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Multiple Site claims, reimbursement, EFT and reconciliation for providers using openEMR

Commercial EHRs have been raising their raising rates from $45 to ro more than $95+ per month. Clearinghouse costs are becoming expensive. The multigroup capability of openEMR is intriguing as a cost saving opportunity. For example, it can cost one provider $35 to $60 a month for a clearinghouse. Or it can cost a group $100 for 100 providers if they use one NPI.

To do this an organization needs functionality to submit claims for all providers and pay each provider individually every 2 weeks. The work flow might be something like…

Submit claim by admin > Clearing house scrubs claim > Clearing house is paid > Clearing house pays organization > organization pays each provider > reconcile payments.

Software to that can manage the money would be game changing in the world of EHRs because it would allow providers to integrate, remain independent, and be paid more money for using an integrated EMR.

An not-for-profit organization using openEMR would not make a profit but it would have money to support openEMR.

@AMHA-OR, and one EIN or tax id for the org that they’re billing under

Yes. Thank you. Not-for-profit has an EIN.

hi @AMHA-OR, do all of the the providers bill with just one EIN?

For providers with group contracts with specific Healthplans (e.g. BCBS, MODA) there will be just one EIN for those contracts. They would be reimbursed by the central billing hub. Ideally, for those same providers they would use their individual EIN for individual contracts (e.g. PacificSource, OHP). The world of behavioral health providers wants independent contract except when a group contract has greater value. So reality is a mixed bag of group contracts and individual contracts.

You are describing an IPA with shared IT support. Setting such a thing is more of trust and legal issue than emr.

From IT/EMR perspective you can set up central billing department. If there is no consolidated billing AND if you have sites (i.e. several databases on same server or same network), you can have a biller select a “site” from dropdown and manage billing within that site. Top level design change would be:

  1. Establish a central “site” management database
  2. Add ability to switch site on the fly using a dropdown from sites list
  3. Minor tweaks to the session management to allow seamless switch by setting last used settings for the selected site.
  4. Each site will still generate separate batches but with common clearinghouse account.
  5. Some changes may be needed to store inbound responses centrally and each site will process only their own.
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Thank you!

Yes. “Setting such a thing is more of trust and legal issue than emr.”

What is a “central site”?

By “site” do you mean a facility? (I understand that a facility is one or more providers.)