Hi:
We would like to model the following requirements in OEMR. Any help appreciated:
1.The rates for billing each of the insurance companies for services provided to the patient varies and there must be a way to maintain and manage them separately. For example the rate for CPT Code 99214 for Blue Cross and Aetna would be different and they need to be reflected in the billing automatically.
2. So this also implies that if the patient is not having insurance (called self-insured) there must also be separate ‘retail rate’ relevant for this. Such rates must show up (along with necessary copay) automatically for the billing process to handle it.
The normal thing to do is bill your customary rate and let the payers adjust each claim. I’ve been told that if you bill less than your normal rate in any situation, payers can use that as an excuse to underpay when they would otherwise pay more.
If for some reason you want different price levels, define them in the “Price Level” list and then fill in their fees on the Services page.
Is there a way I can add more lines in the configuration for the Price Level List? To extrapolate, is there a way to add lines to ANY list in OEMR?
Thanks.
Kish
I have a feeling I don’t understand the question. But to add items to a list, just type them into the empty lines at the end in the Lists administration panel.
I made a note in the bug tracker about the fact that the Superbill (Admin - Services in Tree View) listing will only allow a single CPT code listing, not one for each Price level. So I agree that you should set that and bill EVERYONE at the highest level you will be paid by any payer, then enter the discounting in the EOB using one of the W codes (which can be expanded in Admin - Lists - Adjustment Reasons effective ver 3.1 once all the patches are applied). I wrote a simple instruction set about that sometime earlier, but do not recall where I put it, and it predates the Wiki. I’ll look and see if I can find it and post it there.
Yes. I remember Joe had raised this issue and there were exchanges of idea. Rod, at the moment I agree iwth you that we have to put the higest of the amount for a code and proceed and that is what I have also recommended. Anyway, The insurance companies never reimburse what you claimed. But to keep track of receivables it would be a could idea to provide a solution ( for instance like modifiers ( or some name) for each code based on Insurance companies.
Well you track receipts and adjustments by keeping up with EOB entry. But true this does not give you a good picture of what you can expect to receive. The way insurance works that would be very difficult.
I cannot seem to find the bug tracker. Must have gotten deleted. It was a while back. Anyway:
If you create three Service Categories using Admin - Lists - Service Category, Then create three … - Price Levels the price levels will list in each CPT for which you define them. So, using 90801 as an example, I select from the category which was set for it, although I can manually make it available in other categories using the Fee Sheet setup in Admin - Lists. The three price levels are available (much more than that and the Admin - Services width becomes a limiting factor), but I cannot set a different price for a different category, which would seem to be the preferred method to me if I want to have multiple prices. The 3.2 attempt for this is pretty convoluted, as it does not refresh, even with the refresh button, to the different price level if I have selected the CPT before I set the price level for it. Unwieldy would be the best description, and certainly not intuitive. And having to select the service category, and only one, in the Admin - Services because the system will only allow a single CPT of 90801 to exist makes it impossible to effectively pre-set the price level per category, which would make some sense.
So, either I do not understand the intent (possible), or the intent is really not workable in any case (probable), the only way I can see for it to make sense at all is to have a separate Price level selector on each Service line in Fee Sheet, which would post the fee for that service and that level when it was selected, or to have multiples of any CPT, selected by Category. The latter of those would almost certainly cause problems for the PLX loaders, especially since there really is no such thing as a meaningful price level for ICD, at least not on a CMS 1500.
That all said, my Fee Sheet instructions do not explain the 3.2 well at all, so I will plan to revise them. But I would prefer that we fix what to me seems unworkable.
OH, and BTW - the Service Categories created in the Admin - Services do NOT carry to the Admin - Lists - Fee Sheet listing, which makes it a problem to try to use the Categories for multiple services, does it not?
Price levels are intended as a solution for pricing according to the ability of the patient to pay. Accordingly, price level selection is done in patient demographics (the selector in the Fee Sheet is a shortcut for that), and the selected level applies to all charges for that visit.
Service categories and Admin->Lists->Fee Sheet are two different and independent methods of grouping services in the Fee Sheet. The second is more powerful but more complex. I suggest using only one of them.