$TXT Created by HARPER,AMY R at DEVFEX.FO-ALBANY.MED.VA.GOV (KIDS) on Tuesday, 01/15/08 at 13:31 ============================================================================= Run Date: MAR 06, 2008 Designation: IB*2*370 Package : IB - INTEGRATED BILLING Priority: Mandatory Version : 2 SEQ #358 Status: Released Compliance Date: APR 06, 2008 ============================================================================= Associated patches: (v)IB*2*347 <<= must be installed BEFORE `IB*2*370' (v)IB*2*365 <<= must be installed BEFORE `IB*2*370' Subject: REASONABLE CHARGES 3.0 Category: - Routine - Other - Enhancement (Mandatory) Description: ============ This patch supports Reasonable Charges v3.0, which contains two significant updates to the Reasonable Charges (RC) definition. There are no charges released with this version of Reasonable Charges. Elimination/Revision of the Charge Discounts ------------------------------------------------------- There are four charge discounts associated with Reasonable Charges. Each of these discounts is applied to procedure charges when bill charges are calculated. It has been determined that it is standard procedure for the Fiscal Intermediary to also apply these discounts. Therefore these discounts have been removed from Reasonable Charges. VistA Billing will no longer apply these discounts to bill charges: - Multiple Surgical Procedures Discount - Primary/Secondary Bundled Discount - Provider Discount - Modifier Decrease Adjustment The removal of the charge discounts is not date dependent, the discounts will end when the patch is installed, therefore the discounts will not be applied to any care billed after this patch is installed. Modifier Increase Adjustment: The exception to the removal of the Reasonable Charges discounts are the two Modifier Adjustments that increase the charge, these will continue to be applied to bill charges: - modifier 22 at 120% adjustment (Unusual Procedural Services) - modifier 50 at 154% adjustment (Bilateral Procedure) Any procedure associated with one of these two modifiers will continue to have the corresponding charge adjustment applied to the procedure's charge on the bill. Zero Charge Provider Discount: Also note that the Zero Charge Provider Discount for non-billable providers will continue to be available. This discount is not specific to Reasonable charges. The Zero Charge Provider Discount is a general check for non-billable provider. So cancelling of charges, or zero charge, for providers who should not be billed will remain. Accommodation of Interim Nationally Based Charges ------------------------------------------------------- CPT/HCPCS procedure codes may be updated on a quarterly schedule, new codes are released and some are inactivated. To provide charges for these new codes as quickly as possible, a National Interim charge will be developed for the new procedures. These national interim charges will not be locality specific, but will be the same for all sites. The next full release of Reasonable Charges will provide site specific charges for these procedures. To accommodate these national interim charges an enter option is being provided for each site to add these charges to their Charge Master. The National Reasonable Charges Enter [IBCR ENTER RC NATIONAL CHARGES] option is added to the Charge Master Menu [IBCR CHARGE MASTER MENU]. This option is limited to those users assigned the IB SUPERVISOR key. The national interim charges will be published in a document by Chief Business Office. These will then be entered manually into the Charge Master based on the following information provided in that document: Code: Procedure CPT/HCPCS Effective: Date charge becomes active/effective Modifier: CPT Modifier Code, if applicable Charge Type: Institutional or Professional Unit Charge: Currency, standard charge per procedure unit Base Charge: Currency, Anesthesia and Observation Type charges only. Standard: PR, is this a Standard Type Charge, charge per procedure Anesthesia: MN, Minutes, is this an Anesthesia Type Charge Observation: HR, Hours, is this an Observation Type Charge Ambulance: ML, Miles, is this an Ambulance Type Charge Inpatient: Yes/No, is this procedure billable for Inpatient care SNF: Yes/No, is this procedure billable for SNF care Outpatient: Yes/No, is this procedure billable for Outpatient care Freestanding: Yes/No, is this procedure billable for Non-Provider sites Once this data is entered for a procedure, the charge will be added to each appropriate Charge Set in the Charge Master and then will be billed as all other charges. Other Changes: Anesthesia Minutes ------------------------------------------------------- Anesthesia is billed based on a 15 minute unit. Before this patch the Reasonable Charges anesthesia unit was rounded up after 4 minutes: 1-19 minutes is one unit and 20-34 is two units, etc. However this has been modified to a more standard rounding algorithm. Beginning with Reasonable Charge v3.0, the anesthesia units will be based on a 15 minute unit rounded up after any minutes: 1-15 minutes is one unit and 16-30 is two units, etc. This patch addresses the following New Service Request (NSR): ------------------------------------------------------------- 20050417 Methodology Update Inpatient and Outpatient Reasonable Charges This patch addresses the following NOIS/Remedy Ticket(s): --------------------------------------------------------- There is no NOIS/Remedy tickets associated with this patch. Technical Description ===================== There are 6 routines deleted with this patch (IBCRBCA*). These routines implemented 3 of the Reasonable Charges discounts: Multiple Surgical Procedures Discount, Primary/Secondary Bundled Discount, Modifier Adjustment/Discount. Since these discounts are being removed from the definition of Reasonable Charges, the routines and the calls to them are deleted. The Modifier Adjustment is a special case. There are two modifier charge adjustments that increase the charge and will remain, however the process of applying this modifier adjustment has been changed. The existing modifier adjustment was dependent on how the procedures were defined on the bill. Therefore, the adjustment could not be completed until all the bill charges were compiled. The modifier adjustments that will remain will be applied as a simple adjustment to each charge for procedures with that modifier. So the compiled version of the modifier adjustment (IBCRBCA3) is replaced with application of the adjustment as each charge is calculated (IBCRBC2). The Provider Discounts for Reasonable Charges are also being removed. However, the Zero Charge Provider Discount will remain. Therefore the logic to apply the discount must also remain. To remove specific discounts, the Group is deleted from the BILLING PROVIDER DISCOUNT (#363.34) file. The removal of the RC Provider Discounts will be implemented by the Post-init. The Post-init (IBYPSK) will delete all Provider Discounts in the RC Provider Discount Special Group that were nationally defined, except the ZERO CHARGE group. The Post-Init (IBYPSK) deletes all Provider Discount Groups in the RC PROVIDER DISCOUNTS Special Group, except the ZERO CHARGE group, in the BILLING PROVIDER DISCOUNT (#363.34) file. Delete Reasonable Charges Provider Discounts: >> Discount Deleted: CERT REG NURSE ANESTHETIST >> Discount Deleted: CLINICAL NURSE SPECIALIST >> Discount Deleted: CLINICAL PHARMACIST >> Discount Deleted: CLINICAL PSYCHOLOGIST >> Discount Deleted: CLINICAL SOCIAL WORKER >> Discount Deleted: DIETITIAN >> Discount Deleted: NURSE PRACTITIONER >> Discount Deleted: PHYSICIAN ASSISTANT 8 Provider Discount Groups Deleted (#363.34) COMPONENTS SENT WITH PATCH -------------------------- Routines: --------- Number of Routines = 14 Total number of routines modified = 5 Total number of new routines = 3 Total number of deleted routines = 6 Post-Init: POST^IBYPSK - deletes all Provider Discount Groups in the RC PROVIDER DISCOUNTS Special Group (#363.34), except the ZERO CHARGE group. Stored in the BILLING PROVIDER DISCOUNT (#363.34) file. The following is a list of options included in this patch: Option Name Type New/Modified ----------- ---- ------------ National Reasonable Charges Enter Routine New - [IBCR ENTER RC NATIONAL CHARGES] - New option with IB SUPERVISOR key - Added to Charge Master Menu [IBCR CHARGE MASTER MENU] Charge Master Menu Menu Modified - [IBCR CHARGE MASTER MENU] - used as link for new option only Test Sites: ----------- Central Texas HCS Illiana HCS (Danville) Martinsburg, WV North Chicago, IL Pre/Post Installation Overview ------------------------------ The Post-init of this patch will remove all Reasonable Charges Provider Discounts except the Zero Charge Group. The installation description should be checked for completion of this task. ================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. Enter/Edit Billing Information [IB EDIT BILLING INFO] Charge Master IRM Menu [IBCR CHARGE MASTER IRM MENU] Install Time - less than 5 minutes Please note that Reasonable Charges v3.1 is being released before v3.0. RC v3.0 (IB*2*370) only involves coding changes and only v3.1 (IB*2*390) will involve a rate update. There is no dependency between the two versions. Therefore any order of installation of these two patches is acceptable. 1. LOAD TRANSPORT GLOBAL --------------------- Choose the PackMan message containing this patch and invoke the INSTALL/CHECK MESSAGE PackMan option. 2. START UP KIDS ------------- Start up the Kernel Installation and Distribution System Menu [XPD MAIN]: Edits and Distribution ... Utilities ... Installation ... Select Kernel Installation & Distribution System Option: INStallation --- Load a Distribution Print Transport Global Compare Transport Global to Current System Verify Checksums in Transport Global Install Package(s) Restart Install of Package(s) Unload a Distribution Backup a Transport Global Select Installation Option: 3. Select Installation Option: --------------------------- NOTE: The following are OPTIONAL - (When prompted for the INSTALL NAME, enter IB*2.0*370): 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 DD's 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, DD's, 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. Select Installation Option: Install Package(s) ------------------ **This is the step to start the installation of this KIDS patch: a. Choose the Install Package(s) option to start the patch install. When prompted 'Want KIDS to Rebuild Menu Trees Upon Completion of Install? YES//' Answer YES unless your system does this in a nightly TaskMan process. b. When prompted 'Want KIDS to INHIBIT LOGONs during the install? YES//' answer NO c. When prompted 'Want to DISABLE Scheduled Options, Menu Options, and Protocols? YES//' answer YES d. When prompted 'Enter options you wish to mark as 'Out Of Order':' Enter the following options: IB EDIT BILLING INFO Enter/Edit Billing Information IBCR CHARGE MASTER IRM MENU Charge Master IRM Menu e. When prompted 'Enter protocols you wish to mark as 'Out Of Order':' press . 5. Check Post-init deletion of Provider Discounts The Post-init of this patch will remove all Reasonable Charges Provider Discounts except the Zero Charge Group. Please check the Installation Description for the following: Reasonable Charges v3.0 Post-Install ..... Delete Reasonable Charges Provider Discounts: >> Discount Deleted: CERT REG NURSE ANESTHETIST >> Discount Deleted: CLINICAL NURSE SPECIALIST >> Discount Deleted: CLINICAL PHARMACIST >> Discount Deleted: CLINICAL PSYCHOLOGIST >> Discount Deleted: CLINICAL SOCIAL WORKER >> Discount Deleted: DIETITIAN >> Discount Deleted: NURSE PRACTITIONER >> Discount Deleted: PHYSICIAN ASSISTANT 8 Provider Discount Groups Deleted (#363.34) Reasonable Charges v3.0 Post-Install Complete Note: If there are Provider Discounts that were not deleted, then there might be some local discounts. Please contact support. 6. Clean-up Post-Init Routine -------------------------- Optional - Once this patch has been successfully installed you may delete the post init routine: IBYPSK Routine Information: ==================== The second line of each of these routines now looks like: ;;2.0;INTEGRATED BILLING;**[Patch List]**;21-MAR-94;Build 5 The checksums below are new checksums, and can be checked with CHECK1^XTSUMBLD. Routine Name: IBCRBC Before: B13287981 After: B11588633 **52,80,106,51,137,245,370** Routine Name: IBCRBC1 Before: B55203191 After: B55586137 **52,80,106,138,51,148,245,270,370** Routine Name: IBCRBC2 Before: B24945366 After: B26657513 **52,106,138,148,245,370** Routine Name: IBCRBCA1 Before: B59536766 After: Delete Routine Name: IBCRBCA2 Before: B12988933 After: Delete Routine Name: IBCRBCA3 Before: B15514071 After: Delete Routine Name: IBCRBCAP Before: B51905634 After: Delete Routine Name: IBCRBCAQ Before: B47316097 After: Delete Routine Name: IBCRBCAR Before: B44755741 After: Delete Routine Name: IBCRBH1 Before: B59021504 After: B56713441 **106,245,370** Routine Name: IBCRCC Before: B18670863 After: B26741603 **52,80,106,138,245,223,309,347,370** Routine Name: IBCRER Before: n/a After: B20891309 **370** Routine Name: IBCRER1 Before: n/a After: B44995002 **370** Routine Name: IBYPSK Before: n/a After: B6669891 **370** Routine list of preceding patches: 137, 270, 347 ============================================================================= User Information: Entered By : HARPER,AMY R Date Entered : FEB 20, 2007 Completed By: LYNCH,MARY F. Date Completed: MAR 05, 2008 Released By : BOTTINI,STEVE Date Released : MAR 06, 2008 ============================================================================= Packman Mail Message: ===================== $END TXT