15, it may be necessary to change the codes. I am unaware of another way of accomplishing this.
It should be very simple to determine which box to use. If the old software is not of help, which I highly doubt, the local Medicare carrier should be able to answer the question.
If it isn’t box 15, the CMS form and the Misc Billing Option tab will need to be modified as well.
Medicare will partially defray the cost of a pair of glasses after cataract surgery. When opticians submit claims for those glasses, they usually ask us for the surgery date and box 18 is probably where they would put that date.
Does it work for last visit with the PCP as well, despite the fact that there’s no hospitalization?
If it is box 18, the Misc Billing Option can be used making the original poster’s life simpler.
In the new 02/12 version of the HCFA 1500 form, Box 15 has new qualifiers to indicate one of:
454 Initial Treatment
304 Latest Visit or Consultation
453 Acute Manifestation of a Chronic Condition
439 Accident
455 Last X-ray
471 Prescription
090 Report Start (Assumed Care Date)
091 Report End (Relinquished Care Date)
444 First Visit or Consultation
Well it’s still not clear that the information we’ve provided will address Michael’s problem, especially given that X12 file generation doesn’t support the 304 date qualifier.
Any data input into Box 15 on the Misc Billing Options will currently get put onto HCFA Paper form or in an X12 file as DTP*431
From the X12 guide it looks like 304 is specifically for podiatrist (routine foot care).
Required when claims involve services for routine foot care and it is known to impact the payer’s adjudication process. If not required by this implementation guide do not send.
Michael posted that they are open to customization.
To these untrained eyes, only a minor modification of the gen_x12_837 is required. Two substitutions from lines 470 to 475: dateLastSeen for dateInitialTreatment & 304 for 454.
I would also guess that the Misc Billing Options HCFA Box 15 can be changed as well in interface\forms\ misc_billing_options\new.php line 30, substituting Date Last Seen for Date of same or similar illness and date_last_seen for date_initial_treatment.
I follow the instructions above and see the date generated in the HCFA Box 15 but not in X12, Am I doing something wrong or is there a way someone can show me how to set this up (for X12 generation)?
fsgl: The date of the last visit the patient saw the referring physician. This is used mostly for specialists. It’s needed for procedure codes, not for office visit codes.
In the Generated CMS 1500 PDF form, this date is printed in box 15 with 3 numbers in front of it separate by a space (ex: 302 03012014). I don’t know what the first 3 numbers mean but it appears important! Also, the name of the referring physician is printed in box 17.
In the Generated X12 file, it does not generate the date (in OpenEMR) which is needed when transmitting electronically to clearing house.
I’ve found this out because I am currently using PC-ACE software for billing to Medicare. Before making the transition to OpenEMR billing, I was curious where the “Last visiting date” generated between OpenEMR and PC-ACE in the X12 file. I found the date generated in PC-ACE but not in OpenEMR of the X12 file.
I searched and found this thread has the issue in question, but I am not able to find the solution for it yet. I’m not a programmer so I’m not able to modify the codes to fix this. So hopefully someone has the knowledge to resolve this issue since this is an important subject for billing purpose.