$TXT Created by THAYER,CHRISTOPHER at DEVVFF.FO-ALBANY.MED.VA.GOV (KIDS) on Friday, 05/11/12 at 09:52 ============================================================================= Run Date: AUG 06, 2012 Designation: FB*3.5*108 Package : FB - FEE BASIS Priority: Mandatory Version : 3.5 SEQ #115 Status: Released Compliance Date: SEP 06, 2012 ============================================================================= Associated patches: (v)FB*3.5*25 <<= must be installed BEFORE `FB*3.5*108' (v)FB*3.5*67 <<= must be installed BEFORE `FB*3.5*108' (v)FB*3.5*68 <<= must be installed BEFORE `FB*3.5*108' (v)FB*3.5*79 <<= must be installed BEFORE `FB*3.5*108' (v)FB*3.5*82 <<= must be installed BEFORE `FB*3.5*108' (v)FB*3.5*98 <<= must be installed BEFORE `FB*3.5*108' (v)FB*3.5*103 <<= must be installed BEFORE `FB*3.5*108' (v)FB*3.5*107 <<= must be installed BEFORE `FB*3.5*108' (v)FB*3.5*116 <<= must be installed BEFORE `FB*3.5*108' (v)FB*3.5*122 <<= must be installed BEFORE `FB*3.5*108' (v)FB*3.5*133 <<= must be installed BEFORE `FB*3.5*108' Subject: FEE DATA & HERO ENHANCEMENT Category: - Enhancement (Mandatory) - Data Dictionary - Routine - Input Template - Other Description: ============ This patch enhances Fee Basis to capture additional data associated with Non-VA care. Contracts can be specified for Medical Fee and Civil Hospital authorizations and payments. Civil hospital invoices will allow entry of larger dollar amounts, additional diagnosis codes, present on admission indicators, the admitting diagnosis code, and additional procedure codes. The existing transmissions to NVH Pricer and Central Fee will be modified to include additional data elements. The transmission of these additional data elements will make it possible to comply with inpatient pricing requirements and improve the ability of the VA to review and report on purchased care. The changes made by this patch are described below: 1. CONTRACTED SERVICES AND CONTRACTS This patch allows contracts to be entered for Medical Fee and Civil Hospital authorizations and payments. Payment transactions sent from VistA to Central Fee will be modified to include the contract number. The contract number will be used to identify payments for pilot project HERO. Contracts not associated with project HERO can also be entered and tracked using the new functionality. The new contract functionality does not replace or modify the existing use of contracts in the Community Nursing Home module. This patch also modifies VistA Fee Basis to prevent payments for unauthorized claims from being considered as contracted services. 1A. New Contract File This patch adds a new FEE BASIS CONTRACT (#161.43) file. This file contains a list of contracts for the local site. Each contract can have one or more associated vendors. A new option allows users to enter or edit contracts in this file. The option is named Contract File Enter/Edit [FBAA CONTRACT FILE]. The option is locked with the FBAASUPERVISOR security key. It is attached to the Supervisor Main Menu [FBAA SUPERVISOR OPTIONS]. Four existing options are moved from the supervisor menu to a new sub-menu to make room for the new contract option. The new sub-menu is the Unauthorized Claims File Menu [FBCU FILE MENU]. The options moved to this menu are: Add New Person for Unauthorized Claim [FBUC ADD NEW PERSON] Disapproval Reasons File Enter/Edit [FBUC DISAPPROVAL REASONS FILE] Dispositions File Edit [FBUC DISPOSITIONS FILE] Request Info File Enter/Edit [FBUC REQUEST INFO FILE] 1B. Project HERO Contracts The patch will automatically enter the following two contracts into the FEE BASIS CONTRACT file for sites that are in VISN 8, 16, 20, or 23. CONTRACT NUMBER ASSOCIATED VENDOR ID VA101(049A3)-P-0269 942761537 (Delta) VA101049A3-P-0270 208418853 (HVHS) These two contracts are for pilot project HERO. Sites in these VISNs must ensure that a project HERO contract is specified on all appropriate authorizations and payments. These contract numbers will be used by the Austin database to track services provided under project HERO. 1C. Identify Contract on Authorization The patch modifies the software so users can select a contract when entering or editing authorizations under the Medical Fee and Civil Hospital modules. Only contracts with an active status can be selected. Only contracts associated with the authorized vendor can be selected. Therefore, contracts cannot be entered on a Medical Fee authorization that does not have a specified vendor. Note: Sites that wish to enter contracts on Medical Fee authorizations must ensure the site parameter "ASK VENDOR DURING AUTH." is set to "Y" so vendors can be entered on the authorization. 1D. Payments for Unauthorized Claims not for a Contracted Service This patch modifies the software to stop asking the user if a line item is for a contracted service when a payment for an unauthorized claim is entered or edited. The system shall automatically consider these payments as not being for contracted services. This modification will prevent an interest penalty from being applied to payments for unauthorized claims. This modification applies to payments for all claims entered via the unauthorized claims module including those considered under the provisions of 38 U.S.C. 1725 and 38 U.S.C. 1728. It will not be possible to specify a contract on payments for unauthorized claims. 1E. Identify Contract on Invoice/Payment The patch modifies the software so a contract can be specified when Medical Fee and Civil Hospital invoices/payments are entered or edited. The following rules will apply: o If a contract is specified on the associated authorization and the vendor being paid matches the vendor on the authorization, the software will automatically identify the payment as a contracted service under the same contract as on the authorization. o If the contract is not automatically selected due to the authorization (see above) and the user indicates that the line item is for a contracted service, the user is prompted for a contract. This is an optional field. Only contracts with an active status can be selected. Only contracts associated with the vendor being paid can be selected. 2. ADDITIONAL DATA AND LARGER $ AMOUNTS FOR CIVIL HOSPITAL INVOICE This patch modifies civil hospital authorizations and invoices and the Generic Pricer option. The maximum dollar amount is increased from $999,999.99 to $9,999,999.99. The maximum number of diagnosis codes and maximum number of procedure codes is increased from 5 to 25. Additional data elements must be entered on the invoice and generic Pricer. A present on admission indicator (POA) must be entered for each diagnosis code. An admitting diagnosis code must be entered. These new data elements will be included in the message sent to the NVH Pricer system and in the B9 payment transaction sent to Central Fee. 2A. Present on Admission Indicator This patch modifies the software to require entry of a POA (present on admission indicator) for each diagnosis code on a civil hospital invoice and generic Pricer. An example follows: POA1: ? Enter the present on admission indicator for the ICD1 diagnosis. Answer with PRESENT ON ADMISSION CODE Choose from: 1 Unreported/Not used. Exempt from POA reporting. N Diagnosis was not present at time of inpatient admission. U Documentation insufficient to determine. W Provider unable to clinically determine. Y Diagnosis was present at time of inpatient admission. 2B. Admitting Diagnosis This patch modifies the software to require entry of an Admitting Diagnosis on a civil hospital invoice and a generic Pricer. An example follows: ADMITTING DIAGNOSIS: ? Enter the admitting diagnosis for this claim. Answer with ICD DIAGNOSIS CODE NUMBER, or DESCRIPTION Do you want the entire 14954-Entry ICD DIAGNOSIS List? 3. SEND EDI CLAIM IDENTIFIER TO CENTRAL FEE This patch modifies VistA Fee Basis to include an EDI identifier in the B3 (outpatient and ancillary), B5 (pharmacy), and B9 (civil hospital and community nursing home) payment transactions that are sent to Central Fee. No additional data entry is required since EDI claims will be identified using the existing FPPS CLAIM ID field. 4. SEND PATIENT ACCOUNT NUMBER TO CENTRAL FEE This patch modifies VistA Fee Basis to include the value of the existing PATIENT ACCOUNT NUMBER field in the B3 (outpatient and ancillary) payment transaction that is sent to Central Fee. This patch modifies VistA Fee Basis to include the value of the existing PATIENT CONTROL NUMBER field in the B9 (civil hospital and community nursing home) payment transaction that is sent to Central Fee. 5. REDUCE RISK OF INTERFACE ERRORS This patch contains new line limits for payment batches. It also examines several data fields that are sent in a batch message to ensure the space allotted for that field is not exceeded. 5A. Batch Line Limits Central Fee can only accept 32K characters in a single payment batch. Since this patch includes additional data in payment batches, the maximum number of lines in a batch must be reduced to avoid a reject of the entire batch by Central Fee. This patch reduces the maximum size of a payment batch from 100 to 85 lines. This limit applies to the B3 (outpatient and ancillary) and B5 (pharmacy) payment batches. This patch introduces a maximum 42 line limit for the contract hospital batch and a maximum 61 line limit for the community nursing home batch. The following site parameters control these limits. MAX # PAYMENT LINE ITEMS: 85// ?? The maximum number of payment line items that will be allowed in a batch. Any number between 1 and 85 is acceptable. This value is checked during the enter payment options and will warn the clerks when they are within 20 of the maximum. It will prevent the clerks from exceeding this number. MAX # CH PAYMENT LINES: 42// ?? The maximum number of payment line items that will be allowed in a contract hospital batch. This value is checked during the enter payment options and will warn the clerks when they are within 5 of the maximum. It will prevent the clerks from exceeding this number. MAX # CNH PAYMENT LINES: 61// ?? The maximum number of payment line items that will be allowed in a community nursing home batch. This value is checked during the enter payment options and will warn the clerks when they are within 5 of the maximum. It will prevent the clerks from exceeding this number. 5B. Length of Stay on Pricer Transaction The NVH Pricer system in Austin does not support a length of stay greater than 999 days. The message sent from VistA to the NVH Pricer only allocates 3 digits for the computed length of stay value. Austin has reported instances where the message sent from VistA has included more than 3 digits for the length of stay resulting in a formatting error. This patch modifies the Generic Pricer option to prevent entry of a discharge date that is more than 999 days after the admission date. This patch also modifies the Pricer batch message to send "***" as the length of stay if the computed value exceeds 3 digits. This will result in a reject of the line by the NVH Pricer, but the remaining lines in the batch will no longer be adversely impacted. 5C. State Abbreviation The message sent to the NVH Pricer and the B3, B5, and B9 payment batch sent to Central Fee contain a two character state abbreviation. In some cases, the 'state' CANADA was selected. This 'state' has a five character abbreviation in the STATE file and the entire value was being placed in the message resulting in a format error. This patch modifies these messages to send "**" as the state abbreviation if the state abbreviation exceeds 2 characters. This will result in a reject of the line, but the remaining lines in the batch will no longer be adversely impacted. Patch Components ================ Files & Fields Associated: File Name (Number) Field Name (Number) New/Modified/Deleted ------------------ ------------------- -------------------- FEE BASIS PATIENT (161) CONTRACT (#105) New FEE BASIS SITE PARAMETERS (161.4) MAX # PAYMENT LINE ITEMS (#17) New MAX # CH PAYMENT LINES (#17.1) New MAX # CNH PAYMENT LINES (#17.2) New PRESENT ON ADMISSION (161.94) New FEE BASIS PAYMENT (162) CONTRACT (#54) New VA FORM 10-7078 (162.4) ESTIMATED AMOUNT (#6) Modified FEE BASIS INVOICE (162.5) BILLED CHARGES (#6.6) Modified AMOUNT CLAIMED (#7) Modified AMOUNT PAID (#8) Modified AMOUNT SUSPENDED (#9) Modified NVH PRICER AMOUNT (#26) Modified POA1 (#30.02) New POA2 (#31.02) New POA3 (#32.02) New POA4 (#33.02) New POA5 (#34.02) New ICD6 (#35) New POA6 (#35.02) New ICD7 (#35.1) New POA7 (#35.12) New ICD8 (#35.2) New POA8 (#35.22) New ICD9 (#35.3) New POA9 (#35.32) New ICD10 (#35.4) New POA10 (#35.42) New ICD11 (#35.5) New POA11 (#35.52) New ICD12 (#35.6) New POA12 (#35.62) New ICD13 (#35.7) New POA13 (#35.72) New ICD14 (#35.8) New POA14 (#35.82) New ICD15 (#35.9) New POA15 (#35.92) New ICD16 (#36) New POA16 (#36.02) New ICD17 (#36.1) New POA17 (#36.12) New ICD18 (#36.2) New POA18 (#36.22) New ICD19 (#36.3) New POA19 (#36.32) New ICD20 (#36.4) New POA20 (#36.42) New ICD21 (#36.5) New POA21 (#36.52) New ICD22 (#36.6) New POA22 (#36.62) New ICD23 (#36.7) New POA23 (#36.72) New ICD24 (#36.8) New POA24 (#36.82) New ICD25 (#36.9) New POA25 (#36.92) New ADMITTING DIAGNOSIS (#39) New PROC6 (#44.06) New PROC7 (#44.07) New PROC8 (#44.08) New PROC9 (#44.09) New PROC10 (#44.1) New PROC11 (#44.11) New PROC12 (#44.12) New PROC13 (#44.13) New PROC14 (#44.14) New PROC15 (#44.15) New PROC16 (#44.16) New PROC17 (#44.17) New PROC18 (#44.18) New PROC19 (#44.19) New PROC20 (#44.2) New PROC21 (#44.21) New PROC22 (#44.22) New PROC23 (#44.23) New PROC24 (#44.24) New PROC25 (#44.25) New CONTRACT (#60) New ADJUSTMENT AMOUNT (#2) Modified Forms Associated: Form Name File # New/Modified/Deleted --------- ------ -------------------- N/A Mail Groups Associated: Mail Group Name New/Modified/Deleted --------------- -------------------- N/A Options Associated: Option Name Type New/Modified/Deleted ----------- ---- -------------------- FBAA CONTRACT FILE run routine new FBAA SUPERVISOR OPTIONS menu modified FBUC ADD NEW PERSON run routine Modified FBUC DISAPPROVAL REASONS FILE run routine modified FBUC DISPOSITIONS FILE run routine modified FBUC FILE MENU menu new FBUC REQUEST INFO FILE run routine modified Protocols Associated: Protocol Name New/Modified/Deleted ------------- -------------------- N/A Security Keys Associated: Security Key Name ----------------- N/A Templates Associated: Template Name Type File Name (Number) New/Modified/Deleted ------------- ---- ------------------ -------------------- FBAA AUTHORIZATION INPUT FEE BASIS PATIENT (#161) Modified FBCH EDIT PAYMENT INPUT FEE BASIS INVOICE (#162.5) Modified FBCH ENTER PAYMENT INPUT FEE BASIS INVOICE (#162.5) Modified Additional Information: N/A New Service Requests (NSRs) ---------------------------- NSR 20070585 2007 Fee Data Enhancements Request NSR 20070807 Fee Enhancements to Support Project HERO NSR 20090112 Unauthorized Claims Interest Penalty Indicator Patient Safety Issues (PSIs) ----------------------------- N/A Remedy Ticket(s) & Overview Remedy Ticket #479393 Problem: -------- Patch FB*3.5*116 created an error in the Fee Basis routine FBAACO2 when it mistakenly killed the variable FBAAMM1. The reported issue is that patch FB*3.5*116 broke some functionality that was introduced by patch FB*3.5*4 (released 9/23/1999). This was the patch that added the RBRVS fee schedule to VistA. The problem only occurs on the second and subsequent lines for an invoice that has been marked as contracted services. For these subsequent lines: a. The user is no longer reminded that the payment is for contracted services before the amount paid is asked. b. The software is inappropriately providing a default amount paid for these contracted services (the lesser of the amount claimed or fee schedule amount) c. The FEE SCHEDULE and FEE SCHEDULE AMOUNT fields are being inappropriately populated with data. This may result in an inappropriate payment symbol of "R" or "F" being shown instead of the appropriate Resolution: ----------- Resolution to this error was to remove the erroneous kill from FBAACO2. Remedy Ticket #603189 Problem: -------- On the Potential Cost Recovery Report patch FB*3.5*122 displays the optional line rendering provider data for civil hospital invoice after the associated procedure code. However, the patch is inappropriately assuming that the .01 LINE ITEM NUMBER value entered by the user matches the internal entry number assigned by FileMan for that entry. When that is not true, the line rendering provider is shown with the wrong procedure code. Resolution: ----------- The Resolution to this error was to make the selection based not on the internal entry number but on the .01 LINE ITEM NUMBER value. Test Sites: ---------- St. Cloud, MN Black Hills HCS Fargo, ND Minneapolis, MN Sioux Falls, SD Documentation Retrieval Instructions ------------------------------------ Updated documentation describing the new functionality introduced by this patch is available. The preferred method is to FTP the files from ftp://download.vista.med.va.gov/. This transmits the files from the first available FTP server. Sites may also elect to retrieve software directly from a specific server as follows: Albany ftp.fo-albany.med.va.gov Hines ftp.fo-hines.med.va.gov Salt Lake City ftp.fo-slc.med.va.gov Documentation can also be found on the VA Software Documentation Library at: http://www4.va.gov/vdl/ Title File Name FTP Mode --------------------------------------------------------------------- Fee Basis User Manual FB_3_5_UM_R0512.PDF binary Fee Basis Technical Manual FB_3_5_TM_R0512.PDF binary Release Notes/Installation FB_3_5_P108_RN.PDF binary Guide FB*3.5*108 Patch Installation: Pre/Post Installation Overview ------------------------------ Prior to the installation of FB*3.5*108 all open Fee Basis batches must be closed. And all closed batches must be transmitted to Central Fee at the Austin Information Technology Center (AITC). With the installation of FB*3.5*108 batch message size will be limited to 32k bytes maximum. For an inpatient batch this will be 85 lines of data. If the message exceeds 32k Central Fee will reject the batch. Refer to paragraph 5 of this patch description for the maximum size allowed for each of the batch types. Installation Instructions ------------------------- If installed during the normal workday, it is recommended that the following selection(s) in the OPTION (#19) file, and all of their descendants be disabled to prevent possible conflicts while running the KIDS Install. Other VISTA users will not be affected. Civil Hospital Main Menu [FBCH MAIN MENU] Community Nursing Home Main Menu [FBCNH MAIN MENU] Medical Fee Main Menu [FBAA MEDICAL MAIN MENU] Pharmacy Fee Main Menu [FBAA PHARMACY MAIN MENU] Telephone Inquiry Menu [FB PHONE MENU] Unauthorized Claim Main Menu [FBUC MAIN] Install Time - less than 5 minutes 1. Choose the PackMan message containing this patch. 2. Choose the INSTALL/CHECK MESSAGE PackMan option. 3. From the Kernel Installation and Distribution System Menu, select the Installation Menu. From this menu, you may elect to use the following option. When prompted for the INSTALL enter the patch # (FB*3.5*108): a. Backup a Transport Global - This option will create a backup message of any routines exported with this patch. It will not backup any other changes such as DDs or templates. b. Compare Transport Global to Current System - This option will allow you to view all changes that will be made when this patch is installed. It compares all components of this patch (routines, DDs, templates, etc.). c. Verify Checksums in Transport Global - This option will allow you to ensure the integrity of the routines that are in the transport global. 4. From the Installation Menu, select the Install Package(s) option and choose the patch to install. 5. When prompted 'Want KIDS to Rebuild Menu Trees Upon Completion of Install YES//' Answer NO 6. When prompted 'Want KIDS to INHIBIT LOGONs during the install? NO//' Accept the default of NO 7. When prompted 'Want to DISABLE Scheduled Options, and Protocols? NO//' Answer YES 8. When prompted 'Enter options you wish to mark as 'Out Of Order':' Enter the following options: Civil Hospital Main Menu [FBCH MAIN MENU] Community Nursing Home Main Menu [FBCNH MAIN MENU] Medical Fee Main Menu [FBAA MEDICAL MAIN MENU] Pharmacy Fee Main Menu [FBAA PHARMACY MAIN MENU] Telephone Inquiry Menu [FB PHONE MENU] Unauthorized Claim Main Menu [FBUC MAIN] 9. If prompted "Delay Install (Minutes): (0-60): 0// respond 0 ----------------------------------- Post Installation Instructions ------------------------------ The post installation routine will automatically set up two contracts in the FEE BASIS CONTRACT (# 161.43) that currently have national contracts. Routine Information: ==================== The second line of each of these routines now looks like: ;;3.5;FEE BASIS;**[Patch List]**;JAN 30, 1995;Build 115 The checksums below are new checksums, and can be checked with CHECK1^XTSUMBLD. Routine Name: FBAA79 Before: B22492731 After: B22692839 **12,23,101,103,108** Routine Name: FBAACCB1 Before: B24359201 After: B28490763 **55,61,116,108** Routine Name: FBAACFE Before: n/a After: B1826171 **108** Routine Name: FBAACO Before: B28861560 After: B29088561 **4,61,79,116,122,133,108** Routine Name: FBAACO1 Before: B27913240 After: B42250975 **4,61,77,108** Routine Name: FBAACO2 Before: B14116879 After: B14357578 **4,55,61,77,116,122,133,108** Routine Name: FBAACO3 Before: B48919280 After: B50591838 **4,38,55,61,116,122,133,108** Routine Name: FBAACP Before: B33766747 After: B46974663 **4,38,55,61,77,108** Routine Name: FBAACP1 Before: B6699484 After: B6956346 **4,61,116,108** Routine Name: FBAADEM1 Before: B13894268 After: B14338880 **13,51,103,108** Routine Name: FBAAMP Before: B64408896 After: B64599378 **4,21,38,55,61,67,116,108** Routine Name: FBAAODP0 Before: B4441197 After: B4472268 **108** Routine Name: FBAAPET Before: B35047442 After: B39436624 **4,38,55,61,77,116,122,133,108** Routine Name: FBAAPIE1 Before: B15392299 After: B15539047 **68,108** Routine Name: FBAAPIN Before: B33741138 After: B34775282 **4,61,122,133,108** Routine Name: FBAAPM Before: B5041332 After: B5082140 **13,108** Routine Name: FBAAUTL Before: B23591801 After: B24039594 **101,114,108** Routine Name: FBAAUTL1 Before: B20594708 After: B21242092 **3,12,13,108** Routine Name: FBAAV0 Before: B39796273 After: B43916106 **3,4,55,89,98,116,108** Routine Name: FBAAV01 Before: B12040541 After: B12667626 **89,98,108**,JAN 30, 1995 Routine Name: FBAAV2 Before: B11664283 After: B14009472 **3,89,98,116,108** Routine Name: FBAAV5 Before: B48447360 After: B71438715 **3,55,89,98,116,108** Routine Name: FBAAV6 Before: B18680215 After: B23733544 **55,108** Routine Name: FBCH78 Before: B31111171 After: B39732551 **43,103,108** Routine Name: FBCHCD Before: B20886446 After: B20874782 **108** Routine Name: FBCHEP Before: B30542505 After: B33211512 **4,61,77,82,122,108** Routine Name: FBCHEP1 Before: B11600569 After: B33647893 **38,61,122,133,108** Routine Name: FBCHPET Before: B31374746 After: B36398874 **4,38,61,77,116,108** Routine Name: FBCHRR Before: B9913941 After: B12984210 **61,108** Routine Name: FBCHVH Before: B25718092 After: B31027719 **55,61,122,108** Routine Name: FBNHEA Before: B9786847 After: B9476317 **82,108** Routine Name: FBNHED Before: B11080982 After: B10924946 **108** Routine Name: FBNHEDAT Before: B13820385 After: B13901461 **103,108** Routine Name: FBNHEP Before: B30246134 After: B33126997 **25,108** Routine Name: FBNHEP2 Before: B22842182 After: B25872550 **108** Routine Name: FBNHET Before: B9172247 After: B9055754 **108** Routine Name: FBNHRC Before: B13739085 After: B13819457 **108** Routine Name: FBPAY67 Before: B38135461 After: B41443321 **4,32,55,69,108** Routine Name: FBPAY671 Before: B36548177 After: B38061313 **4,32,55,69,101,108** Routine Name: FBPCR67 Before: B24858243 After: B27748859 **4,48,55,69,98,122,108** Routine Name: FBPCR671 Before: B40566981 After: B46739204 **4,48,55,69,76,98,122,108** Routine Name: FBPRICE Before: B20572423 After: B22445892 **108** Routine Name: FBPRICE1 Before: B8962799 After: B12291028 **56,55,77,108** Routine Name: FBSHAUT Before: B73464234 After: B73848186 **13,108** Routine Name: FBUTL7 Before: n/a After: B17958373 **108** Routine Name: FBXIP108 Before: n/a After: B13213914 **108** Routine list of preceding patches: 25, 68, 103, 114, 133 ============================================================================= User Information: Entered By : BAUMANN,SCOTT A Date Entered : NOV 13, 2008 Completed By: CORONA,JOSE Date Completed: JUL 19, 2012 Released By : MARSHALL,FALENCIA B. Date Released : AUG 06, 2012 ============================================================================= Packman Mail Message: ===================== $END TXT