REMITT is a format-independent billing system. It is capable of generating HCFA-1500 (CMS-1500), UB-92, and X12 837P formatted bills (among other formats).

Creating a Claim or Bill in REMITT

Some prerequisites

REMITT is a comprehensive billing engine. In order to create HCFA's for billing purposes there are a number of issues that need to be addressed. This how-to assumes a working setup of both FreeMED and REMITT. (There are numerous dependencies mainly within PERL that were more challenging to set up in my MacBook than you might have on your Linux system). In addition, a physician must be set up in Main - Support Data - Provider Maintenance. Also, some insurance company data must be set in Main – Support Data – Insurance Companies. In the following series of photos, I edit my Medicare carrier's information. Note there are data points for electronic submission which may vary according to your electronic clearinghouse. On photo 6.png I've entered under 'ID' my medicare provider number which will print in the corresponding area of BOX 33 on the HCFA form. Your assigned provider number will be entered accordingly for each insurance carrier, i.e. BCBS number for the BCBS carrier, AETNA number for AETNA and so on. (1.png; 2.png; 3.png; 4.png; 5.png; 6.png).

Both CPT coding and ICD-9 coding must be entered for your specialty and practice. Thankfully under freemed 0.8.3, there are ways to enter data directly into the ICD-9 and CPT database from the billing encounter page simply by clicking on the '+' sign to the right of the text box. This can also be done from Main – Support Data – ICD9 Codes or CPT Codes respectively. If you're new to Freemed, entering CPT and ICD9 codes is tedious work. Generally you will enter only the codes you use in your daily practice, and these will grow with time. You will be prompted to enter fees for each procedure you set up.

Generating a Procedure

From your patient menu, assuming you've assigned an insurance carrier under patient coverage, clicking on Procedures / Add will bring you to an add procedure form. Here you will specify a provider, date of procedure, procedural code (7.png) (i.e. CPT code), diagnosis (this will remain persistent through subsequent sessions but editable), place of service, authorization (if necessary for hmo), and claim type (hcfa type. If left as 'none' this will default to cash billing). (8.png; 9.png)

The next screen will allow you to select the insurance carrier. (10.png) The next screen will allow you to edit the calculated charge for the service (usually this is specified when you set up the CPT code). (11.png) The next screen refers to medicaid and lab resubmission and can be ignored.. press finish. (12.png; 13.png) Freemed now has a procedure that needs to be sent out for billing. Note in this last picture of the 'manage patient' screen that there is a procedure registered in the right hand column dated 9/17/06 (14.png)

Note: HCFA's can also be customized as well by editing specific XSL forms under ~/remitt/xsl/hcfa1500.xsl
(15.png)

Clearinghouses

You may also wish to set up a relationship with an online electronic clearinghouse such as FreeClaims or MCSI. They will require some testing prior to moving your billing to live status. They are generally helpful in this endeavor.

In Order to Begin Billing

Open up Terminal and as root type
./remitt_server.pl within the /remitt/bin folder
(On my MacBook it is done thusly; sudo -s, cd Sites/remitt/bin, ./remitt_server.pl If under debian linux the commands might be sudo -s, cd /www/remitt/bin, ./remitt_server.pl) This starts the remitt server. You can then safely close your terminal window as the daemon will remain active. (16.png)

On to Generating Claims

You now will be ready to bill both HCFA and Cash bills. In order to generate HCFA forms;
Enter Main – Billing System – Remitt Billing System – Perform Billing (17.png; 18.png)
You will be presented with the patient names followed by a '+' sign that when clicked expands some of the billing options. From here you can select whether you wish to generate a txt file for electronic billing or a PDF file of the HCFA for printing and mailing in yourself. (19.png) (note: most clearinghouses offer competitively priced mailing of a claim submitted to them electronically). In picture 19.png, I've expanded the options for the second patient and dropped down my submission options. In this case I have set up Medicare to submit as electronic - hcfa1500/FreeClaims. I could also set up Medicare to generate a Paper/Text or, although not shown here, Paper/PDF, and simply generate a pdf of my hcfa claim, print it and mail it. You can choose which type of electronic or paper bill to generate in the Support Data – Insurance Companies – Modify and then set the default output, format, and target.
You may submit only one particular patient or date of service or you can click on Submit Claims in the upper right corner to submit all of them.
Click on Submit Claims
You will see a screen with remitt billing sent, then another with Identifier/Status/Report/Action indicating progress (20.png) and finally a completed bill in either time stamped pdf form or time stamped txt form. (these remitt generated files are stored in /remitt/spool/*yourname*/output/).
The PDF file can simply be printed. The txt file can be uploaded per the rules of your clearinghouse. From the pictures you may notice that my default electronic billing is set to HCFA1500/Freeclaims. I have set up Remitt for automatic claims submission to Freeclaims Clearing House, thus saving me the step of uploading a TXT file to my account on their website.

Once you are satisfied that the bills are either correctly printed or sent electronically, you may click on Mark All Batches as Billed, thus updating freemed database moving the claim from queued to billed. Once you receive payment, the patient's account can be updated by entering the monetary data in the Claims Manager. If a secondary insurance is involved, once the claim is moved from queued to billed and money is applied, a new claim is automatically generated under the 2nd insurance and placed in the queue for the next time you run a billing cycle. (note; secondary insurance is common under Medicare. In these cases, secondary insurance is often automatically identified and sent from Medicare. When this occurs, any secondary bills that are 'queued' can safely be modified to 'billed' under Claims Manager).

In order to generate cash statements, go to Main – Billing functions – Remitt Billing System – Patient Statements. This will generate a multipage PDF of all patients to whom you wish to send a cash bill. Please note, you may need to modify /remitt/pdf/statement.pdf to suite your own practice. Modifying PDF's is a bit tricky so please refer to available software on your particular platform for doing so. The corresponding statement.xsl file in /remitt/xsl/statement.xsl will automatically place the correct patient data into the pdf form.
You may print these pdf's and mail them to your patients. Your practice name and address, when properly edited into the statement.pdf, allows for use in double windowed envelopes. This means one accordion fold of the printed bill, put into windowed envelope, place stamp and mail!