Hi - I am struggling with patients who want to give us money beforehand. Not that we don’t want the money - but how do we record it best.
The procedure is that a patient comes in, gets a consultation and signs up for a surgical procedure. Before that happens he/she will make one or more payments for the amount of the procedure. So, we can not record a co-payment in the encounter that deals with the surgery, but we will have to create a new encounter when the patient calls in with a CC or mails a check. No problem to record that payment. Now the surgery comes around and in that surgery-encounter we add the procedure in the fee sheet. What we don’t know is how to match the payments in the fee sheet of encounter 1 (possible also 2 and 3) with the fees for the surgery in the surgery-encounter.
How would that be done?
Thanks you so much in advance!
Merlin
Seems like some thought should be put into this process so that we can include it in the billing upgrade project. Creating “future” encounters is a kludge, might work, but not ideal.
It’s really just an unapplied credit balance, I think we could store transactions like that in ar_activity as unapplied payments at the patient level and apply them as encounters are created.
No decent way to enter an unapplied credit balance at present.
Extra payment can be entered against a charge that is closely related; but then when it comes time to apply the amount, the total has to be adjusted out & the payment divided between 2 charges. Sure fire way to have staff grumbling in no time.
The other alternative is to enter the amount in Billing Note in Billing View. Problem is that there will be no record of that payment reflected in any of the Reports or Day Sheets. If staff forgets to credit it later on, a bunch of irate patients will call demanding to know what happened to the prior payments.
We can stick anything in the tables, but do we want the Front Office fooling with the database?
Now if we had a bona fide unapplied payment, that’s another matter. Then we will have a way to deal with overpayments from insurers/patients, extraneous payments (few pennies when insurers are late), refunds & Merlin’s situation.
On the database side, it should be reasonable to have payments in the ar_activity table with the encounter set to 0. Then it’s just a small matter or programming to allow such entries, get them assigned to encounters at some point, and include them in reports.
Nono, my comment was a design suggestion for anyone considering doing programming for this, not at all suggesting direct user manipulation of the database!
Looks like ‘encounter’ in ar_activity set to Zero would support more than
one bucket of ‘unapplied’ dollars, since there is also a Sequence_No column
in the Index. Need to be able to track each and every unit of money
separately for GAAP purposes. (Transaction based).
Tony McCormick, CTO
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We probably could live for now with the idea of creating the encounter for the service/surgery at the time of the first payment for it.
But it would be great to get some kind of transfer of moneys from one encounter to another.
How about the idea of another type of payment, beside cash, check or CC: a transfer. If that is selected a selection box for all payments that were made (and that are not applied to any services) could be displayed and selected to initiate the transfer from another encounter to the current one.
This could be even expanded to allow a transfer from another patient - I imagine a married couple where the husband added money to his account but then finds out he wants to keep his sixth finger after all - but his wife could use the money for a face lift.
I am not - by far - familiar enough with the structure of OpenEMR to attempt to do this myself - so I have to hope that somebody will volunteer
Applying an unapplied payment from one patient to another would obviate the need for a transfer. But no such animal exists at this time. Meanwhile your surgeons require a solution.
Future encounters for elective surgery should work most of the time. Unless the patient becomes ill for other reasons & the procedure needs postponing, the surgery is a predictable event that in all probability will happen.
If the patient gets “cold feet”, the worse thing would be to delete the encounter & refund the money, both of which can be easily accomplished.
Future encounters would make no sense in any other circumstance within a non-surgical practice.
Actually it is already possible to easily move money from one encounter to another.
Look up the patient and then in the left frame click Popups -> Payment. For the encounter you want to take money from, enter the amount as a negative number. For the target encounter enter the same amount as a positive number. The net total at the bottom should read 0.00. Save it and it’s done.
