Billing Feature review

[aethelwulffe]

@teryhill Would you consider reviewing the starting code for diffs against your favorite billing features? I would also like to get in a number of items dealing with claim generation, as well as removing ICD9 hard-coding that messes with manually entered dx. I would like to put together a definition of a second milestone that moves us toward a billing re-write...and allows me to scope a funding request. We need a fundamental advance in billing logic.

[teryhill]

Will do

  From: Art Eaton <notifications@github.com>

To: LibreEHR/LibreEHR LibreEHR@noreply.github.com Cc: Terry Hill teryhill@yahoo.com; Mention mention@noreply.github.com Sent: Saturday, July 16, 2016 10:56 AM Subject: [LibreEHR/LibreEHR] Billing Feature review (#10)

@teryhill Would you consider reviewing the starting code for diffs against your favorite billing features? I would also like to get in a number of items dealing with claim generation, as well as removing ICD9 hard-coding that messes with manually entered dx. I would like to put together a definition of a second milestone that moves us toward a billing re-write...and allows me to scope a funding request. We need a fundamental advance in billing logic.— You are receiving this because you were mentioned. Reply to this email directly, view it on GitHub, or mute the thread.

[aethelwulffe]

@teryhill Should I start on a claim file gen and parse script set (clean re-write) based on the current system?

[teryhill]

I have not looked at the Misc Billing form and the x837 to make sure that they contain the EPSDT and electronic submission for corrected claims. These can be added later if you want to go ahead and start.

[teryhill]

also Daniel Pflieger was going to add some checking and logging for one of @tony customers. Perhaps @tony could check his progress

[aethelwulffe]

OK: Target changes for the fee sheet to enable better accounting:

1. When a line item is deleted, the "activity" field is set to 0. When this happens, the date field of this line item should not change, but a new field called "date_deleted" should record the datetime of this activity.
2. When a line item is UPDATED (modified) in any other way, the original row should have the activity field set to 0, the datetime of that change recorded in the new date_deleted row, and a new row be entered into the table.
3. Furthermore, it is probably desirable to preserve all the dates of billing and all the billing file names that a row has been billed under.

The above will allow actual double entry accounting to happen at the billing table level. Deleted rows will be reported on twice: First as a credit, then as a debit (or vice versa, depending on your accounting philosophy). From there, the a/r tables take over for addressing actual payments and adjustments to the date of service level line items.

[aethelwulffe]

Billing notes in fee sheet.

[aethelwulffe]

https://github.com/teryhill/openemr/commit/323953a63eb8b29f5eb15c90880b9e828e9f4da2 All the above done in LibreEHR?

[teryhill]

Yes that was done and commited to OpenEMR before the fork on 4/20.

[aethelwulffe]

I would like to have a discussion on the treatment of billing table rows at tomorrow's meeting.

[aethelwulffe]

Updated Billing adjustment codes to current standard.

[aethelwulffe]

pull request #138

[aethelwulffe]

Pull request #154 handles the claim status codes, which will also require tweaking the the eob manager (not called sl_eob anymore I imagine) to correlate the denial codes. It has been noticed that not all denials are showing up in red as companies are starting to use more of the newer codes. I also added another array, which is a status category. We should be looking into the use of that and a few other arrays. Once we have everything being properly utilized (if not all the intelligent behavior figured out) then we should look to pushing these into a single table that can be upgraded easily.

[aethelwulffe]

Next item for the billing manager, and global configuration: I think we want: Units Patient Billing Notes Claim Billing Notes Encounter Reason Service Location (Facility) Billing Facility and possibly all Clinicians involved in the encounter. These can be in the "expanded" section if need be, but these are all things that people with complex multi-facility and multi-provider

[aethelwulffe]

I added a pull for a change to POS code facility to remove a HUGE piece of drama involved with training people to create encounters properly for billing. Personal experience tells me this tiny little stupid thing is actually a huge cause of a whole 40 days and 40 nights kind of cataclysm. Aside from that, I would like to (after release) address the whole CPT vs PCS issue.

1. CPT codes are pretty much a USA thing. Using "CPT4" as a default type/search is a bad as using "ICD9".
2. ICD10 isn't just a dx code set. It is dx and tx. Treatment ICD10 codes are properly called ICD-10- PCS. The Medicaid version is called HCPCS. Diagnosis codes are ICD-10-CM.
3. There is other stuff from the W.H.O. These include procedure stuff called OPCS.
4. Different countries have alternate versions like Medicare/Medicaid's HC-PCS.

We need to both know how this stuff really works, know what it is called, and call it what it is in both the front and back end.

Something that should hit very close to home @tmccormi : Ireland uses ICD-10-AM. This is the Australian version of ICD-10-CM. We need to have better billing adaptability for other nations. LibreEHR is not on an immediate path to MU certification. We ARE however on a path that can take us to a flexible and extensible billing system that can be swallowed by users in other nations. Billing modules need to be versioned by specialty as well as by nationality. We need to learn more about both sets of requirements.

[aethelwulffe]

Oh yeah. While both CPT, PCS, OPCS, CM, HCPCS, and AM procedure codes are running around out there, soon we will see the WHO ICHI stuff. I have no idea why they would call a set of intervention codes "Who Itchy?" but there it is.

[tmccormi]

Ireland also uses ICPCS...

Tony McCormick

On Sep 9, 2016 8:28 PM, "Art Eaton" notifications@github.com wrote:

Oh yeah. While both CPT, CM, HCPCS, and AM procedure codes are running around out there, soon we will see the WHO ICHI stuff. I have no idea why they would call a set of intervention codes "Who Itchy?" but there it is.

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