library/sl_eob.inc.php

   1 <?php
   2   // Copyright (C) 2005-2006 Rod Roark <rod@sunsetsystems.com>
   3   //
   4   // This program is free software; you can redistribute it and/or
   5   // modify it under the terms of the GNU General Public License
   6   // as published by the Free Software Foundation; either version 2
   7   // of the License, or (at your option) any later version.
   8
   9   include_once("sql-ledger.inc");
  10   include_once("patient.inc");
  11   include_once("billing.inc");
  12   include_once("invoice_summary.inc.php");
  13
  14   $chart_id_cash   = 0;
  15   $chart_id_ar     = 0;
  16   $chart_id_income = 0;
  17   $services_id     = 0;
  18
  19   function slInitialize() {
  20     global $chart_id_cash, $chart_id_ar, $chart_id_income, $services_id;
  21     global $sl_cash_acc, $sl_ar_acc, $sl_income_acc, $sl_services_id;
  22     SLConnect();
  23
  24     $chart_id_cash = SLQueryValue("select id from chart where accno = '$sl_cash_acc'");
  25     if ($sl_err) die($sl_err);
  26     if (! $chart_id_cash) die(xl("There is no COA entry for cash account ") . "'$sl_cash_acc'");
  27
  28     $chart_id_ar = SLQueryValue("select id from chart where accno = '$sl_ar_acc'");
  29     if ($sl_err) die($sl_err);
  30     if (! $chart_id_ar) die(xl("There is no COA entry for AR account ") . "'$sl_ar_acc'");
  31
  32     $chart_id_income = SLQueryValue("select id from chart where accno = '$sl_income_acc'");
  33     if ($sl_err) die($sl_err);
  34     if (! $chart_id_income) die(xl("There is no COA entry for income account ") . "'$sl_income_acc'");
  35
  36     $services_id = SLQueryValue("select id from parts where partnumber = '$sl_services_id'");
  37     if ($sl_err) die($sl_err);
  38     if (! $services_id) die(xl("There is no parts entry for services ID ") . "'$sl_services_id'");
  39   }
  40
  41   function slTerminate() {
  42     SLClose();
  43   }
  44
  45   // Try to figure out our invoice number (pid.encounter) from the
  46   // claim ID and other stuff in the ERA.  This should be straightforward
  47   // except that some payers mangle the claim ID that we give them.
  48   //
  49   function slInvoiceNumber(&$out) {
  50     $invnumber = $out['our_claim_id'];
  51     $atmp = preg_split('/[ -]/', $invnumber);
  52     $acount = count($atmp);
  53
  54     $pid = 0;
  55     $encounter = 0;
  56     if ($acount == 2) {
  57       $pid = $atmp[0];
  58       $encounter = $atmp[1];
  59     }
  60     else if ($acount == 3) {
  61       $pid = $atmp[0];
  62       $brow = sqlQuery("SELECT encounter FROM billing WHERE " .
  63         "pid = '$pid' AND id = '" . $atmp[1] . "' AND activity = 1");
  64       $encounter = $brow['encounter'];
  65     }
  66     else if ($acount == 1) {
  67       $pres = sqlStatement("SELECT pid FROM patient_data WHERE " .
  68         "lname LIKE '" . addslashes($out['patient_lname']) . "' AND " .
  69         "fname LIKE '" . addslashes($out['patient_fname']) . "' " .
  70         "ORDER BY pid DESC");
  71       while ($prow = sqlFetchArray($pres)) {
  72         if (strpos($invnumber, $prow['pid']) === 0) {
  73           $pid = $prow['pid'];
  74           $encounter = substr($invnumber, strlen($pid));
  75           break;
  76         }
  77       }
  78     }
  79
  80     if ($pid && $encounter) $invnumber = "$pid.$encounter";
  81     return array($pid, $encounter, $invnumber);
  82   }
  83
  84   // Insert a row into the acc_trans table.
  85   //
  86   function slAddTransaction($invid, $chartid, $amount, $date, $source, $memo, $insplan, $debug) {
  87     global $sl_err;
  88     $date = fixDate($date);
  89     $query = "INSERT INTO acc_trans ( " .
  90       "trans_id, "     .
  91       "chart_id, "     .
  92       "amount, "       .
  93       "transdate, "    .
  94       "source, "       .
  95       "project_id, "   .
  96       "memo "          .
  97       ") VALUES ( "    .
  98       "$invid, "       . // trans_id
  99       "$chartid, "     . // chart_id
 100       "$amount, "      . // amount
 101       "'$date', "      . // transdate
 102       "'$source', "    . // source
 103       "$insplan, "     . // project_id
 104       "'$memo' "       . // memo
 105       ")";
 106     if ($debug) {
 107       echo $query . "<br>\n";
 108     } else {
 109       SLQuery($query);
 110       if ($sl_err) die($sl_err);
 111     }
 112   }
 113
 114   // Insert a row into the invoice table.
 115   //
 116   function slAddLineItem($invid, $serialnumber, $amount, $insplan, $description, $debug) {
 117     global $sl_err, $services_id;
 118     $query = "INSERT INTO invoice ( " .
 119       "trans_id, "          .
 120       "parts_id, "          .
 121       "description, "       .
 122       "qty, "               .
 123       "allocated, "         .
 124       "sellprice, "         .
 125       "fxsellprice, "       .
 126       "discount, "          .
 127       "unit, "              .
 128       "project_id, "        .
 129       "serialnumber "       .
 130       ") VALUES ( "         .
 131       "$invid, "            . // trans_id
 132       "$services_id, "      . // parts_id
 133       "'$description', "    . // description
 134       "1, "                 . // qty
 135       "0, "                 . // allocated
 136       "$amount, "           . // sellprice
 137       "$amount, "           . // fxsellprice
 138       "0, "                 . // discount
 139       "'', "                . // unit
 140       "$insplan, "          . // project_id
 141       "'$serialnumber'"     . // serialnumber
 142       ")";
 143     if ($debug) {
 144       echo $query . "<br>\n";
 145     } else {
 146       SLQuery($query);
 147       if ($sl_err) die($sl_err);
 148     }
 149   }
 150
 151   // Update totals and payment date in the invoice header.  Dollar amounts are
 152   // stored as double precision floats so we have to be careful about rounding.
 153   //
 154   function slUpdateAR($invid, $amount, $paid = 0, $paydate = "", $debug) {
 155     global $sl_err;
 156     $paydate = fixDate($paydate);
 157     $query = "UPDATE ar SET amount = round(CAST (amount AS numeric) + $amount, 2), " .
 158       "netamount = round(CAST (netamount AS numeric) + $amount, 2)";
 159     if ($paid) $query .= ", paid = round(CAST (paid AS numeric) + $paid, 2), datepaid = '$paydate'";
 160     $query .= " WHERE id = $invid";
 161     if ($debug) {
 162       echo $query . "<br>\n";
 163     } else {
 164       SLQuery($query);
 165       if ($sl_err) die($sl_err);
 166     }
 167   }
 168
 169   function slPostPayment($trans_id, $thispay, $thisdate, $thissrc, $code, $thisins, $debug) {
 170     global $chart_id_cash, $chart_id_ar;
 171     // Post a payment: add to ar, subtract from cash.
 172     slAddTransaction($trans_id, $chart_id_ar  , $thispay    , $thisdate, $thissrc, $code, $thisins, $debug);
 173     slAddTransaction($trans_id, $chart_id_cash, 0 - $thispay, $thisdate, $thissrc, $code, $thisins, $debug);
 174     slUpdateAR($trans_id, 0, $thispay, $thisdate, $debug);
 175   }
 176
 177   function slPostCharge($trans_id, $thisamt, $thisdate, $code, $thisins, $description, $debug) {
 178     global $chart_id_income, $chart_id_ar;
 179     // Post an adjustment: add negative invoice item, add to ar, subtract from income
 180     slAddLineItem($trans_id, $code, $thisamt, $thisins, $description, $debug);
 181     if ($thisamt) {
 182       slAddTransaction($trans_id, $chart_id_ar    , 0 - $thisamt, $thisdate, $description, $code, $thisins, $debug);
 183       slAddTransaction($trans_id, $chart_id_income, $thisamt    , $thisdate, $description, $code, $thisins, $debug);
 184       slUpdateAR($trans_id, $thisamt, 0, '', $debug);
 185     }
 186   }
 187
 188   function slPostAdjustment($trans_id, $thisadj, $thisdate, $thissrc, $code, $thisins, $reason, $debug) {
 189     global $chart_id_income, $chart_id_ar;
 190     // Post an adjustment: add negative invoice item, add to ar, subtract from income
 191     $adjdate = fixDate($thisdate);
 192     $description = "Adjustment $adjdate $reason";
 193     slAddLineItem($trans_id, $code, 0 - $thisadj, $thisins, $description, $debug);
 194     if ($thisadj) {
 195       slAddTransaction($trans_id, $chart_id_ar, $thisadj, $thisdate, "InvAdj $thissrc", $code, $thisins, $debug);
 196       slAddTransaction($trans_id, $chart_id_income, 0 - $thisadj, $thisdate, "InvAdj $thissrc", $code, $thisins, $debug);
 197       slUpdateAR($trans_id, 0 - $thisadj, 0, '', $debug);
 198     }
 199   }
 200
 201   // Do whatever is necessary to make this invoice re-billable.
 202   //
 203   function slSetupSecondary($invid, $debug) {
 204     global $sl_err, $GLOBALS;
 205     $info_msg = '';
 206
 207     // Get some needed items from the SQL-Ledger invoice.
 208     $arres = SLQuery("select invnumber, transdate, customer_id, employee_id, " .
 209       "shipvia from ar where ar.id = $invid");
 210     if ($sl_err) die($sl_err);
 211     $arrow = SLGetRow($arres, 0);
 212     if (! $arrow) die(xl('There is no match for invoice id') . ' = ' . "$trans_id.");
 213     $customer_id = $arrow['customer_id'];
 214     $date_of_service = $arrow['transdate'];
 215     list($trash, $encounter) = explode(".", $arrow['invnumber']);
 216
 217     // Get the OpenEMR PID corresponding to the customer.
 218     $pdrow = sqlQuery("SELECT patient_data.pid " .
 219       "FROM integration_mapping, patient_data WHERE " .
 220       "integration_mapping.foreign_id = $customer_id AND " .
 221       "integration_mapping.foreign_table = 'customer' AND " .
 222       "patient_data.id = integration_mapping.local_id");
 223     $pid = $pdrow['pid'];
 224     if (! $pid) die(xl("Cannot find patient from SQL-Ledger customer id") . " = $customer_id.");
 225
 226     // Determine the ID of the next insurance company (if any) to be billed.
 227     $new_payer_id = -1;
 228     $insdone = strtolower($arrow['shipvia']);
 229     foreach (array('ins1' => 'primary', 'ins2' => 'secondary', 'ins3' => 'tertiary') as $key => $value) {
 230       if (strpos($insdone, $key) === false) {
 231         $nprow = sqlQuery("SELECT provider FROM insurance_data WHERE " .
 232           "pid = '$pid' AND type = '$value' AND date <= '$date_of_service' " .
 233           "ORDER BY date DESC LIMIT 1");
 234         if (!empty($nprow['provider'])) {
 235           $new_payer_id = $nprow['provider'];
 236         }
 237         break;
 238       }
 239     }
 240
 241     // Find out if the encounter exists.
 242     $ferow = sqlQuery("SELECT pid FROM form_encounter WHERE " .
 243       "encounter = $encounter");
 244     $encounter_pid = $ferow['pid'];
 245
 246     // If it exists, just update the billing items.
 247     if ($encounter_pid) {
 248       if ($encounter_pid != $pid)
 249         die(xl("Expected form_encounter.pid to be ") . $pid . ', ' . xl(' but was ') . $encounter_pid);
 250
 251       // If there's a payer ID queue it up, otherwise just reopen it.
 252       if ($new_payer_id > 0) {
 253         // TBD: implement a default bill_process and target in config.php,
 254         // it should not really be hard-coded here.
 255         /****
 256         $query = "UPDATE billing SET billed = 0, bill_process = 5, " .
 257           "target = 'hcfa', payer_id = $new_payer_id, " .
 258           "bill_date = NOW(), process_date = NULL, process_file = NULL " .
 259           "WHERE encounter = $encounter AND pid = $pid AND activity = 1";
 260         ****/
 261         if (!$debug)
 262           updateClaim(true, $pid, $encounter, $new_payer_id, 1, 5, '', 'hcfa');
 263       } else {
 264         /****
 265         $query = "UPDATE billing SET billed = 0, bill_process = 0, payer_id = -1, " .
 266           "bill_date = NULL, process_date = NULL, process_file = NULL " .
 267           "WHERE encounter = $encounter AND pid = $pid AND activity = 1";
 268         ****/
 269         if (!$debug)
 270           updateClaim(true, $pid, $encounter, -1, 1, 0, '');
 271       }
 272
 273       /****
 274       if ($debug) {
 275         echo $query . "<br>\n";
 276       } else {
 277         sqlQuery($query);
 278       }
 279       ****/
 280
 281       $info_msg = xl("Encounter ") . $encounter . xl(" is ready for re-billing.");
 282       return;
 283     }
 284
 285     // If we get here then the encounter does not already exist.  This should
 286     // only happen if A/R was converted from an earlier system.  In this case
 287     // the encounter ID should be the date of service, and we will create the
 288     // encounter.
 289
 290     // If it does not exist then it better be (or start with) a date.
 291     if (! preg_match("/^20\d\d\d\d\d\d/", $encounter))
 292       die(xl("Internal error: encounter '") . $encounter . xl("' should exist but does not."));
 293
 294     $employee_id = $arrow['employee_id'];
 295
 296     // Get the OpenEMR provider info corresponding to the SQL-Ledger salesman.
 297     $drrow = sqlQuery("SELECT users.id, users.username, users.facility_id " .
 298       "FROM integration_mapping, users WHERE " .
 299       "integration_mapping.foreign_id = $employee_id AND " .
 300       "integration_mapping.foreign_table = 'salesman' AND " .
 301       "users.id = integration_mapping.local_id");
 302     $provider_id = $drrow['id'];
 303     if (! $provider_id) die(xl("Cannot find provider from SQL-Ledger employee = ") . $employee_id );
 304
 305     if (! $date_of_service) die(xl("Invoice has no date!"));
 306
 307     // Generate a new encounter number.
 308     $conn = $GLOBALS['adodb']['db'];
 309     $new_encounter = $conn->GenID("sequences");
 310
 311     // Create the "new encounter".
 312     $encounter_id = 0;
 313     $query = "INSERT INTO form_encounter ( " .
 314       "date, reason, facility_id, pid, encounter, onset_date " .
 315       ") VALUES ( " .
 316       "'$date_of_service', " .
 317       "'" . xl('Imported from Accounting') . "', " .
 318       "'" . addslashes($drrow['facility_id']) . "', " .
 319       "$pid, " .
 320       "$new_encounter, " .
 321       "'$date_of_service' " .
 322       ")";
 323     if ($debug) {
 324       echo $query . "<br>\n";
 325       echo xl("Call to addForm() goes here.<br>") . "\n";
 326     } else {
 327       $encounter_id = idSqlStatement($query);
 328       if (! $encounter_id) die(xl("Insert failed: ") . $query);
 329       addForm($new_encounter, xl("New Patient Encounter"), $encounter_id,
 330         "newpatient", $pid, 1, $date_of_service);
 331       $info_msg = xl("Encounter ") . $new_encounter . xl(" has been created. ");
 332     }
 333
 334     // For each invoice line item with a billing code we will insert
 335     // a billing row with payer_id set to -1.  Order the line items
 336     // chronologically so that each procedure code will be followed by
 337     // its associated icd9 code.
 338
 339     $inres = SLQuery("SELECT * FROM invoice WHERE trans_id = $invid " .
 340       "ORDER BY id");
 341     if ($sl_err) die($sl_err);
 342
 343     // When nonzero, this will be the ID of a billing row that needs to
 344     // have its justify field set.
 345     $proc_ins_id = 0;
 346
 347     for ($irow = 0; $irow < SLRowCount($inres); ++$irow) {
 348       $row = SLGetRow($inres, $irow);
 349       $amount   = $row['sellprice'];
 350
 351       // Extract the billing code.
 352       $code = xl("Unknown");
 353       if (preg_match("/([A-Za-z0-9]\d\d\S*)/", $row['serialnumber'], $matches)) {
 354         $code = strtoupper($matches[1]);
 355       }
 356       else if (preg_match("/([A-Za-z0-9]\d\d\S*)/", $row['description'], $matches)) {
 357         $code = strtoupper($matches[1]);
 358       }
 359
 360       list($code, $modifier) = explode("-", $code);
 361
 362       // Set the billing code type and description.
 363       $code_type = "";
 364       $code_text = "";
 365
 366       foreach ($code_types as $key => $value) {
 367         if (preg_match("/$key/", $row['serialnumber'])) {
 368           $code_type = $key;
 369           if ($value['fee']) {
 370             $code_text = xl("Procedure") . " $code";
 371           } else {
 372             $code_text = xl("Diagnosis") . " $code";
 373             if ($proc_ins_id) {
 374               $query = "UPDATE billing SET justify = '$code' WHERE id = $proc_ins_id";
 375               if ($debug) {
 376                 echo $query . "<br>\n";
 377               } else {
 378                 sqlQuery($query);
 379               }
 380               $proc_ins_id = 0;
 381             }
 382           }
 383           break;
 384         }
 385       }
 386
 387       // Skip adjustments.
 388       if (! $code_type) continue;
 389
 390       // Insert the billing item.  If this for a procedure code then save
 391       // the row ID so that we can update the "justify" field with the ICD9
 392       // code, which should come next in the loop.
 393       //
 394       $query = "INSERT INTO billing ( " .
 395         "date, code_type, code, pid, provider_id, user, groupname, authorized, " .
 396         "encounter, code_text, activity, payer_id, billed, bill_process, " .
 397         "bill_date, modifier, units, fee, justify, target " .
 398         ") VALUES ( " .
 399         "NOW(), " .
 400         "'$code_type', " .
 401         "'$code', " .
 402         "$pid, " .
 403         "$provider_id, " .
 404         "'" . $_SESSION['authId'] . "', " .
 405         "'" . $_SESSION['authProvider'] . "', " .
 406         "1, " .
 407         "$new_encounter, " .
 408         "'$code_text', " .
 409         "1, " .
 410         "$new_payer_id, " .
 411         ($new_payer_id > 0 ? "1, " : "0, ") .
 412         ($new_payer_id > 0 ? "5, " : "0, ") .
 413         ($new_payer_id > 0 ? "NOW(), " : "NULL, ") .
 414         "'$modifier', " .
 415         "0, " .
 416         "$amount, " .
 417         "'', " .
 418         ($new_payer_id > 0 ? "'hcfa' " : "NULL ") .
 419         ")";
 420       if ($debug) {
 421         echo $query . "<br>\n";
 422       } else {
 423         $proc_ins_id = idSqlStatement($query);
 424         if ($code_type != "CPT4" && $code_type != "HCPCS")
 425           $proc_ins_id = 0;
 426       }
 427     }
 428
 429     // Finally, change this invoice number to contain the new encounter number.
 430     //
 431     $new_invnumber = "$pid.$new_encounter";
 432     $query = "UPDATE ar SET invnumber = '$new_invnumber' WHERE id = $invid";
 433     if ($debug) {
 434       echo $query . "<br>\n";
 435     } else {
 436       SLQuery($query);
 437       if ($sl_err) die($sl_err);
 438       $info_msg .= xl("This invoice number has been changed to ") . $new_invnumber;
 439     }
 440
 441     return $info_msg;
 442   }
 443 ?>