$TXT Created by at MNTVBB.DOMAIN.EXT (KIDS) on Monday, 06/22/20 at 11:07 ============================================================================= Run Date: AUG 05, 2020 Designation: IB*2*673 Package : IB - INTEGRATED BILLING Priority: Mandatory Version : 2 SEQ #615 Status: Released Compliance Date: SEP 05, 2020 ============================================================================= Subject: 2020 UPDATE OF VALUE/CONDITION/REVENUE/RNB CODES Category: - Routine Description: ============ This patch involves updates to the MCCR UTILITY (#399.1) file, the REVENUE CODE (#399.2) file and the CLAIMS TRACKING NON-BILLABLE REASONS (#356.8) file for 2020. Patch Components: ----------------- Files & Fields Associated: File Name (Number) Field Name (Number) New/Modified/Deleted ------------------ ------------------- -------------------- N/A 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 ----------- ---- -------------------- N/A Protocols Associated: Protocol Name New/Modified/Deleted ------------- -------------------- N/A Security Keys Associated: Security Key Name ----------------- N/A Remote Procedures Associated: Remote Procedure Name New/Modified/Deleted --------------------- -------------------- N/A Parameter Definitions Associated: Parameter Name New/Modified/Deleted -------------- -------------------- N/A Templates Associated: Template Name Type File Name (Number) New/Modified/Deleted ------------- ---- ------------------ -------------------- N/A Additional Information: ----------------------- N/A Blood Bank Coordination: ------------------------ N/A New Service Requests (NSRs): ---------------------------- N/A Patient Safety Issues (PSIs): ----------------------------- N/A Defect Tracking System Ticket(s) & Overview: -------------------------------------------- 1. INC10816331 new Condition Codes, Value Codes, and Revenue Code Problem: -------- The Office of Community Care (OCC) has requested a patch to update the MCCR UTILITY (#399.1) file and the REVENUE CODE (#399.2) file with the following Value/Condition/Revenue Codes for 2020. Value Code (new) ================ 87 GENE THERAPY INVOICE COST 90 CELL THERAPY INVOICE COST Condition Code (new) ==================== A7 HOSP SVCS PRVD IN A MBL FAC OR W PORT UNTS Revenue Code (activation) ========================= 892 SPECIAL PROCESSED DRUGS Resolution: ----------- A post install routine IB20P673 was created to update the associated files with those Value/Condition/Revenue Codes for 2020. 2. INC9899085 IB -THIRD PARTY REASONS NOT BILLABLE UPDATES NEEDED Problem: -------- Revenue Operations has requested a patch to update the CLAIMS TRACKING NON-BILLABLE (#356.8) file with the following Reasons Not Billable (RNB) for 2020. Reason Not Billable (new) ========================= BL10 BILLING LIMITATIONS CV30 NO COVERAGE CV31 POLICY LIMITATIONS DC20 DOCUMENTATION DOES NOT SUPPORT MC30 NON-BILLABLE SERVICE MN05 MEDICAL NECESSITY RX20 RX LIMITATIONS Reason Not Billable (inactivation) ================================== BL01 CHARGES SPLIT BL08 COMBINED CHARGES CV02 COVERAGE CANCELED CV03 HMO POLICY CV04 OUT OF NETWORK (PPO) CV11 CONCURRENT CARE CV12 CUSTODIAL/RESIDENTIAL CARE CV13 NO OUTPATIENT COVERAGE CV14 NO INPATIENT COVERAGE CV15 NO PHARMACY COVERAGE CV16 NO DENTAL COVERAGE CV17 NO MENTAL HEALTH COVERAGE CV18 NO LTC COVERAGE CV21 NO VISION COVERAGE CV22 NO PROSTHETIC COVERAGE DC01 NO DOCUMENTATION DC02 NO TX PROVIDED/ADVICE ONLY DC03 UNSIGNED DOCUMENT DC04 NO DIAGNOSIS/SYMPTOMS IN NOTE DC05 NO CHIEF COMPLAINT DC06 NOTE NOT WRITTEN TIMELY DC07 NO PHYSICIAN ORDER DC08 NO PLAN OF CARE DC09 STUDENT NOTE ONLY DC10 NEW PT/NO HX DC11 NEW PT/NO EXAM DC12 NEW PT/NO COMPLEXITY DC13 EST PT/NO HX/NO EXAM DC14 EST PT/NO HX/NO COMPLEXITY DC15 EST PT/NO EXAM/NO COMPLEXITY MC01 NON-BILLABLE APPOINTMENT TYPE MC02 REFUSES TO SIGN RELEASE (ROI) MC03 NON-BILLABLE STOP CODE MC04 RESEARCH VISIT MC05 NON-BILLABLE CLINIC MC08 GLOBAL SURGERY MC10 DUPLICATE ENCOUNTER MC11 TELEPHONE ENCOUNTER MC13 72 HOUR RULE MC14 RESIDENT SUPERVISION NOT MET MC15 ANCILLARY PROVIDER AT CBOC MC20 APPT CANCELLED/PT NOT SEEN MC21 SEEN BY PROVIDER ON SAME DAY MC22 NON-BILLABLE DME/PROSTHETIC MC23 NON-BILLABLE PROCEDURE MC25 ENCOUNTER DURING INPT STAY MN01 MED NEC-DX NOT COVERE D MN02 MED NEC-CPT NOT COVERE D MN03 MED NEC-LCD EDIT MN04 MED NEC-OTHER RX02 REFILL ON VISIT DATE RX08 INVALID MULTIPLES PER DAY SUPP RX14 RX MEDICARE PART D RX15 RX DISCOUNT CARD Resolution: ----------- A post install routine IB20P673 was created to update the associated file with those RNBs for 2020. Test Sites: ----------- Connecticut HCS Erie VAMC Software and Documentation Retrieval Instructions: -------------------------------------------------- N/A Patch Installation: Pre/Post Installation Overview: ------------------------------- It is recommended that this patch be installed outside of normal business hours to avoid any complications resulting from users on the system. Installation will take less than 2 minutes. Installation Instructions: -------------------------- 1. From the Kernel Installation and Distribution System Menu, select the Installation Menu. From this menu, A. Select the Verify Checksums in Transport Global option to confirm the integrity of the routines that are in the transport global. When prompted for the INSTALL NAME enter the patch or build name IB*2.0*673. B. Select the Backup a Transport Global option to create a backup message of any routines exported with this patch. It will not backup any other changes such as DDs or templates. C. You may also elect to use the following options: i. Print Transport Global - This option will allow you to view the components of the KIDS build. ii. 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 of the components of this patch, such as routines, DDs, templates, etc. D. Select the Install Package(s) option and choose the patch to install, IB*2.0*673. i. When prompted 'Want KIDS to INHIBIT LOGONs during the install? NO//', answer NO ii. When prompted 'Want to DISABLE Scheduled Options, Menu Options, and Protocols? NO//', answer NO Post-Installation Instructions: ------------------------------- You may delete the routine IB20P673 from your production system after the patch has been successfully verified. Use the 'Install File Print' option to review the updates and ensure that the install has been completed. For an example: Note: If results show otherwise, please check the settings for the codes in files (#399.1/#399.2/#356.8) or log a ticket with The Enterprise Service Desk for assistance. IB*2.0*673 Post-Install starts ..... >> Adding Value Code 87 GENE THERAPY INVOICE COST 90 CELL THERAPY INVOICE COST >> Adding Condition Code A7 HOSP SVCS PRVD IN A MBL FAC OR W PORT UNTS Total 3 codes added to MCCR UTILITY (#399.1) file >> Activating Revenue Code 892 SPECIAL PROCESSED DRUGS Total 1 code updated in REVENUE CODE (#399.2) file >> Adding Reason Not Billable (RNB) BL10 BILLING LIMITATIONS CV30 NO COVERAGE CV31 POLICY LIMITATIONS DC20 DOCUMENTATION DOES NOT SUPPORT MC30 NON-BILLABLE SERVICE MN05 MEDICAL NECESSITY RX20 RX LIMITATIONS >> Inactivating Reason Not Billable (RNB) BL01 CHARGES SPLIT BL08 COMBINED CHARGES CV02 COVERAGE CANCELED CV03 HMO POLICY CV04 OUT OF NETWORK (PPO) CV11 CONCURRENT CARE CV12 CUSTODIAL/RESIDENTIAL CARE CV13 NO OUTPATIENT COVERAGE CV14 NO INPATIENT COVERAGE CV15 NO PHARMACY COVERAGE CV16 NO DENTAL COVERAGE CV17 NO MENTAL HEALTH COVERAGE CV18 NO LTC COVERAGE CV21 NO VISION COVERAGE CV22 NO PROSTHETIC COVERAGE DC01 NO DOCUMENTATION DC02 NO TX PROVIDED/ADVICE ONLY DC03 UNSIGNED DOCUMENT DC04 NO DIAGNOSIS/SYMPTOMS IN NOTE DC05 NO CHIEF COMPLAINT DC06 NOTE NOT WRITTEN TIMELY DC07 NO PHYSICIAN ORDER DC08 NO PLAN OF CARE DC09 STUDENT NOTE ONLY DC10 NEW PT/NO HX DC11 NEW PT/NO EXAM DC12 NEW PT/NO COMPLEXITY DC13 EST PT/NO HX/NO EXAM DC14 EST PT/NO HX/NO COMPLEXITY DC15 EST PT/NO EXAM/NO COMPLEXITY MC01 NON-BILLABLE APPOINTMENT TYPE MC02 REFUSES TO SIGN RELEASE (ROI) MC03 NON-BILLABLE STOP CODE MC04 RESEARCH VISIT MC05 NON-BILLABLE CLINIC MC08 GLOBAL SURGERY MC10 DUPLICATE ENCOUNTER MC11 TELEPHONE ENCOUNTER MC13 72 HOUR RULE MC14 RESIDENT SUPERVISION NOT MET MC15 ANCILLARY PROVIDER AT CBOC MC20 APPT CANCELLED/PT NOT SEEN MC21 SEEN BY PROVIDER ON SAME DAY MC22 NON-BILLABLE DME/PROSTHETIC MC23 NON-BILLABLE PROCEDURE MC25 ENCOUNTER DURING INPT STAY MN01 MED NEC-DX NOT COVERED MN02 MED NEC-CPT NOT COVERED MN03 MED NEC-LCD EDIT MN04 MED NEC-OTHER RX02 REFILL ON VISIT DATE RX08 INVALID MULTIPLES PER DAY SUPP RX14 RX MEDICARE PART D RX15 RX DISCOUNT CARD Total 61 codes updated in CLAIMS TRACKING NON-BILLABLE REASONS (#356.8) file IB*2.0*673 Post-Install is complete. Back-Out/Roll Back Plan: ------------------------ Use FileMan to remove the newly added codes or activate or inactivate the codes from the associated files if it is necessary. Routine Information: ==================== The second line of each of these routines now looks like: ;;2.0;INTEGRATED BILLING;**[Patch List]**;21-MAR-94;Build 10 The checksums below are new checksums, and can be checked with CHECK1^XTSUMBLD. Routine Name: IB20P673 Before: n/a After: B42544330 **673** ============================================================================= User Information: Entered By : Date Entered : APR 01, 2020 Completed By: Date Completed: AUG 04, 2020 Released By : Date Released : AUG 05, 2020 ============================================================================= Packman Mail Message: ===================== $END TXT