$TXT Created by at MNTVBB.DOMAIN.EXT (KIDS) on Thursday, 11/03/22 at 09:20 ============================================================================= Run Date: FEB 16, 2023 Designation: IB*2*630 Package : IB - INTEGRATED BILLING Priority: Mandatory Version : 2 SEQ #684 Status: Released Compliance Date: MAR 18, 2023 ============================================================================= Associated patches: (v)IB*2*706 <<= must be installed BEFORE `IB*2*630' (v)IB*2*715 <<= must be installed BEFORE `IB*2*630' (v)IB*2*677 <<= must be installed BEFORE `IB*2*630' Subject: DUPLICATE TRANSACTION TRACKING Category: - Routine - Data Dictionary - Other Description: ============ Integrated Billing patch, IB*2.0*630, updates two options that allow for the releasing of copay charges with a status of On Hold to include a check for duplicate copays. This same duplicate copay check has also been added to the nightly background job to perform those same checks for charges that are being released due to hitting the end of the 90-day window for On Hold charges. Patch Components: ----------------- Files & Fields Associated: File Name (Number) Field Name (Number) New/Modified/Deleted ------------------ ------------------- -------------------- INTEGRATED BILLING PATIENT (#.02) Modified ACTION (#350) Forms Associated: Form Name File # New/Modified/Deleted --------- ------ -------------------- N/A Mail Groups Associated: Mail Group Name New/Modified/Deleted --------------- -------------------- IB DUPLICATE TRANSACTIONS New 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 Templates Associated: Template Name Type File Name (Number) New/Modified/Deleted ------------- ---- ------------------ -------------------- N/A Additional Information: N/A New Service Requests (NSRs): ---------------------------- N/A Patient Safety Issues (PSIs): ----------------------------- N/A Defect Tracking System Ticket(s) & Overview: -------------------------------------------- INC09339213 - The Vista system will allow a duplicate copayment charge to be created for a single event date of service. Problem: -------- There are specific rules regarding how copay charges are assessed for patients. For certain copay charges, Integrated Billing (IB) has been inadvertently sending duplicate copay charges over to Accounts Receivable (AR). Resolution: ------------ Research has revealed that there are two options that are used to release charges that are currently in a status of ON HOLD. These options can release copay charges, but there are currently no checks for duplicate copays when a copay charge is selected to be passed over to Accounts Receivable (AR). After discussing the business rules for copay charges with Veterans Affairs (VA) Facility Revenue Managers, a new Application Programming Interface (API) has been created to apply the necessary checks to determine if there are more than one copay charge for a given patient/date. This new API has been added to the following two options in IB: 1. Release Charges 'On Hold' [IB MT RELEASE CHARGES] 2. Cancel/Edit/Add Patient Charges [IB CANCEL/EDIT/ADD CHARGES] in the Pass a Charge action. If duplicate copay charges for the same date exist, the software will display information on the duplicate charges to the user and return them to the previous screen so they can determine what action(s) to take. The Queue Means Test Compilation of Charges [IB MT NIGHT COMP] option is scheduled to run nightly at the medical centers. This option has logic to release charges in a status of ON HOLD if they have been ON HOLD for more than 90 days. For copay charges hitting the end of their 90 day On Hold window, a new call to the duplicate copay API has been added. If duplicate copay charges are found for a patient/date, appropriate information on these charges will be stored in a temporary global. At the end of the processing, if there is stored duplicate copay data, the data will be sent via a MailMan message to the IB DUPLICATE TRANSACTIONS mail group. Subscribers to this mail group can then review the duplicate copay information and determine what action(s) should be taken. The new duplicate copay API is COPAYCHK^IBAUTL8 and it can be called both interactively and from background jobs. When called interactively the API will display the appropriate information about the duplicate copay charges to the user and return them to the previous option so they can take the appropriate action(s). When called non-interactively from a background job, the API will store the related duplicate copay charge information and send this information to the IB DUPLICATE TRANSACTIONS mail group for review and processing. For the specified charge types listed below, here are the actions taken by the software: INPATIENT COPAY - (Billing Group #1 or #2) ========================================================================== IF the patient has NOT been charged an Inpatient Copay charge (Billing Group #1 or #2) for the Event Date. THEN check for an existing Outpatient Observation Copay (Billing Group #4) for the Event Date. IF an Outpatient Observation Copay exists for the Event Date. THEN Interactive: Display appropriate message about the duplicate copay charges. Don't release charge and return user to option to take the necessary action(s). Non-Interactive: Store the necessary data and send to IB DUPLICATE TRANSACTIONS mail group for review and processing. IF the patient has already been charged an Inpatient Copay (Billing Group #1 or #2) charge for the Event Date. THEN Compare the TOTAL CHARGE for the charge currently being processed to TOTAL CHARGE of the existing Inpatient Copay charge. IF the current charge being processed is <= than the existing Inpatient Copay charge. THEN Interactive: Display appropriate message about the duplicate copay charges. Don't release charge and return user to option to take the necessary action(s). Non-Interactive: Store the necessary data and send to IB DUPLICATE TRANSACTIONS mail group for review and processing. Check for the existence of an existing Outpatient Observation Copay (Billing Group #4) for the event date. IF one exists. Interactive: Display appropriate message about the duplicate copay charges. Don't release charge and return user to option to take the necessary action(s). Non-Interactive: Store the necessary data and send to IB DUPLICATE TRANSACTIONS mail group for review and processing. IF the current charge being processed is > than the existing Inpatient Copay charge. THEN Interactive: Display appropriate message about the duplicate copay charges. Don't release charge and return user to option to take the necessary action(s). Non-Interactive: Store the necessary data and send to IB DUPLICATE TRANSACTIONS mail group for review and processing. Check for the existence of an existing Outpatient Observation Copay (Billing Group #4) for the event date. IF one exists. THEN Interactive: Display appropriate message about the duplicate copay charges. Don't release charge and return user to option to take the necessary action(s). Non-Interactive: Store the necessary data and send to IB DUPLICATE TRANSACTIONS mail group for review and processing. IF the patient has been charged an Inpatient Per Diem charge (Billing Group #3) for the Event Date. THEN Check to make sure it is a legal pairing. IF pairing is not a legal pair: THEN Interactive: Display appropriate message about the duplicate copay charges. Don't release charge and return user to option to take the necessary action(s). Non-Interactive: Store the necessary data and send to IB DUPLICATE TRANSACTIONS mail group for review and processing. IF the patient has already been charged an Outpatient Copay charge (Billing Group #4) for the Event Date. OR the patient has already been charged a Long Term Care Copay charge (Billing Group #8) for the Event Date. THEN Interactive: Display appropriate message about the duplicate copay charges. Don't release charge and return user to option to take the necessary action(s). Non-Interactive: Store the necessary data and send to IB DUPLICATE TRANSACTIONS mail group for review and processing. INPATIENT PER DIEM CHARGES - (Billing Group #3) ========================================================================== IF the patient has already been charged an Inpatient Copay charge for the Event Date. THEN Interactive: Display appropriate message about the duplicate copay charges. Don't release charge and return user to option to take the necessary action(s). Non-Interactive: Store the necessary data and send to IB DUPLICATE TRANSACTIONS mail group for review and processing. IF the patient has already been charged an Inpatient Per Diem for the Event Date. THEN Compare the TOTAL CHARGE for the charge currently being processed to the TOTAL CHARGE of the existing Inpatient Per Diem. IF the current charge being processed is <= than the existing Inpatient Per Diem. THEN Interactive: Display appropriate message about the duplicate copay charges. Don't release charge and return user to option to take the necessary action(s). Non-Interactive: Store the necessary data and send to IB DUPLICATE TRANSACTIONS mail group for review and processing. IF the current charge being processed is > than the existing Inpatient Per Diem. THEN Interactive: Display appropriate message about the duplicate copay charges. Don't release charge and return user to option to take the necessary action(s). Non-Interactive: Store the necessary data and send to IB DUPLICATE TRANSACTIONS mail group for review and processing. IF the patient has already been charged an Outpatient Copay charge (Billing Group #4) for the Event Date. OR the patient has already been charged a Long Term Care Copay charge (Billing Group #8) for the Event Date. THEN Interactive: Display appropriate message about the duplicate copay charges. Don't release charge and return user to option to take the necessary action(s). Non-Interactive: Store the necessary data and send to IB DUPLICATE TRANSACTIONS mail group for review and processing. OUTPATIENT COPAYS - (Billing Group #4) ========================================================================== IF the patient has already been charged an Inpatient Copay (Billing Group #1 or #2) charge for the Event Date. OR the patient has already been charged an Inpatient Per Diem (Billing Group #3) charge for the Event Date. OR the patient has already been charged an Outpatient Observation (Billing Group #4) Copay charge for the Event Date. THEN Interactive: Display appropriate message about the duplicate copay charges. Don't release charge and return user to option to take the necessary action(s). Non-Interactive: Store the necessary data and send to IB DUPLICATE TRANSACTIONS mail group for review and processing. IF the patient has already been charged an Outpatient Copay charge (Billing Group #4) for the Event Date. THEN Compare the TOTAL CHARGE for the charge currently being processed to the TOTAL CHARGE of the existing Outpatient Copay charge. IF the current charge being processed is <= than the existing Outpatient Copay charge. THEN Interactive: Display appropriate message about the duplicate copay charges. Don't release charge and return user to option to take the necessary action(s). Non-Interactive: Store the necessary data and send to IB DUPLICATE TRANSACTIONS mail group for review and processing. IF the current charge being processed is > than the existing Outpatient Copay charge. THEN Interactive: Display appropriate message about the duplicate copay charges. Don't release charge and return user to option to take the necessary action(s). Non-Interactive: Store the necessary data and send to IB DUPLICATE TRANSACTIONS mail group for review and processing. IF the patient has already been charged a Long Term Care Copay charge (Billing Group #8) for the Event Date. THEN Interactive: Display appropriate message about the duplicate copay charges. Don't release charge and return user to option to take the necessary action(s). Non-Interactive: Store the necessary data and send to IB DUPLICATE TRANSACTIONS mail group for review and processing. LONG TERM CARE COPAYS - (Billing Group #8) ========================================================================== IF the patient has already been charged an Inpatient Copay (Billing Group #1 or #2) charge for the Event Date. OR the patient has already been charged an Inpatient Per Diem (Billing Group #3) charge for the Event Date. OR the patient has already been charged an Outpatient Observation Copay (Billing Group #4) charge for the Event Date. OR the patient has already been charged an Outpatient Copay (Billing Group #4) charge for the Event Date. THEN Interactive: Display appropriate message about the duplicate copay charges. Don't release charge and return user to option to take the necessary action(s). Non-Interactive: Store the necessary data and send to IB DUPLICATE TRANSACTIONS mail group for review and processing. IF the patient has already been charged a Long Term Care Copay charge (Billing Group #8) for the Event Date. THEN Compare the TOTAL CHARGE for the charge currently being processed to the TOTAL CHARGE of the existing Long Term Care Copay charge. IF the current charge being processed is <= than the existing Long Term Care Copay charge. THEN Interactive: Display appropriate message about the duplicate copay charges. Don't release charge and return user to option to take the necessary action(s). Non-Interactive: Store the necessary data and send to IB DUPLICATE TRANSACTIONS mail group for review and processing. IF the current charge being processed is > than the existing Long Term Care Copay charge. THEN Interactive: Display appropriate message about the duplicate copay charges. Don't release charge and return user to option to take the necessary action(s). Non-Interactive: Store the necessary data and send to IB DUPLICATE TRANSACTIONS mail group for review and processing. Test Sites: ----------- Nebraska-Western Iowa HCS Sioux Falls VA Health Care System VA Pittsburgh Health Care System Software and Documentation Retrieval Instructions: -------------------------------------------------- The software for this patch is being released in a PackMan message. Pre/Post Installation Overview: Pre-Installation Instructions: ============================== A new mail group, IB DUPLICATE TRANSACTIONS, will be added during the installation of this patch. The person installing the patch will automatically be added as the organizer. After installation, the Facility Revenue Manager (FRM) at your site should be added to this mail group. Check with the FRM to see if there are other revenue personnel who should be added to this mail group as well. This patch may be installed with users on the system although it is recommended that it be installed during non-peak hours to minimize potential disruption to users. This patch should take less than 5 minutes to install. Installation Instructions: 1. Choose the PackMan message containing this build. Then select the INSTALL/CHECK MESSAGE PackMan option to load the build. 2. 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*630. B. The Backup a Transport Global option is used to create a backup message of any routines exported with this patch. For each patch you can specify what to backup; the entire Build or just Routines. When asked to specify what to backup, select Build. However, it is NOT recommended to use this backup to restore the system as it will NOT restore your system to system to pre-patch condition. When prompted for a response: Select one of the following: B Build R Routines Enter response: Build i. When prompted "Do you wish to secure your build? NO//", press and take the default response of "NO". ii. When prompted with, "Send mail to: Last name, First Name", press to take default recipient. Add any additional recipients. iii. When prompted with "Select basket to send to: IN//", press and take the default IN mailbox or select a different mailbox. ***Please refer to the section below, "Back-Out/Roll Back Plan".*** 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*630. i. Enter the Coordinator for Mail Group 'IB DUPLICATE TRANSACTIONS': (FRM's name can be added here) ii. When prompted 'Want KIDS to INHIBIT LOGONs during the install? NO//', answer NO iii. When prompted 'Want to DISABLE Scheduled Options, Menu Options, and Protocols? YES//', answer YES a. When prompted 'Enter options you wish to mark as 'Out Of Order':', select the following option: Option Name Menu Text ----------- --------- [IB MT RELEASE CHARGES] Release Charges 'On Hold' [IB CANCEL/EDIT/ADD CHARGES] Cancel/Edit/Add Patient Charges Press the Enter key when you are done selecting options. b. When prompted 'Enter protocols you wish to mark as 'Out Of Order':', select the following protocol: press the Enter key Post Installation Overview: ------------------------------- A new mail group, IB DUPLICATE TRANSACTIONS, will be added during the installation of this patch. The person installing the patch will automatically be added as the organizer. After installation, the Facility Revenue Manager (FRM) at your site should be added to this mail group. Check with the FRM to see if there are other revenue personnel who should be added to this mail group as well. Back-Out Plan: -------------- Due to the complexity of this patch, it is not recommended for back-out, and a restore from a backup of the Transport Global should not be attempted. In the event that this patch needs to be backed out, the patch installer should enter a ServiceNow Ticket. The development team will need to issue a follow-up patch in order to comprehensively back-out this patch. Routine Information: ==================== The second line of each of these routines now looks like: ;;2.0;INTEGRATED BILLING;**[Patch List]**;21-MAR-94;Build 39 The checksums below are new checksums, and can be checked with CHECK1^XTSUMBLD. Routine Name: IBAMTC Before: B52657929 After: B53936908 **34,52,70,93,100,118,115,132, 150,153,137,176,215,275,321, 312,457,519,549,614,703,706, 630** Routine Name: IBAUTL10 Before: n/a After: B607118 **630** Routine Name: IBAUTL8 Before: n/a After: B46790256 **630** Routine Name: IBAUTL8A Before: n/a After:B165576427 **630** Routine Name: IBAUTL8B Before: n/a After: B50537353 **630** Routine Name: IBAUTL8C Before: n/a After:B130773182 **630** Routine Name: IBAUTL9 Before: n/a After:B133985720 **630** Routine Name: IBECEA1 Before: B17838366 After: B72329722 **15,27,45,176,312,663,630** Routine Name: IBR Before: B19009359 After: B23573877 **52,70,93,113,132,51,715,630** Routine Name: IBRREL Before: B32880699 After: B36820519 **95,153,199,347,452,651,663, 675,677,630** Routine list of preceding patches: 677, 706, 715 ============================================================================= User Information: Entered By : Date Entered : AUG 23, 2018 Completed By: Date Completed: FEB 16, 2023 Released By : Date Released : FEB 16, 2023 ============================================================================= Packman Mail Message: ===================== $END TXT