At our practice (behavioral health) we bill monthly, each patient will have several visits on one claim with the same CPT and same diagnosis. I found this link which is similar…
… but I didn’t see resolution.
Related, it appears that one can only reconcile a single claim (“encounter”) at a time. On a single screen for entire month’s EOB, can we:
*write off insurance allowable amount
*enter copay
*enter insurance payment.
Thanks.
hi @sole_practitioner , billing is still 1 encounter per claim but you can post multiple encounters with Fees->Batch Payments
Hi @sole_practitioner
We may be seeing a terminology issue here. I think @stephenwaite uses ‘claim’ to refer to the billing info that is sent to the insurance co for a single encounter. It appears that you use the term to mean the x12 batch file that contains the billing info for all the encounters for one patient in a certain time period.
In the usage that OpenEMR’s billing manager is built around, it will generate an x12 ‘claim file’, or ‘batch file’, that can contain the billing info for as many claims as desired.
The claims can be selected by entering any combination of search criteria into the Billing Manager; please refer to the wiki documentation, OpenEMR 6.x Billing - Claims Workflows - OpenEMR Project Wiki
In the ‘Claims Creation’ section, step 1, ‘Search for the claims’: you can add more than one criterion to the claim selection. So if you wanted to bill all claims for one patient for the past month, add to the search criteria the pt name or PID, and then do the same steps to add the date range also. The resulting x12 batch file will have in it every claim for all of that patient’s encounters in the specified date range. So, technically speaking the file that is sent to the clearing house is called in this context, a ‘claim batch file’ rather than simply the ‘claim’.
Re: your other requirements,
*write off insurance allowable amount
*enter copay
*enter insurance payment.
they can all be performed, but the best workflow may not do them all on the same screen.
Check out the wiki docs, OpenEMR 6.x Billing - Process Payments - OpenEMR Project Wiki
to see what that the EOB posting screen does that suits you. I believe it shows that you can enter adjustments there, and the section, ‘Apply Payments from Patients or Insurance EOBs’ talks about manually entering insurance company payments.
The copay can be entered for each of a patient’s insurance companies, in the panel for the appropriate insurance (primary, secondary, tertiary insurances) in the patient dashboard. Entered there it will be automatically applied to the payment for each encounter.
Best- Harley
Thank you Stephen, Harley.
My challenges are moving around, as is typical learning new software and changing workflow as needed. Believe it or not, I still print the CMS1500 forms to use as a check that I got the data right, amazing how much easier it is form me to backcheck with a piece of paper. I’ll look around for a different report that I can use for that purpose, and perhaps it will be easier, with less paper!
Regarding reconciling, it would be nice to get that all on one data entry screen. I realize that my particular need is different than most, and I fully understand that with resources available, this might fall lower on wish list. <my last computer language was fortran, doubt that would be of much use>.
Thanks again for your replies.