$TXT Created by at MNTVBB.DOMAIN.EXT (KIDS) on Thursday, 01/16/25 at 10:45 ============================================================================= Run Date: FEB 10, 2025 Designation: IB*2*814 Package : IB - INTEGRATED BILLING Priority: Mandatory Version : 2 SEQ #738 Status: Released Compliance Date: FEB 17, 2025 ============================================================================= Associated patches: (v)IB*2*809 <<= must be installed BEFORE `IB*2*814' Subject: CY25 REASONABLE CHARGES UPDATE Category: - Routine Description: ============ ************************************************************************** NOTE: This patch is being released with a shortened compliance date of 7 days. ************************************************************************** Implementation of Reasonable Charges v5.25 is a two-step process: 1. Installation of this patch. This will inactivate Reasonable Charges v5.241 charges with an inactive date of 12/31/24. (See Installation Instructions.) 2. Uploading the Reasonable Charges v5.25 charges. This will load new charges with an effective date of 01/01/25 and needs to be done immediately after the patch install. (See Upload Instructions.) PLEASE NOTE: It is highly recommended that you install the Lexicon Utility patch LEX*2.0*152 - CODE SET FY25 2ND QTR UPDATE and the DRG Grouper Update ICD*18*120 - FY25 ANNUAL DRG GROUPER UPDATE before IB*2.0*814 install. Failure to install these patches may require uploading and installing Reasonable Charges twice. ************************************************************************** Reasonable Charges version 5.25 is a charge update to the existing Reasonable Charges billed to Third Party Payers. The primary update with this patch is to the charges, which will be implemented when the new RC v5.25 charges are uploaded (step 2 in Installation Overview). This version of Reasonable Charges implements the following charge changes: Effective Date of Reasonable Charges v5.25 is 01/01/25. Inactive Date of Reasonable Charges v5.241 is 12/31/24. Reasonable Charges v5.241 loaded on your system will be inactivated with an inactivation date of 12/31/24 when this patch is installed. Reasonable Charges v5.25 with an effective date of 01/01/25 will be loaded on your system when the charges are uploaded as described below. This patch is approved for both VA VistA and EHRM sites. 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 Templates Associated: Template Name Type File Name (Number) New/Modified/Deleted ------------- ---- ------------------ -------------------- N/A Remote Procedures Associated: Remote Procedure Name New/Modified/Deleted --------------------- -------------------- N/A Parameter Definitions Associated: Parameter Name New/Modified/Deleted -------------- -------------------- N/A Additional Information: ----------------------- Blood Bank Coordination: N/A New Service Requests (NSRs): N/A Defect Tracking System Ticket(s) & Overview: -------------------------------------------- 1. INC36646984 - Initiate IB Outpatient Patch V5.25 for CY25 in VistA Problem: -------- Changes in the national Diagnosis Related Group (DRG) rates need to be distributed to all hospitals so that proper billing can take place. Resolution ----------- This patch updates the Reasonable Charges files and distributes them with a new version number and a new effective date. Routines: IBCRHBRV, IBYP814 Technical Description ===================== This patch exports 2 routines, one of which is the post-init (IBYP814) The post-init routine will inactivate all existing Reasonable Charges defined in the Charge Master. Reasonable Charges v5.241 will be inactivated with an inactivation date of 12/31/24 when the patch is installed. The following is an example of the post-init portion of the installation: Running Post-Install Routine: POST^IBYP814 Reasonable Charges v5.25 Post-Install ..... >> Inactivating Existing Reasonable Charges, Please Wait... Done. 156448 existing charges inactivated Reasonable Charges v5.25 Post-Install Complete Note: The actual number of charges inactivated and facility type of billing regions changed will vary based on the number of divisions billed at your site. This will also determine the time required for the installation. Test Sites: ----------- VA Connecticut Health Care System (West Haven, Newington),CT VISN 2 - Upstate New York Health Care System (Buffalo, Batavia, Canandaigua, Syracuse, Bath, Albany),NY SNOW Change Order #: -------------------------------- VISN 2 - UNY - CHG0562801 Connecticut - CHG0562667 Software and Documentation Retrieval Instructions: -------------------------------------------------- The software for this patch is being released in a PackMan message. This release also includes other software files. Sites may retrieve the charge files using Secure File Transfer Protocol (SFTP) in ASCII format at the location: /srv/vista/patches/SOFTWARE or by accessing the URL: https://download.vista.domain.ext/index.html/SOFTWARE. Other Software Files: File Title File Name Format --------------------------------------------------------------------- Inpatient Facility Charges (DRG) IBRC2501A.TXT ASCII Facility Charge (CPT) IBRC2501B.TXT ASCII Physician Charges (CPT) IBRC2501C.TXT ASCII Service Category Codes IBRC2501D.TXT ASCII Area Factors IBRC2501E.TXT ASCII Site Identification IBRC2501F.TXT ASCII Patch Installation: Pre/Post Installation Overview: ------------------------------- 1. Installation of this patch will inactivate Reasonable Charges v5.241 charges with an inactive date of 12/31/24. (See Installation Instructions.) 2. Uploading the Reasonable Charges v5.25 charges. This will load new charges with an effective date of 01/01/25 and needs to be done immediately after the patch install. (See Upload Instructions.) (1) Pre-Installation Instructions: ---------------------------------- If installed during the normal workday, it is recommended that the following selection(s) in the OPTION (#19) file be disabled to prevent possible conflicts while running the KIDS Install. Other Vista users will not be affected. Enter/Edit Billing Information [IB EDIT BILLING INFO] Enter/Edit Charge Master [IBCR DISPLAY CHARGE MASTER] Install Time - less than 30 minutes - but will vary from site to site depending on the size of the CHARGE ITEM (#363.2) file which is searched for charges to inactivate in the post-init routine. Loading the Charge Master with the new RC v5.25 charges is separate from the patch installation and will take additional time per division. 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*814. B. Select the Backup a Transport Global option 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 Routines. When prompted for a response, select Routines: Select one of the following: B Build R Routines Enter response: Build 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*814. 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? YES//', answer YES a. When prompted 'Enter options you wish to mark as 'Out Of Order':' Enter the following option: Option Name Menu Text ----------- --------- Enter/Edit Billing Information [IB EDIT BILLING INFO] Enter/Edit Charge Master [IBCR DISPLAY CHARGE MASTER] Press the Enter key when you are done selecting options. b. When prompted 'Enter protocols you wish to mark as 'Out Of Order':' press . c. When prompted 'Delay Install (Minutes): (0 - 60): 0//', answer 0. Post-Installation Instructions: (2) UPLOAD REASONABLE CHARGES V5.25 ------------------------------------ Follow instructions below: RC v5.25 Upload Instructions ********************** RC v5.25 Upload Instructions ******************** After patch installation, the Reasonable Charges v5.25 charges will need to be loaded into the Charge Master for each division billed at the site. The charges for each Division will require approximately 1.8 - 2.0 MB of disk space. Other files will be searched, but the new charges will be added to the CHARGE ITEM file (#363.2). *** PLEASE NOTE *** Sites may see this error when uploading the reasonable charges. This error can be ignored (2 with $=0). If your site receives an error for two records, CPT 90611 and 90622, in which the charge is $0.00, this is acceptable to allow. The national charge for these codes is $.01 as the vaccines are provided to VA by the government and we do not bill third party payers, however we need a charge present to bill for the associated administration charge. If these vaccines are given to patients with billable insurance in any of the 15 zip codes that have a geographic adjustment factor of less than .5 resulting in the $.01 to be rounded down to $.00, billing staff will reach out to the Rates and Charges Team for guidance at that time. It is appropriate to accept the error if the results show two charges with $=0. SNF Fac 1 7940 of 7940 records checked, 0 duplicates, 2 with $=0 0 line/data errors or warnings found for a 0% error rate. 7938 entries added to the Charge Set RC-SNF FAC PR XXXXX. Opt Fac 1 8708 of 8708 records checked, 0 duplicates, 2 with $=0 0 line/data errors or warnings found for a 0% error rate. 8706 entries added to the Charge Set RC-OPT FAC PR XXXXX. Opt Fac 1 8708 of 8708 records checked, 0 duplicates, 2 with $=0 0 line/data errors or warnings found for a 0% error rate. 8706 entries added to the Charge Set RC-OPT FAC PR XXXXX. Files Required for Upload: -------------------------- Sites may retrieve the charge files using Secure File Transfer Protocol (SFTP) in ASCII format at the location: /srv/vista/patches/SOFTWARE or by accessing the URL: https://download.vista.domain.ext/index.html/SOFTWARE. The Reasonable Charge v5.25 Host Files, effective 01/01/25: (ASCII) IBRC2501A.TXT Inpatient Facility Charges (DRG) IBRC2501B.TXT Facility Charge (CPT) IBRC2501C.TXT Physician Charges (CPT) IBRC2501D.TXT Service Category Codes IBRC2501E.TXT Area Factors IBRC2501F.TXT Site Identification Upload Instructions: ==================== Step 1: Get Host Files ----------------------- Retrieve the 6 Reasonable Charges v5.25 Host Files in ASCII format (see previous section). Step 2: Determine Divisions ---------------------------- Use the Print Charge Master [IBCR REPORTS FOR CHARGE MASTER] option and print the Billing Regions report to find which Billing Regions and Divisions have charges loaded onto your system. These are the divisions that will need new charges loaded. Step 3: Begin Upload Process ----------------------------- Use the Load Host File into Charge Master [IBCR HOST FILE LOAD] option to load Reasonable Charges onto your system for every division for which care is billed at your site. Carefully follow the instructions below, for each Billing Region. You will see the prompt: Select one of the following: 1.1 Load CMAC into XTMP 1.2 Load AWP into XTMP 1.3 Load RC into XTMP 1.4 Load TP into XTMP 2 Assign Charge Set 3 Check Data Validity 4 Load into Charge Master 5 Delete XTMP files Below, in more detail, the steps will guide you through the process of selecting first 1.3, then 3, then 4, and wait until 4 stops before continuing on to the next division (and capturing or printing all output for future reference). Step 4: Load the Reasonable Charges ------------------------------------ From the menu, select option 1.3 - Load RC into XTMP This loads the Host Files into temporary storage and calculates charges for individual Divisions. - If there are no previously existing host files loaded, it will ask which version of Reasonable Charges to load. Select 5.25 - When loading Reasonable Charges v5.25 the IBRC2501x.TXT files may be used for multiple divisions without reloading. - If there exists any previously calculated charges (files) for a division, they will be displayed, and you will get the prompt: The above files already exist in XTMP. Delete the above files and continue with upload? Select Yes, to delete the previously calculated charges. - If there exist any previously loaded host files for any RC version, they will be displayed, and it will ask if they should be deleted. Select No, if the files are IBRC2501x.TXT since these are the correct files for v5.25, they may be re-used for multiple divisions. Select Yes only if the files are from a different version. - Select Division: Select the division number to load charges for. This should correspond to the Divisions associated with the Billing Regions determined previously. Once the correct division is selected, answer Yes to Calculate Charges. Step 5: Check Data Validity --------------------------- From the menu, select option 3 - Check Data Validity This is optional, but it is suggested that it be run at least once, for the first division loaded. If the resulting report has any Line Data Errors, then check that the latest version of CPT and DRG has been installed. The Error key at the end of the report does not mean that errors have occurred. It simply provides definitions of the types of errors that might occur. Check the individual line items in the report to see if any of the listed errors have been detected. Step 6: Load into Charge Master ------------------------------- From the menu, select option 4 - Load into Charge Master Moves the charges calculated in selection 1.3 to permanent storage in the Charge Master. The results report should match the examples below. It is important that this option completes before continuing. Allow the upload of a division's charges to finish before attempting to upload another division. A summary report will be printed when the upload is complete. This option uses the same temporary files to calculate the charges for all divisions, therefore they must be calculated and loaded serially. Step 7: Repeat steps 4-6 for each Division needed ------------------------------------------------- Steps 4-6 must be repeated for each division billed at your site. Refer to the Divisions that already have charges assigned using the Billing Region Report list determined previously. In most cases, simply using the above options for loading Reasonable Charges will result in the correct set up in the Charge Master. - Option 1.3, to calculate charges for a division - Option 4, to load those calculated charges into the Charge Master permanent files. However, if you are loading charges for a new site, or a site that may have changed its division number, then extra care is needed to ensure the setup of the Charge Master is correct. The following sections provide examples of displays and reports for the upload. ================= Reasonable Charges v5.25 Upload Details ============== The Charge Host Files should load with the following counts: The following files were created in XTMP, they will be purged in 2 days: ------------------------------------------------------------------------ IBRC2501A.TXT RC v5.25 Host File Upload, 1/2/25@23:24 by XXXX,XXXXX 772 IBRC2501B.TXT RC v5.25 Host File Upload, 1/2/25@23:24 by XXXX,XXXXX 8717 IBRC2501C.TXT RC v5.25 Host File Upload, 1/2/25@23:24 by XXXX,XXXXX 17935 IBRC2501D.TXT RC v5.25 Host File Upload, 1/2/25@23:24 by XXXX,XXXXX 30 IBRC2501E.TXT RC v5.25 Host File Upload, 1/2/25@23:24 by XXXX,XXXXX 917 IBRC2501F.TXT RC v5.25 Host File Upload, 1/2/25@23:24 by XXXX,XXXXX 1552 Any division that provides Inpatient Care should result in a summary with the following counts: IBCR UPLOAD RC 552 DAYTON VA MEDICAL CENTER, OH Count = 57110 IB Upload RC v5.25 552 DAYTON VA MEDICAL CENTER, OH, 1/2/25@23:24 by ROWE,D ONNA M Subfile Item Count Charge Set ------- ---- ----- ------------------------- 1 Inpt Fac 1 CPT 81 RC-INPT FAC PR 552 2 Inpt Fac 2 CPT 3 RC-INPT FAC HR 552 3 Inpt Fac 4 CPT 5 RC-INPT FAC ML 552 4 Inpt Fac/Phys 1 CPT 2886 RC-INPT FAC PR 552 5 Inpt PD Anc DRG 771 RC-INPT ANC 552 6 Inpt PD Anc ICU DRG 771 RC-INPT ANC ICU 552 7 Inpt PD R&B DRG 771 RC-INPT R&B 552 8 Inpt PD R&B ICU DRG 771 RC-INPT R&B ICU 552 9 Inpt Phys 1 CPT 8662 RC-PHYSICIAN INPT PR 552 10 Inpt Phys 3 CPT 275 RC-PHYSICIAN INPT MN 552 11 Opt Fac 1 CPT 8708 RC-OPT FAC PR 552 12 Opt Fac 2 CPT 3 RC-OPT FAC HR 552 13 Opt Fac 4 CPT 5 RC-OPT FAC ML 552 14 Opt Fac/Phys 1 CPT 5558 RC-OPT FAC PR 552 15 Opt PD PHosp MISCE 1 RC-OPT MISC 552 16 Opt Phys 1 CPT 7034 RC-PHYSICIAN OPT PR 552 17 Opt Phys 3 CPT 225 RC-PHYSICIAN OPT MN 552 18 SNF Fac 1 CPT 7940 RC-SNF FAC PR 552 19 SNF Fac 2 CPT 3 RC-SNF FAC HR 552 20 SNF Fac 4 CPT 5 RC-SNF FAC ML 552 21 SNF Fac/Phys 1 CPT 3677 RC-SNF FAC PR 552 22 SNF PD INC BEDSE 2 RC-SNF INC 552 23 SNF Phys 1 CPT 8678 RC-PHYSICIAN SNF PR 552 24 SNF Phys 3 CPT 275 RC-PHYSICIAN SNF MN 552 IB Upload Data Validity Check on Temporary files 1/2/2 5@23:25:14 Page 1 -------------------------------------------------------------------------- ------ ------------------- IBCR UPLOAD RC 552 DAYTON VA MEDICAL CENTER, OH Inpt Fac 1 81 of 81 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate. Inpt Fac 2 3 of 3 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate. Inpt Fac 4 5 of 5 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate. Inpt Fac/Phys 1 2886 of 2886 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate. Inpt PD Anc 771 of 771 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate. Inpt PD Anc ICU 771 of 771 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate. Inpt PD R&B 771 of 771 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate. Inpt PD R&B ICU 771 of 771 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate. Inpt Phys 1 8662 of 8662 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate. Inpt Phys 3 275 of 275 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate. Opt Fac 1 8708 of 8708 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate. Opt Fac 2 3 of 3 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate. Opt Fac 4 5 of 5 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate. Opt Fac/Phys 1 5558 of 5558 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate. Opt PD PHosp 1 of 1 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate. Opt Phys 1 7034 of 7034 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate. Opt Phys 3 225 of 225 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate. SNF Fac 1 7940 of 7940 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate. SNF Fac 2 3 of 3 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate. SNF Fac 4 5 of 5 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate. SNF Fac/Phys 1 3677 of 3677 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate. SNF PD INC 2 of 2 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate. SNF Phys 1 8678 of 8678 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate. SNF Phys 3 275 of 275 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate. Any provider-based division that provides Outpatient Care only should result in a summary with the following counts: IBCR UPLOAD RC 552GA MIDDLETOWN VA CLINIC, OH Count = 21534 IB Upload RC v5.25 552GA MIDDLETOWN VA CLINIC, OH, 1/2/25@23:29 by ROWE,DON NA M Subfile Item Count Charge Set ------- ---- ----- ------------------------- 1 Opt Fac 1 CPT 8708 RC-OPT FAC PR 552GA 2 Opt Fac 2 CPT 3 RC-OPT FAC HR 552GA 3 Opt Fac 4 CPT 5 RC-OPT FAC ML 552GA 4 Opt Fac/Phys 1 CPT 5558 RC-OPT FAC PR 552GA 5 Opt PD PHosp MISCE 1 RC-OPT MISC 552GA 6 Opt Phys 1 CPT 7034 RC-PHYSICIAN OPT PR 552GA 7 Opt Phys 3 CPT 225 RC-PHYSICIAN OPT MN 552GA IB Upload Data Validity Check on Temporary files 1/2/2 5@23:29:17 Page 1 -------------------------------------------------------------------------- ------ ------------------- IBCR UPLOAD RC 552GA MIDDLETOWN VA CLINIC, OH Opt Fac 1 8708 of 8708 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate. Opt Fac 2 3 of 3 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate. Opt Fac 4 5 of 5 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate. Opt Fac/Phys 1 5558 of 5558 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate. Opt PD PHosp 1 of 1 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate. Opt Phys 1 7034 of 7034 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate. Opt Phys 3 225 of 225 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate. Optional - Once this patch has been successfully installed you may delete the post init routines: IBYP814. Back-Out/Roll Back 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 the patch installer decides to back out this patch, the patch installer should log a Service Now ticket or contact the Enterprise Service Desk (ESD) at 855-673-4357. Backout or rollback of the software will be a joint decision between the development team, VA site/region personnel and other appropriate VA personnel and will require their concurrence. The development team will need to issue a follow-on 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 4 The checksums below are new checksums, and can be checked with CHECK1^XTSUMBLD. Routine Name: IBCRHBRV Before: B57305217 After: B57730469 **148,169,245,270,285,298,325, 334,355,360,365,382,390,408, 412,423,427,439,445,462,468, 484,491,508,520,536,542,556, 559,573,584,600,612,628,634, 658,667,683,693,719,724,744, 755,783,809,814** Routine Name: IBYP814 Before: n/a After: B8229467 **814** Routine list of preceding patches: 809 ============================================================================= User Information: Entered By : Date Entered : DEC 06, 2024 Completed By: Date Completed: FEB 10, 2025 Released By : Date Released : FEB 10, 2025 ============================================================================= Packman Mail Message: ===================== $END TXT