sunsetsystems wrote on Monday, April 04, 2005:
Looking at FreeB and related code for paper (HCFA) claims, I’m not able to see any place where it cares about how much was paid by the primary insurance. Indeed, this information is not even available outside of SQL-Ledger.
Is this a bug, or does the amount already paid not need to appear on a secondary paper claim?
– Rod <rod at sunsetsystems dot com>
emilykillian wrote on Monday, April 04, 2005:
It needs to appear on the secondary claim and sounds like a bug to me.
A secondary claim should include:
Amount paid by primary insurance carrier
Amount adjusted/disallowed by primary insurance carrier
Balance still owed on the claim
A copy of the primary EOB
Reasons why charges were disallowed or applied to deductible
sunsetsystems wrote on Monday, April 04, 2005:
Humm. So where in the form is this information put?
My client says they currently use the same form 1500 for primary and secondary claims, and I’m not seeing any boxes for the amount paid by primary, amount disallowed or reason for disallowance. Perhaps the payer just figures things out from the EOB copy?
emilykillian wrote on Tuesday, April 05, 2005:
Rod,
The amount paid by the primary insurance goes in box #29 (Some places use this for only the payment, while others use it for the primary payment + primary adjustment)
Box #30 is for the balance still owed on the claim.
In our CompuSystems billing, we have the option of entering EOB information that prints out when we print the claim or we have the option of making photocopies of the EOB. This includes the reason for disallowance.
sunsetsystems wrote on Tuesday, April 05, 2005:
Thanks Emily, that’s very helpful. It appears OpenEMR is just not doing enough to handle secondary claims properly. I guess it will need to be enhanced to reference the SQL-Ledger database in addition to the OpenEMR billing table.
I’m amazed that I’m having to fix so many problems. It makes me wonder if we have the latest code. Is ANYONE successfully using OpenEMR for billing?
– Rod <rod at sunsetsystems dot com>
emilykillian wrote on Tuesday, April 05, 2005:
Rod,
As far as I know, you’re in new territory, here.
I agree that OpenEMR’s billing and claim handling isn’t up to snuff yet.
I don’t think anyone is actively using OpenEMR for billing. As far as I know, Dr. Roller and his developer are the farthest along with billing. If I remember correctly, his office has sent out some test claims. I don’t know if they were only primary claims or if they included secondaries. You may want to compare notes with him on that.
The only temporary solution I can think of is to use a service that tracks the status of claims. Possibly Zirmed or Realmed could help. Even at that, I’m not sure.
If I hear or think of any other possible solutions, I’ll let you know.
jimbo456 wrote on Tuesday, April 05, 2005:
I have setup a billing company with OpenEMR. We have done a Zirmed claim today for the first time. We are getting ramped up and have worked through a ton of issues. One thing I like about Zirmed is you can map things from the web page that will take care of issue that freeb doesn’t do. IE As of now it does not put in the doctors Pin# in the last block. ect. Zirmed will allow you to put map this number to this provider all the time.
Feel free to ask where we stand on specific billing issues.
I am hiring a 3rd year comp science student at the end of May to hopefulling work through some of these concerns.
Jim
sunsetsystems wrote on Tuesday, April 05, 2005:
Thanks for the feedback, Emily and Jim. My client also uses Zirmed (yes their claims tracking and mapping features help a lot). We have just started billing live claims from OpenEMR. So this is trial by fire and obviously I have been and will be fixing a lot of things in a short period of time. Come hell or high water we’re gonna make this sucker work.
– Rod <rod at sunsetsystems dot com>
drbowen wrote on Tuesday, April 05, 2005:
Rod,
SQL-Ledger was tacked on in January. There has been very little functionality added other than basic "add a claim".
While SQL-Ledger is very capable as a double entry accounting system. All the features that we need to run a medical office simple have not been added. It is "a blank slate".
sunsetsystems wrote on Tuesday, April 05, 2005:
Yeah I know. I know this is useless whining, but I was just hoping that the stuff already done would sort of work. You might be surprised to see all the things I’ve fixed in CVS (and svn before that).
Right now I’m developing some reporting for cash receipts, which SQL-Ledger cannot do by doctor (salesman) nor by insurance company. These will be separate little web apps, not part of SQL-Ledger proper since its author does not seem to like anyone messing with his code.
– Rod <rod at sunsetsystems dot com>