biller2 wrote on Tuesday, April 05, 2011:
I was wondering how OpenEMR handles patients without insurance. I have entered a patient in the software, leaving out all the insurance information. When I go to send claims, their claims are present as well. Am I missing a box to check telling the software not to create a claim? How does the software no not to bill the insurance company but bill the client directly. Thanks in advance for your help. John
tsvas wrote on Tuesday, April 05, 2011:
Yes, if there is no check box means the claim will not be billed.
aethelwulffe wrote on Tuesday, April 05, 2011:
Hi John!
Remember to always post your OEMR version when posting questions. In ref to you billing using the new 4.0 billing module, just search for claims relevant to the x-12 partner(or just insurance company) that you are creating a 837 or HCFA for. Then, you do not get uninsured/cash customers on the list. In any version, the above suggestion stands: You uncheck claims that appear on your list that you don’t want. If you are not processing claims, and just need to check out or post payments, the above still applies. Since all of this seems rather obvious to me, perhaps I am not getting the real question. You state “when I go to send claims” and “software no (*know*) not to bill the insurance company”…Well, you bill insurance companies by three methods (here in the US anyway):
1. Create an 837 file to upload to a clearing house or EDI interface of an insurance company.
2. Print a HCFA
3. Go online to an insurance company, and enter data for billing directly.
Otherwise, we send “Statements” to patients that are self pay, often at check out time. That is done by running one of a variety of reports available in the EMR, and selecting patients to send statements to. We don’t bill insurance companies (in the US) via a statement.
If you are using an early version of the EMR, and need more flexibility in billing and reporting, I strongly recommend you upgrade to 4.0
biller2 wrote on Wednesday, April 06, 2011:
Aethelwulffe thank you for your response in spite of my missing information. I’m sorry I forgot the version number and my os. I am currently using version 4-dev and running ubuntu-maverick with apache 2.2.16 php 5.3.3-1 mysql 5.1.49-1. I wasn’t able to find what you were describing in my version so I decided to try version4, not the development version and viola. Thanks so much for your help, the new release is awesome, lots of improvements. The new features that allow you to select by criteria is awesome. You did a great job in answering my vague question thank you very much. My question was how do I remove the non-insurance claims from the list. I thought that the fees-billing selection was for claims. My understanding was that since they didn’t have insurance information they shouldn’t be on that list because that was a claims list. Is that list merely a list of transactions and not necessary claims? If I wanted to remove the non-insurance claims from the list could I go ahead and generate on x12 and just not send the file? Thanks again for your response the information you gave answered my question perfectly. John
aethelwulffe wrote on Wednesday, April 06, 2011:
err…
Really the best way to get them out of the list would be to process the patient’s payment or charge-off with the payment invoice for that patient. Next would be to select any claims you want to not show up on the unbilled list, and hit “mark as cleared”.
Make sure your php settings for magic quotes and such is compliant with instructions, and the billing module will search and report correctly. If not, search parameters/filters will not function correctly, and you will have a big mess on your hands with the billing module giving lists that do not comply with your stated search settings.
aethelwulffe wrote on Wednesday, April 06, 2011:
PS, it is a BILLING list, and not an insurance claims list. The billing module isn’t just taking care of x-12’s and HCFA’s, it is also doing your accounting, processing payments, handling co-pays, and yes, self pay clients. “Unbilled” as a sole search parameter will give you every fee sheet with a outstanding balance.
Take some time with the new billing module, and learn the new payments screen and all that, and if you have any questions, we will now both be talking apples with your emr version.
biller2 wrote on Wednesday, April 06, 2011:
aethelwulffe, awesome response thanks again for your input and explanations they were very helpfull. John