I think this means go ahead. I will do the first installment tonight. I
don't know how to do "open forum." Is it related to this list? Let me know
how to post or subscribe and I will gladly post there as well.

Thanks,

Thurman

> -----Original Message-----
> From: [EMAIL PROTECTED] [mailto:hardhats-
> [EMAIL PROTECTED] On Behalf Of Nancy Anthracite
> Sent: Saturday, February 05, 2005 3:53 PM
> To: hardhats-members@lists.sourceforge.net
> Subject: Re: [Hardhats-members] differential charging for diagnostic tests
> 
> Maybe this needs to be posted in both places, here on Hardhats and on Open
> Forum.  I think it reaches two different audiences and both have something
> to
> gain and to offer.
> 
> On Saturday 05 February 2005 04:39 pm, Chris Richardson wrote:
> > Thurman;
> >
> >   It would be even more interesting if we could move this discussion to
> the
> > Open FORUM.  In the future we are expecting to have these discussions
> > indexed for hypertext and for people to do research with.  Existing
> general
> > Fileman messages and discussions will be retro-fit to hypertext.  We
> will
> > try to capture some of these discussions later, but no guarantees.
> This
> > is important knowledge-base for the whole community.  Thanks for your
> > input, Thurman.
> >
> >     Best wishes;   Chris
> >
> >
> > ----- Original Message -----
> > From: "Thurman Pedigo" <[EMAIL PROTECTED]>
> > To: <hardhats-members@lists.sourceforge.net>
> > Sent: Saturday, February 05, 2005 9:20 AM
> > Subject: RE: [Hardhats-members] differential charging for diagnostic
> tests
> >
> > > Nancy, thanks for the invite. Our homepage got out of date and we took
> it
> > > down. My wife is working on new site which should be back online by
> the
> >
> > end
> >
> > > of 02/05. I will post appropriate to that site. For now, I offer the
> > > following scheme. First I will post a series on RBRVS. It will be in
> 3-4
> > > installments and is a series I already posted to another list (AAFP
> >
> > Practice
> >
> > > Management).
> > >
> > > Next I will give a brief history of the tribulations of AR in private
> > > practice, including the migration to Practice Management software.
> Each
> >
> > post
> >
> > > will be limited to one or two screens to avoid bandwidth overload. All
> >
> > this
> >
> > > will later be posted to our website when is restarted. The series can
> be
> > > stopped anytime on request.
> > >
> > > Let me know any recommended plan modifications....tx/t
> > >
> > > > -----Original Message-----
> > > > From: [EMAIL PROTECTED] [mailto:hardhats-
> > > > [EMAIL PROTECTED] On Behalf Of Nancy Anthracite
> > > > Sent: Saturday, February 05, 2005 9:45 AM
> > > > To: hardhats-members@lists.sourceforge.net
> > > > Subject: Re: [Hardhats-members] differential charging for diagnostic
> >
> > tests
> >
> > > > Thurman, this billing issue is such a thorn in the side of VistA
> users
> > > > that I
> > > > certainly hope you will continue this thread ONLINE and that others
> > > > will contribute to it.  I think it is a major cause for the
> > > > non-adoption of VistA
> > > > and something important for the VistA-Office adopters to consider.
> > > > Remember
> > > > that the archive of this mailing list is an important reference for
> > > > many of
> > > > us strugglers, and this is an important topic to have included in
> it.
> > > >
> > > > On Saturday 05 February 2005 09:39 am, Thurman Pedigo wrote:
> > > > > This is an excellent example to demonstrate the use of adjustment
> >
> > codes.
> >
> > > > It
> > > >
> > > > > is important to remember the systems doesn't care how one names
> these
> > > > > codes. The code names only need have meaning to you and your
> > > > > correspondents. Below are just a few examples:
> > > > > =========================
> > > > > 4        Employer Reduction
> > > > > 5        Not Approved
> > > > > 6        Lab Rejected
> > > > > 7        Additional Emp Payment
> > > > > 8        Professional Courtesy
> > > > > =========================
> > > > > These codes can be unlimited (1,000s) and represent insurance
> >
> > companies,
> >
> > > > > special employer arrangements, or special indigent categories such
> as
> > > > > unemployed, disabled, or whatever applies to your population.
> > > > >
> > > > > The added value of this system is the ease of adding cost
> accounting.
> > > >
> > > > Any
> > > >
> > > > > material or activity coat may be attached to the procedure.  I
> don't
> > > >
> > > > want
> > > >
> > > > > to chew up a lot of bandwidth on this post, but will be glad to
> >
> > continue
> >
> > > > > this thread online of off line. Strongly advise understanding this
> > > >
> > > > concept
> > > >
> > > > > before adding complications to charges.
> > > > >
> > > > > Example below- partial AR record: Notice the $62.03 write off
> > > > > (Adj)hopefully format works...tx/t
> > > > > ===============================================
> > > > > Company: XXXXXX    COMPANYXXXXXXXXXX   DOI:03/29/01
> > > > >
> > > > > CHG SLIP # PATIENT                                         DR
> > > > >    17065.0 PATIENT NAMEXXXXXX - 1006901                    Pedigo
> > > > > DOS    DISCRIPTION                     AMT       ADJUSTMENTS
> >
> > LINE
> >
> > > > > BAL 032901 99203 - Office/outpa          110.00
> > > > >        043001  COMPANYXXXXX  8      -110.00
> > > >
> > > > 0
> > > >
> > > > > 032901 73564 - X-ray exam o          118.00
> > > > >         043001 COMPANYXXXXX  8       -55.97          -62.03Ins Adj
> > > >
> > > > 0
> > > >
> > > > > 032901 L1810 - KNEE SUPPORT           25.00
> > > > >         043001  COPANYXXXXX  8       -25.00
> > > >
> > > > 0
> > > >
> > > > 0.00
> >
> >   -----
> >
> > > > ---
> > > >
> > > > > TOTAL
> > > >
> > > > 0.00
> > > >
> > > > > > -----Original Message-----
> > > > > > From: [EMAIL PROTECTED]
> > > > > > [mailto:hardhats- [EMAIL PROTECTED] On Behalf
> Of
> > > > > > Nick James Sent: Friday, February 04, 2005 10:48 PM
> > > > > > To: hardhats-members@lists.sourceforge.net
> > > > > > Subject: RE: [Hardhats-members] differential charging for
> > > > > > diagnostic tests
> > > > > >
> > > > > > Hi Thurman,
> > > > > >
> > > > > > Thanks, that is certainly helpful.
> > > > > >
> > > > > > But the issues also relate to a categorisation of
> > > > > > direct paying patients which includes free (only some
> > > > > > select tests are free) subsidy, semi-subsidy, normal
> > > > > > private and luxury provate. The hospital where we once
> > > > > > worked for had six categories, each with differing
> > > > > > charges for the same test. I suppose one could treat
> > > > > > each category as a different employer using the same
> > > > > > logic as in industrial billing. Please comment.
> > > > > >
> > > > > > --- Thurman Pedigo <[EMAIL PROTECTED]> wrote:
> > > > > > > This is a little different philosophy that has
> > > > > > > worked well for me over the
> > > > > > > past 30 years.
> > > > > > >
> > > > > > > Billing for commercial insurance, Medicare, and
> > > > > > > Medicaid, have no need for
> > > > > > > "multiple rate" billing. Adjustments/write-offs,
> > > > > > > bring the payments into
> > > > > > > compliance with the charge and provides a powerful
> > > > > > > tool to assess
> > > > > > > performance in the accounts receivables.
> > > > > > >
> > > > > > > Industrial billing, where one contracts to with an
> > > > > > > employer to do specific
> > > > > > > services at a set price uses modification of the
> > > > > > > last 2 characters in the
> > > > > > > CPT code AND includes the company name in the
> > > > > > > description.
> > > > > > >
> > > > > > > Thanks,
> > > > > > >
> > > > > > > thurman
> > > > > > >
> > > > > > > > -----Original Message-----
> > > > > > > > From: [EMAIL PROTECTED]
> > > > > > >
> > > > > > > [mailto:hardhats-
> > > > > > >
> > > > > > > > [EMAIL PROTECTED] On Behalf Of
> > > > > > >
> > > > > > > Nancy Anthracite
> > > > > > >
> > > > > > > > Sent: Friday, February 04, 2005 1:11 PM
> > > > > > > > To: hardhats-members@lists.sourceforge.net
> > > > > > > > Subject: Re: [Hardhats-members] differential
> > > > > > >
> > > > > > > charging for diagnostic tests
> > > > > > >
> > > > > > > > I believe the majority of the billing is not done
> > > > > > >
> > > > > > > within VistA.  The
> > > > > > >
> > > > > > > > recent
> > > > > > > > billing patches, to my knowledge, only gather
> > > > > > >
> > > > > > > together information for a
> > > > > > >
> > > > > > > > third party billing service to use to process a
> > > > > > >
> > > > > > > claim, and it may not even
> > > > > > >
> > > > > > > > include charges at all, as I believe that is
> > > > > > >
> > > > > > > probably handled by the
> > > > > > >
> > > > > > > > processing entity or information provided to that
> > > > > > >
> > > > > > > entity separately.  Even
> > > > > > >
> > > > > > > > if
> > > > > > > > there are charges withing VistA, I doubt there are
> > > > > > >
> > > > > > > any rates that would
> > > > > > >
> > > > > > > > differ from patient to patient.
> > > > > > > >
> > > > > > > > On Friday 04 February 2005 07:22 am, Nick James
> > > > > > >
> > > > > > > wrote:
> > > > > > > > > can multople rates be maintained by VistA?
> > > > > > > > >
> > > > > > > > > If the charges applicable for a test are to be
> > > > > > >
> > > > > > > based
> > > > > > >
> > > > > > > > > on the patient type, and multiple rates apply
> > > > > > >
> > > > > > > for the
> > > > > > >
> > > > > > > > > same test depending on the patient type.
> > > > > > > > >
> > > > > > > > > If so how is it defined and which file is it
> > > > > > >
> > > > > > > stored in?
> > > > > > >
> > > > > > > > > __________________________________
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> > > > > >
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> > > > > > > > --
> > > > > > > > Nancy Anthracite
> > > > > >
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> > > > --
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> > > >
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> --
> Nancy Anthracite
> 
> 
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