tmccormi wrote on Monday, December 20, 2010:
I have been unable to get the MedicareReferrerisRenderer selection to work at all. It does not put the rendering provider in X12 (NM1*DN, loop 2310A) or on line 17 of the CMS 1500. Tested on Demo 4.0 site.
Has anyone ever seen this working? Claim.class.php does not seem to return a referrer array with any content when that flag is set.
The X12 works if a provider_id is set in patient_data, but CMS 1500 does not.
-Tony
tmccormi wrote on Tuesday, December 21, 2010:
Maybe I’m just insane, it does appear to be working on X12, don’t know why I could not find the record. but it does not appear to be working on CMS1500s (line 17).
-Tony
sunsetsystems wrote on Tuesday, December 21, 2010:
The current logic for this in the case of paper claims might be wrong. See if you can find out what the real requirements are. From gen_hcfa_1500.inc.php:
// Referring provider stuff. Reports are that for primary care doctors,
// Medicare forbids an entry here and other payers require one.
// There is still confusion over this.
tmccormi wrote on Tuesday, December 21, 2010:
I found an interesting (or disturbing) issue last night on this. Testing the Claim.class.php produced different results depending on whether it was run on php 5.3 or php 5.2. Here’s the gist of it.
This is the current code and it work fine in: 5.3.2
$referrer_id = (empty($GLOBALS['MedicareReferrerIsRenderer']) ||
$this->insurance_numbers['provider_number_type'] != '1C') ?
$this->patient_data['providerID'] : $provider_id;
This is what I had to do to make it work in 5.2.10
if ($GLOBALS['MedicareReferrerIsRenderer'] or
$this->insurance_numbers['provider_number_type'] == '1C') {
$referrer_id = $provider_id;
} else {
$referrer_id = $this->patient_data['providerID'];
}
There is logically no difference other than I prefer positive logic to negative. So the difference must be somewhere else. I have not researched this extensively yet, however this link may be of use to us…
5.2 to 5.3 migration: http://devzone.zend.com/article/11701
sunsetsystems wrote on Tuesday, December 21, 2010:
Actually those are not equivalent. Change “or” to “and” in your version and they will be.
(NOT A) or (NOT B) == NOT (A and B).
Did you find out what the specific Medicare requirements are?
tmccormi wrote on Tuesday, December 21, 2010:
Good catch it should be ‘and’ to be the same. However the current code fails regardless in 5.2.
Medicare requires a referring provider at all times. It can be the rendering provider if there is no external provider. I think globals option could just be dropped in favor of just checking if the carrier is medicare type and use the rendering provider if no patient_data referring provider exists.
Is it possible that the ‘1C’ mapping to insurance_numbers is being unnecessarily required by that logic? What if the globals is set and there is no insurance_numbers entry for that carrier? It’s not needed as Medicare takes NPI now so no extra mapping by provider is required, NPI is not a specifically listed choice in the insurance_numbers type lists, though one could argue that 1C is now the “Medicare” number type.
-Tony
tmccormi wrote on Tuesday, December 21, 2010:
My client is a billing service doing work for a wide variety of providers, mostly in the eldercare category, so lots of medicare, medicaid, cross over claims and secondary billing. It’s a good shake out of the tools.
ZHH has similar issues going on with their business …
-Tony
sunsetsystems wrote on Wednesday, December 22, 2010:
I thought we were talking about CMS 1500 claims? Is your billing service client really sending paper claims to Medicare?
ajperezcrespo wrote on Tuesday, May 10, 2011:
Hi
Has this been resolved? I have a client printing 1500 forms and Items 17 are not showing up.
Ubuntu 10
PHP 5.3.5
Thanks
aethelwulffe wrote on Tuesday, May 10, 2011:
1. Version of EMR, OS, PHP, etc…?
2. Verified that they have entered a rendering provider, and that provider has complete data?
ajperezcrespo wrote on Tuesday, May 10, 2011:
Is this functional? Is anyone producing printed 1500s with items 17 on it?
1. Ubuntu 10, PHP 5.3.5, OEMR 4.0
2. Rendering provider OK and has Complete Data.
Thanks
aethelwulffe wrote on Tuesday, May 10, 2011:
I am testing for you on 4.1dev with calender mod + some other tweaks.
Did you check Administration/Globals/Miscellaneous/Medicare Referrer is Renderer ?
aethelwulffe wrote on Wednesday, May 11, 2011:
Oh, btw, is this for claim type MB? Medicare FORBIDS use of box 17. Are you just trying to get the referrer onto the form, or print for Medicare?
Related code:
// Referring provider stuff. Reports are that for primary care doctors,
// Medicare forbids an entry here and other payers require one.
// There is still confusion over this.
//
if ($claim->referrerLastName() &&
(empty($GLOBALS['MedicareReferrerIsRenderer']) || $claim->claimType() != 'MB'))
{
// Box 17a. Referring Provider Alternate Identifier
if ($claim->referrerUPIN() && $claim->claimType() != 'MB') {
put_hcfa(33, 30, 2, '1G');
put_hcfa(33, 33, 15, $claim->referrerUPIN());
}
// Box 17. Name of Referring Provider or Other Source
$tmp = $claim->referrerLastName() . ', ' . $claim->referrerFirstName();
if ($claim->referrerMiddleName())
$tmp .= ', ' . substr($claim->referrerMiddleName(),0,1);
put_hcfa(34, 1, 25, $tmp);
// Box 17b. Referring Provider NPI
if ($claim->referrerNPI()) {
put_hcfa(34, 33, 15, $claim->referrerNPI());
}
}ajperezcrespo wrote on Wednesday, May 11, 2011:
Hi
Search for item 17 in this manual from CMS
http://www.cms.gov/manuals/downloads/clm104c26.pdf
Here is part of the text….
“Item 17 - Enter the name of the referring or ordering physician if the service or item was
ordered or referred by a physician. All physicians who order services or refer Medicare
beneficiaries must report this data. When a claim involves multiple referring and/or
ordering physicians, a separate Form CMS-1500 shall be used for each ordering/referring
physician.”
What were your results with 4.1?
Thanks
uhsarp wrote on Friday, September 23, 2011:
I’m still unable to get the box 17 filled up. I’m using php 5.2, OpenEMR 4.00. Ayone else want to share their experience billing Medicare with Availity reg. this issue?