SOS Query Library

Service Count, Total Charges, and Applied Payments by Provider and Patient Category

admin — Mon, 14 May 2012 15:59:43 +0000

We would like to know the income generated for services based on provider and patient category.

The following query shows these results in a “ROLLUP” grid, displaying both detail down to the service code level as well as subtotals and grand totals. When you run the query and examine the results, you should interpret “NULL” in the Provider, PtCategory, and Service columns as meaning “ALL”. For example, the row that shows NULL in all three of these columns is showing the totals for ALL providers, ALL ptcategories, and ALL service codes — in other words, the grand totals. A row that shows a specific provider and a specific category, but NULL in the Service column provides the subtotal of all service codes for the indicated provider and category. You could limit the result set by replacing the wildcard percent sign in the WHERE clause with a specific provider code and/or patient category code if you like.

Select All Code:

SELECT
   (a.provfname + ' '+a.provlname) AS "Provider",
   c.categcode AS "PtCategory",
   a.srvcode AS "Service",
   COUNT(DISTINCT jnum) AS "Srv Count",
   SUM(a.chgsplamt) AS "TotalCharges",
   SUM(COALESCE((SELECT SUM(COALESCE(crsplamt,0)) FROM rv_creditsplits
   WHERE  chgsplnum = a.chgsplnum AND credtype IN ('CASH','CHECK','CHARGE')),0)) AS "TotalPayments"
FROM
   rv_charges a
   JOIN patients b ON a.ptnum = b.ptnum
   LEFT OUTER JOIN ptcategs c ON b.ptcategnum = c.ptcategnum
WHERE
   a.trandate BETWEEN '1980-01-01' AND '2008-12-31'
   AND a.provcode LIKE '%'
   AND "PtCategory" LIKE '%'
GROUP BY
  ROLLUP ("Provider","PtCategory","Service")

Appointment Count by Patient Category and Appointment Type

admin — Tue, 24 Apr 2012 20:01:46 +0000

We need a report that provides total number of a particular type of appointment by pt category for a specified period.

Be sure to adjust the date range in the WHERE clause for your desired period.

This query uses the GROUP BY ROLLUP ( ) statement to give grand and subtotals as well as the results for each specific patient category, provider type, and service code combination. Wherever you see NULL in the result set, interpret as “ALL”.

Select All Code:

SELECT
  COALESCE(d.categcode,'None') AS "PtCategory",
  COALESCE(f.ApptType,'None') AS "ApptType",
  COUNT(DISTINCT a.detailnum) AS ApptCount
FROM
  appt_d a
  JOIN patients c ON a.ptnum = c.ptnum
  LEFT OUTER JOIN ptcategs d ON c.ptcategnum = d.ptcategnum 
  LEFT OUTER JOIN appttypes f ON a.appttypenum = f.appttypenum
WHERE 
  a.adate BETWEEN '2012-01-01' AND '2012-12-31'
  AND c.licnum = 101
GROUP BY ROLLUP ("PtCategory","ApptType")

Service Count and Units By Patient Category, Provider Type, and Service Code

admin — Tue, 24 Apr 2012 19:58:23 +0000

We need a report that provides units provided/charges for a specified patient category, broken down by provider type and service code for a specified date range from both active and inactive clients in dataset 101.

Be sure to adjust the date range in the WHERE clause for your desired period.

Select All Code:

SELECT
  COALESCE(d.categcode,'None') AS "PtCategory",
  COALESCE(f.provtypecode,'None') AS "ProvType",
  g.srvcode AS "ServiceCode",
  COUNT(DISTINCT b.jnum) AS ServiceCount,
  SUM(b.units) AS TotalUnits
FROM
  journal a
  JOIN jcharges b ON a.jnum = b.jnum
  JOIN patients c ON a.ptnum = c.ptnum
  LEFT OUTER JOIN ptcategs d ON c.ptcategnum = d.ptcategnum
  JOIN providers e ON b.providernum = e.providernum
  JOIN services g ON b.servicenum = g.servicenum
  LEFT OUTER JOIN provtype f ON e.provtypenum = f.provtypenum
WHERE
  a.trandate BETWEEN '2012-01-01' AND '2012-12-31'
  AND a.amount > 0
  AND c.licnum = 101
GROUP BY ROLLUP ("PtCategory","ProvType","ServiceCode")

Count of Intakes for Past 365 Days With Specified Dx

admin — Tue, 17 Apr 2012 21:18:11 +0000

We need the total number of new (the past 365 days) intakes that were given a primary or secondary diagnosis of 304.4, including sub-diagnoses. In addition to the grand total, we also would like a breakdown by provider.

The following query demonstrates some simple date arithmetic in the WHERE clause to provide a dynamic calculation of the date 365 days ago. In addition, we are using the GROUP BY ROLLUP ( … ) structure to get both the grand total and the subtotals in the same result set. When you run the query you will see a top row where NULL appears in the provider and provcode columns. In this context, whereever you see NULL, it actually should be interpreted as “all”. The first row then shows the number of intakes for “all providers” and “all provcodes,” in other words, the grand total.

Select All Code:

SELECT
  UPPER(provlname) + ', ' + provfname AS "Provider",provcode, COUNT(DISTINCT pt.ptnum) AS "N"
FROM
  patients pt
  JOIN ptcsu csu ON pt.ptnum = csu.ptnum
  JOIN ptcsudx ptdx ON csu.ptcsunum = ptdx.ptcsunum
  JOIN providers prv ON pt.providernum = prv.providernum
WHERE
  (pt.intakedate >= (TODAY()-365))
  AND (dxcode1 LIKE '304.4%' OR dxcode2 LIKE '304.4%')
GROUP BY
  ROLLUP ("Provider",provcode)

Balance Breakdown By Patient On Specified Date

admin — Wed, 11 Apr 2012 17:02:16 +0000

Our auditors have requested a report of outstanding balances per client, as of Dec 31, 2011, separated by liability (Medicare, Medicaid, private insurance and self-pay). Insurance type is specified by “Coverage Type” on the Additional tab of the Insurance Carrie/Plan. We want to report patients in either the Active or Inactive lists, as long as they have a balance of some kind at the end of 2011.

Because we are looking for balances on a previous date, we have to tally up all the charges and payments on or before that date, then subtract the latter from the former to find the balance. To do that will require a bunch of embedded subqueries as you can see in the query below. If you want to run the query for a different date, be sure to replace ALL the instances of ’2011-12-31′!

The output specified in this example will go to an HTML format file called AUDIT2011.HTML located in the C:\SOS folder. You can output the results to screen for inspection before outputting to file by inserting two dashes or slashes at the beginning of the last line. Just remove those characters when you are ready to generate the file. The benefit of outputting in HTML format is that you can view the results in a web browser, or open the file with Excel for additional massaging.

Select All Code:

SELECT
   a.lastname, a.firstname, a.id AS "Account ID",
   -- Medicare
   COALESCE((SELECT SUM(chgsplamt) 
   FROM jchgsplits chs JOIN ptpayors ptp ON chs.ptpayornum = ptp.ptpayornum JOIN carriers car ON ptp.payornum = car.payornum
   WHERE chs.ptnum = a.ptnum AND car.coverage = 'C' AND chs.chgspldate <= '2011-12-31'),0) AS "Medicare Charges",
   COALESCE((SELECT SUM(crsplamt) 
   FROM jcrsplits crs 
     JOIN jchgsplits chs ON crs.chgsplnum = chs.chgsplnum 
     JOIN ptpayors ptp ON chs.ptpayornum = ptp.ptpayornum 
     JOIN carriers car ON ptp.payornum = car.payornum 
     JOIN jcredits cre ON crs.jnum = cre.jnum 
     JOIN journal jou ON cre.jnum = jou.jnum
   WHERE chs.ptnum = a.ptnum 
     AND car.coverage = 'C' 
     AND chs.chgspldate <= '2011-12-31' 
     AND jou.trandate <= '2011-12-31') ,0) AS "Medicare Credits",
   ("Medicare Charges" - "Medicare Credits") AS "Medicare Balance",
  -- Medicaid
   COALESCE((SELECT SUM(chgsplamt) 
   FROM jchgsplits chs JOIN ptpayors ptp ON chs.ptpayornum = ptp.ptpayornum JOIN carriers car ON ptp.payornum = car.payornum
   WHERE chs.ptnum = a.ptnum AND car.coverage = 'D' AND chs.chgspldate <= '2011-12-31'),0) AS "Medicaid Charges",
   COALESCE((SELECT SUM(crsplamt) 
   FROM jcrsplits crs 
     JOIN jchgsplits chs ON crs.chgsplnum = chs.chgsplnum 
     JOIN ptpayors ptp ON chs.ptpayornum = ptp.ptpayornum 
     JOIN carriers car ON ptp.payornum = car.payornum 
     JOIN jcredits cre ON crs.jnum = cre.jnum 
     JOIN journal jou ON cre.jnum = jou.jnum
   WHERE chs.ptnum = a.ptnum 
     AND car.coverage = 'D' 
     AND chs.chgspldate <= '2011-12-31' 
     AND jou.trandate <= '2011-12-31' ) ,0) AS "Medicaid Credits",
   ("Medicaid Charges" - "Medicaid Credits") AS "Medicaid Balance",
   -- Private Ins 
   COALESCE((SELECT SUM(chgsplamt) 
   FROM jchgsplits chs JOIN ptpayors ptp ON chs.ptpayornum = ptp.ptpayornum JOIN carriers car ON ptp.payornum = car.payornum
   WHERE chs.ptnum = a.ptnum AND car.coverage NOT IN ('C','D') AND chs.chgspldate <= '2011-12-31'),0) AS "Private Ins Charges",
   COALESCE((SELECT SUM(crsplamt) 
   FROM jcrsplits crs 
     JOIN jchgsplits chs ON crs.chgsplnum = chs.chgsplnum 
     JOIN ptpayors ptp ON chs.ptpayornum = ptp.ptpayornum 
     JOIN carriers car ON ptp.payornum = car.payornum 
     JOIN jcredits cre ON crs.jnum = cre.jnum 
     JOIN journal jou ON cre.jnum = jou.jnum
   WHERE chs.ptnum = a.ptnum 
     AND car.coverage NOT IN ('C','D') 
     AND chs.chgspldate <= '2011-12-31' 
     AND jou.trandate <= '2011-12-31' ) ,0) AS "Private Ins Credits",
   ("Private Ins Charges" - "Private Ins Credits") AS "Private Ins Balance",
   -- Self-Pay
   COALESCE((SELECT SUM(chgsplamt) 
   FROM jchgsplits chs JOIN ptpayors ptp ON chs.ptpayornum = ptp.ptpayornum JOIN payors pay ON ptp.payornum = pay.payornum
   WHERE chs.ptnum = a.ptnum AND pay.payortype IN ('P','O') AND chs.chgspldate <= '2011-12-31'),0) AS "Self-Pay Charges",
   COALESCE((SELECT SUM(crsplamt) 
   FROM jcrsplits crs 
     JOIN jchgsplits chs ON crs.chgsplnum = chs.chgsplnum 
     JOIN ptpayors ptp ON chs.ptpayornum = ptp.ptpayornum 
     JOIN payors pay ON ptp.payornum = pay.payornum
     JOIN jcredits cre ON crs.jnum = cre.jnum 
     JOIN journal jou ON cre.jnum = jou.jnum
   WHERE chs.ptnum = a.ptnum 
     AND pay.payortype IN ('P','O') 
     AND chs.chgspldate <= '2011-12-31' 
     AND jou.trandate <= '2011-12-31' ) ,0) AS "Self-Pay Credits",
   ("Self-Pay Charges" - "Self-Pay Credits") AS "Self-Pay Balance"
 
FROM 
  patients a  
WHERE
  "Medicare Balance" <> 0
  OR "Medicaid Balance" <> 0
  OR "Private Ins Balance" <> 0
  OR "Self-Pay Balance" <> 0
ORDER BY
  a.lastname, a.firstname, a.id

Insurance Carriers with Active Patients

admin — Fri, 30 Mar 2012 15:55:33 +0000

In order to clean up my list of insurance carriers in SOS I would like to list all active Insurance Carrier’s/ Plans (defined as insurances with Patients tied to them) with their Address, Phone number, and NEIC Numbers. Actually I would like this list with just the count of active patient accounts, and a second list that includes the patients linked to each carrier.

This request is a little vague in that it is not clear whether the linked patients should be restricted to active patients or not. The first query assumes that it is only carriers linked to active patients (in the Active Patient List and without a discharge date), but you can just remove the flag and dischargedate conditions in the WHERE clause to get carriers linked to any patient.

Select All Code:

SELECT
  c.payorname AS "Ins Plan",
  COUNT(a.ptnum) AS "ActivePatientCount",
  c.PayorNum,
  d.companynum AS "NEIC#",
  c.Addr1,
  c.Addr2,
  c.City,
  c.State,
  c.Zip,
  c.Phone1Desc,
  (c.phone1area+'-'+phone1) AS "Phone1",
  c.Phone2Desc,
  (c.phone2area+'-'+phone2) AS "Phone2",
  c.Phone3Desc,
  (c.phone3area+'-'+phone3) AS "Phone3"
FROM
  patients a
  JOIN ptpayors b ON a.ptnum = b.ptnum
  JOIN payors c ON b.payornum = c.payornum
  JOIN carriers d ON c.payornum = d.payornum
WHERE
  a.flag = 0
  AND a.dischargedate IS NULL
  AND c.payortype = 'I'
GROUP BY
  "Ins Plan",c.payornum,"NEIC#",c.Addr1, c.Addr2, c.City, c.State, c.Zip,c.Phone1Desc,"Phone1",c.Phone2Desc,"Phone2",c.Phone3Desc,"Phone3"
HAVING
  "ActivePatientCount" > 0
ORDER BY
  c.payorname, c.payornum

The second query removes the COUNT function, the GROUP BY and HAVING clauses, and adds the patient names and ID’s.

Select All Code:

SELECT
  c.payorname AS "Ins Plan",
  c.PayorNum,
  (UPPER(a.lastname)+', '+a.firstname+' / '+a.id) AS "Patient Name/ID",
  d.companynum AS "NEIC#",
  c.Addr1 AS "InsAddr1",
  c.Addr2 AS "InsAddr2",
  c.City AS "InsCity",
  c.State AS "InsState",
  c.Zip AS "InsZip",
  c.Phone1Desc AS "InsPhone1Desc",
  (c.phone1area+'-'+phone1) AS "Phone1",
  c.Phone2Desc AS "InsPhone2Desc",
  (c.phone2area+'-'+phone2) AS "Phone2",
  c.Phone3Desc AS "InsPhone3Desc",
  (c.phone3area+'-'+phone3) AS "Phone3"
FROM
  patients a
  JOIN ptpayors b ON a.ptnum = b.ptnum
  JOIN payors c ON b.payornum = c.payornum
  JOIN carriers d ON c.payornum = d.payornum
WHERE
  a.flag = 0
  AND a.dischargedate IS NULL
  AND c.payortype = 'I'
ORDER BY
  c.payorname, c.payornum

Flyspeed SQL Query: How to configure your SOSDATA connection

seth — Thu, 15 Mar 2012 20:43:52 +0000

Flyspeed is a general purpose query tool that is compatible with SOS’s Sybase SQL Anywhere database, as well as most other popular databases, such as Microsoft SQL Server. It provides structure that will be welcome to those who are new to SQL, as well as to those who are SQL experts. Flyspeed is free, but if you would like to print or export the results of your queries you will have to purchase a $29 license. See http://www.activedbsoft.com/overview-querytool.html for more details.

Once you have your copy of Flyspeed, just follow these steps to get started:

Make sure that you have followed the instructions in http://www.sosoft.com/queries/how2010/ or http://www.sosoft.com/queries/how2009/ (depending on the version of SOS you are using). Do a simple query using the SOS-provided DBISQL utility to be sure everything is working: SELECT * FROM PATIENTS for example.
Now start up Flyspeed.
Select Connection > New Connection from the menu at the top of the screen to launch the New Connection Wizard.
On the Database Server window, select "Generic ODBC Connection" as the Connection Type. For SQL Syntax, select "Sybase". A third field, Server version, will appear. Make sure it says "Sybase ASA" (NOT "Sybase ASE"), then click Next.
On the Connection properties window, select the first option, System/User DSN, and type or select SOSDATA. If you are on a secure workstation, you can add your SOS login ID and, optionally, password so that you can connect without having to enter your credentials each time. Be sure to type your password in all UPPERCASE. If, and only if, your workstation is secure and not located in a public area, you may check the Save password option. Click Next.
Finally, give the connection a name, such as "SOS", and click Finish. You will see your connection listed in the pane on the left. Click the little plus to the left of the connection name to expand it. You will see a folder in which you can save your queries and other folders containing all the base tables and views in the SOSDATA database. If at some point you want to query other databases you may have on your network, they can be added in a similar fashion. In the screenshot below you will see several of the other databases running here at SOS in the list.
To start working on your first query, click the New Query button in the toolbar at the top.
Next, click the Add Object button in the toolbar to select the tables, views, or both for your query. Ignore the system objects and scroll right until you see items that you recognize, starting with "AdjustX" (adjustment explanations) in the tables, and "AGINGBYSORTCODE" in the views. As soon as you select the first one, you will see your query start to take shape in the worksheet. If you add more than one object (table or view), drag from a field in one object to the appropriate field in a second object to create a JOIN to link the two. You can change the type of JOIN by right-clicking on the line that will appear between the two objects.
Click the checkboxes next to the columns/fields you want to output in your query, and configure your filter conditions in the middle pane of the worksheet.

That should be enough to get you started. There is no way for you to damage the database, so feel free to experiment.

Medicaid Patients by Rendering Provider within Specified Date Range

admin — Thu, 08 Mar 2012 22:41:09 +0000

I need a report that lists Medicaid clients seen between a specific date range by rendering provider.

The following query should deliver the goods. Because we are looking at RENDERING provider, the same patient may be listed two or more times, depending on the number of different providers seen during the specified period. Speaking of period, be sure to adjust the desired date range in the first condition under WHERE.

Notice that the second word of the query is DISTINCT. Adding that keyword after SELECT eliminates duplicate rows in the output. Without that word, there would be a row for every matching charge in each patient’s ledger.

Select All Code:

SELECT DISTINCT
  (prv.provlname + ', '+ prv.provfname + ' (' + prv.provcode + ')') AS "provider",
  (UPPER(pt.lastname) +', '+ pt.firstname+ ' '+ pt.midinit) AS "ptfullname",
  ('Acct ID: '+ pt.id) AS "acctid",
  ('Medicaid #: ' + pol.insdid) AS "medicaidnum"
FROM
  patients pt
  JOIN ptpayors ptp ON pt.ptnum = ptp.ptnum
  JOIN carriers car ON ptp.payornum = car.payornum
  JOIN ptpolicies pol ON ptp.ptpayornum = pol.ptpayornum
  JOIN journal jou ON pt.ptnum = jou.ptnum
  JOIN jcharges chg ON jou.jnum = chg.jnum
  JOIN providers prv ON chg.providernum = prv.providernum
WHERE
  -- desired date range of charge entries
  jou.trandate BETWEEN '2000-01-01' AND '2012-3-31'
  -- carrier is set as "Medicaid"
  AND (car.coverage = 'D' OR car.insflag = 'A')
  -- the Medicaid policy was active on the date of the charge entry
  AND jou.trandate BETWEEN COALESCE(pol.active,'1900-01-01') AND COALESCE(pol.inactive,'2100-12-31')
ORDER BY
  "provider","ptfullname"

Checking for Fields that Should Be Included in Encounter Import

admin — Wed, 07 Mar 2012 22:16:48 +0000

The following query generates an HTML report that indicates the field elements that should be considered for inclusion if you are planning to import encounter data from a third-party product for billing by SOS Office Manager. The previous year of charge entries are analyzed.

Select All Code:

SELECT 'Total Charge Count',COUNT(*) FROM journal JOIN jcharges WHERE trandate > (today() - 365)
UNION
SELECT 'CSU = U',COUNT(*) FROM journal JOIN jcharges WHERE trandate > (today() - 365) AND csutype = 'u'
UNION
SELECT 'CSU = N',COUNT(*) FROM journal JOIN jcharges WHERE trandate > (today() - 365) AND csutype = 'n'
UNION
SELECT 'Date Range',COUNT(*) FROM journal JOIN jcharges WHERE trandate > (today() - 365) AND COALESCE(startdate,trandate) <> trandate
UNION
SELECT 'Units <> 1',COUNT(*) FROM journal JOIN jcharges WHERE trandate > (today() - 365) AND units <> 1
UNION
SELECT 'Cost',COUNT(*) FROM journal JOIN jcharges WHERE trandate > (today() - 365) AND COALESCE(cost,0) <> 0
UNION
SELECT 'CPT Modifiers',COUNT(*) FROM journal JOIN jcharges WHERE trandate > (today() - 365) AND COALESCE(cptmod1,'')+COALESCE(cptmod2,'')+COALESCE(cptmod3,'')+COALESCE(cptmod4,'') <> ''
UNION
SELECT 'Non-default POS',COUNT(*) FROM journal JOIN jcharges WHERE trandate > (today() - 365) AND poscodenum <> (SELECT lastpos FROM ptvars WHERE ptnum = journal.ptnum)
UNION
SELECT 'FP',COUNT(*) FROM journal JOIN jcharges WHERE trandate > (today() - 365) AND COALESCE(fp,'') <> ''
UNION
SELECT 'EMG',COUNT(*) FROM journal JOIN jcharges WHERE trandate > (today() - 365) AND COALESCE(emergency,'') <> ''
UNION
SELECT 'COB',COUNT(*) FROM journal JOIN jcharges WHERE trandate > (today() - 365) AND COALESCE(cob,'') <> ''
UNION
SELECT 'Box 24K',COUNT(*) FROM journal JOIN jcharges WHERE trandate > (today() - 365) AND COALESCE(box24k,'') <> ''
UNION
SELECT 'Lab Charge',COUNT(*) FROM journal JOIN jcharges WHERE trandate > (today() - 365) AND COALESCE(labchg,0) <> 0
UNION
SELECT 'SortCode',COUNT(*) FROM journal JOIN jcharges WHERE trandate > (today() - 365) AND COALESCE(sortcode,0) <> 0
UNION
SELECT 'Comment1',COUNT(*) FROM journal JOIN jcharges WHERE trandate > (today() - 365) AND COALESCE(comment1,'') <> ''
UNION
SELECT 'Comment2',COUNT(*) FROM journal JOIN jcharges WHERE trandate > (today() - 365) AND COALESCE(comment2,'') <> ''
UNION
SELECT 'Remark',COUNT(*) FROM journal JOIN jcharges WHERE trandate > (today() - 365) AND COALESCE(remark,'') <> ''
UNION
SELECT 'Memo',COUNT(*) FROM journal JOIN jcharges WHERE trandate > (today() - 365) AND COALESCE(memo,'') <> ''
UNION
SELECT 'MemoHA0',COUNT(*) FROM journal JOIN jcharges WHERE trandate > (today() - 365) AND COALESCE(memoisha0,0) <> 0
;
OUTPUT TO 'c:\sos\ChargeImportCheck.html' format html
;

Identifying Accounts with Unapplied “Balance Forward” Amounts

seth — Fri, 17 Feb 2012 21:44:50 +0000

During the conversion of data from the old DOS software to the Windows version of SOS, one option was to create a dummy payor called “Balance Forward” and initialize it with the total balance from the old software. Years later, some customers have had difficulties determining accurate account balances because of credit amounts that linger as unapplied payments attributed to the Balance Forward payor. The following query lists the accounts showing this issue.

Select All Code:

SELECT 
  fullnameid, 
  licnum AS dataset, 
  (IF flag = 0 THEN 'active' ELSE 'inactive' ENDIF) AS PtList,
  SUM(crsplamt) AS Tot_Unapplied
FROM 
  rv_creditsplits
WHERE 
  payornum = 2
AND 
  (chgsplnum = 0 OR chgsplnum IS NULL)
GROUP BY 
  fullnameid, licnum, ptlist
ORDER BY 
  fullnameid