src/Billing/InvoiceSummary.php

   1 <?php
   2
   3 /**
   4  * @package OpenEMR
   5  * @author Rod Roark <rod@sunsetsystems.com>
   6  * @author Stephen Waite <stephen.waite@cmsvt.com>
   7  * @copyright Copyright (c) 2005-2020 Rod Roark <rod@sunsetsystems.com>
   8  * @copyright Copyright (c) 2018-2019 Stephen Waite <stephen.waite@cmsvt.com>
   9  * @link https://www.open-emr.org
  10  * @license https://github.com/openemr/openemr/blob/master/LICENSE GNU General Public License 3
  11  */
  12
  13 // This returns an associative array keyed on procedure code, representing
  14 // all charge items for one invoice.  This array's values are themselves
  15 // associative arrays having the following keys:
  16 //
  17 //  chg - the sum of line items, including adjustments, for the code
  18 //  bal - the unpaid balance
  19 //  adj - the (positive) sum of inverted adjustments
  20 //  ins - the id of the insurance company that was billed (obsolete)
  21 //  dtl - associative array of details, if requested
  22 //
  23 // Where details are requested, each dtl array is keyed on a string
  24 // beginning with a date in yyyy-mm-dd format, or blanks in the case
  25 // of the original charge items.  The value array is:
  26 //
  27 //  pmt - payment amount as a positive number, only for payments
  28 //  src - check number or other source, only for payments
  29 //  chg - invoice line item amount amount, only for charges or
  30 //        adjustments (adjustments may be zero)
  31 //  rsn - adjustment reason, only for adjustments
  32 //  plv - provided for "integrated A/R" only: 0=pt, 1=Ins1, etc.
  33 //  dsc - for tax charges, a description of the tax
  34 //  arseq - ar_activity.sequence_no when it applies.
  35 namespace OpenEMR\Billing;
  36
  37 require_once(dirname(__FILE__) . "/../../custom/code_types.inc.php");
  38
  39 use OpenEMR\Billing\SLEOB;
  40
  41 // for Integrated A/R.
  42 //
  43 class InvoiceSummary
  44 {
  45     public static function arGetInvoiceSummary($patient_id, $encounter_id, $with_detail = false)
  46     {
  47         $codes = array();
  48         $keysuff1 = 1000;
  49         $keysuff2 = 5000;
  50
  51         // Get charges from services.
  52         $res = sqlStatement("SELECT " .
  53             "date, code_type, code, modifier, code_text, fee " .
  54             "FROM billing WHERE " .
  55             "pid = ? AND encounter = ? AND " .
  56             "activity = 1 AND fee != 0.00 ORDER BY id", array($patient_id, $encounter_id));
  57
  58         while ($row = sqlFetchArray($res)) {
  59             $amount = sprintf('%01.2f', $row['fee']);
  60
  61             $code = $row['code'];
  62             if (!$code) {
  63                 $code = "Unknown";
  64             }
  65
  66             if ($row['modifier']) {
  67                 $code .= ':' . $row['modifier'];
  68             }
  69
  70             $codes[$code]['chg'] += $amount;
  71             $codes[$code]['bal'] += $amount;
  72
  73             // Pass the code type, code and code_text fields
  74             // Although not all used yet, useful information
  75             // to improve the statement reporting etc.
  76             $codes[$code]['code_type'] = $row['code_type'];
  77             $codes[$code]['code_value'] = $row['code'];
  78             $codes[$code]['modifier'] = $row['modifier'];
  79             $codes[$code]['code_text'] = $row['code_text'];
  80
  81             // Add the details if they want 'em.
  82             if ($with_detail) {
  83                 if (!$codes[$code]['dtl']) {
  84                     $codes[$code]['dtl'] = array();
  85                 }
  86
  87                 $tmp = array();
  88                 $tmp['chg'] = $amount;
  89                 $tmpkey = "          " . $keysuff1++;
  90                 $codes[$code]['dtl'][$tmpkey] = $tmp;
  91             }
  92         }
  93
  94         // Get charges from product sales.
  95         $query = "SELECT s.drug_id, s.sale_date, s.fee, s.quantity " .
  96             "FROM drug_sales AS s " .
  97             "WHERE " .
  98             "s.pid = ? AND s.encounter = ? AND s.fee != 0 " .
  99             "ORDER BY s.sale_id";
 100         $res = sqlStatement($query, array($patient_id, $encounter_id));
 101         while ($row = sqlFetchArray($res)) {
 102             $amount = sprintf('%01.2f', $row['fee']);
 103             $code = 'PROD:' . $row['drug_id'];
 104             $codes[$code]['chg'] += $amount;
 105             $codes[$code]['bal'] += $amount;
 106             // Add the details if they want 'em.
 107             if ($with_detail) {
 108                 if (!$codes[$code]['dtl']) {
 109                     $codes[$code]['dtl'] = array();
 110                 }
 111
 112                 $tmp = array();
 113                 $tmp['chg'] = $amount;
 114                 $tmpkey = "          " . $keysuff1++;
 115                 $codes[$code]['dtl'][$tmpkey] = $tmp;
 116             }
 117         }
 118         // Get insurance data for stuff
 119         $ins_data = array();
 120         $res = sqlStatement("SELECT insurance_data.type as type, insurance_companies.name as name " .
 121             "FROM insurance_data " .
 122             "INNER JOIN insurance_companies ON insurance_data.provider = insurance_companies.id " .
 123             "WHERE insurance_data.pid = ?", array($patient_id));
 124         while ($row = sqlFetchArray($res)) {
 125             $ins_data[$row['type']] = $row['name'];
 126         }
 127         // Get payments and adjustments. (includes copays)
 128         $res = sqlStatement("SELECT " .
 129             "a.code_type, a.code, a.modifier, a.memo, a.payer_type, a.adj_amount, a.pay_amount, a.reason_code, " .
 130             "a.post_time, a.session_id, a.sequence_no, a.account_code, a.follow_up_note, " .
 131             "s.payer_id, s.reference, s.check_date, s.deposit_date " .
 132             ",i.name " .
 133             "FROM ar_activity AS a " .
 134             "LEFT OUTER JOIN ar_session AS s ON s.session_id = a.session_id " .
 135             "LEFT OUTER JOIN insurance_companies AS i ON i.id = s.payer_id " .
 136             "WHERE a.deleted IS NULL AND a.pid = ? AND a.encounter = ? " .
 137             "ORDER BY s.check_date, a.sequence_no", array($patient_id, $encounter_id));
 138         while ($row = sqlFetchArray($res)) {
 139             $code = $row['code'];
 140             if (!$code) {
 141                 $code = "Unknown";
 142             }
 143
 144             if ($row['modifier']) {
 145                 $code .= ':' . $row['modifier'];
 146             }
 147
 148             $ins_id = 0 + $row['payer_id'];
 149             $codes[$code]['bal'] -= $row['pay_amount'];
 150             $codes[$code]['bal'] -= $row['adj_amount'];
 151             $codes[$code]['chg'] -= $row['adj_amount'];
 152             $codes[$code]['adj'] += $row['adj_amount'];
 153             if ($ins_id) {
 154                 $codes[$code]['ins'] = $ins_id;
 155             }
 156
 157             // Add the details if they want 'em.
 158             if ($with_detail) {
 159                 if (!$codes[$code]['dtl']) {
 160                     $codes[$code]['dtl'] = array();
 161                 }
 162
 163                 $tmp = array();
 164                 $paydate = empty($row['deposit_date']) ? substr($row['post_time'], 0, 10) : $row['deposit_date'];
 165                 if ($row['pay_amount'] != 0) {
 166                     $tmp['pmt'] = $row['pay_amount'];
 167                 }
 168
 169                 if (isset($row['reason_code'])) {
 170                     $tmp['msp'] = $row['reason_code'];
 171                 }
 172
 173                 if ($row['adj_amount'] != 0 || $row['pay_amount'] == 0) {
 174                     $tmp['chg'] = 0 - $row['adj_amount'];
 175                     // $tmp['rsn'] = (empty($row['memo']) || empty($row['session_id'])) ? 'Unknown adjustment' : $row['memo'];
 176                     $tmp['rsn'] = empty($row['memo']) ? $row['follow_up_note'] : $row['memo'];
 177                     $tmp['rsn'] = str_replace("Ins1", $ins_data['primary'], $tmp['rsn']);
 178                     $tmp['rsn'] = str_replace("Ins2", $ins_data['secondary'], $tmp['rsn']);
 179                     $tmp['rsn'] = str_replace("Ins3", $ins_data['tertiary'], $tmp['rsn']);
 180                     $tmpkey = $paydate . $keysuff1++;
 181                 } else {
 182                     $tmpkey = $paydate . $keysuff2++;
 183                 }
 184
 185                 if ($row['account_code'] == "PCP") {
 186                     //copay
 187                     $tmp['src'] = 'Pt Paid';
 188                 } else {
 189                     $tmp['src'] = empty($row['session_id']) ? $row['memo'] : $row['reference'];
 190                 }
 191
 192                 $tmp['insurance_company'] = substr($row['name'], 0, 10);
 193                 if ($ins_id) {
 194                     $tmp['ins'] = $ins_id;
 195                 }
 196
 197                 $tmp['plv'] = $row['payer_type'];
 198                 $tmp['arseq'] = $row['sequence_no'];
 199                 $codes[$code]['dtl'][$tmpkey] = $tmp;
 200             }
 201         }
 202
 203         return $codes;
 204     }
 205
 206 // This determines the party from whom payment is currently expected.
 207 // Returns: -1=Nobody, 0=Patient, 1=Ins1, 2=Ins2, 3=Ins3.
 208 // for Integrated A/R.
 209 //
 210     public static function arResponsibleParty($patient_id, $encounter_id)
 211     {
 212         $row = sqlQuery("SELECT date, last_level_billed, last_level_closed " .
 213             "FROM form_encounter WHERE " .
 214             "pid = ? AND encounter = ? " .
 215             "ORDER BY id DESC LIMIT 1", array($patient_id, $encounter_id));
 216         if (empty($row)) {
 217             return -1;
 218         }
 219
 220         $next_level = $row['last_level_closed'] + 1;
 221         if ($next_level <= $row['last_level_billed']) {
 222             return $next_level;
 223         }
 224
 225         if (SLEOB::arGetPayerID($patient_id, substr($row['date'], 0, 10), $next_level)) {
 226             return $next_level;
 227         }
 228
 229         // There is no unclosed insurance, so see if there is an unpaid balance.
 230         // Currently hoping that form_encounter.balance_due can be discarded.
 231         $balance = 0;
 232         $codes = self::arGetInvoiceSummary($patient_id, $encounter_id);
 233         foreach ($codes as $cdata) {
 234             $balance += $cdata['bal'];
 235         }
 236
 237         if ($balance > 0) {
 238             return 0;
 239         }
 240
 241         return -1;
 242     }
 243 }