$TXT Created by CITTY,WAYNE R at LEXINGTON.MED.VA.GOV (KIDS) on Tuesday, 08/12/03 at 11:59 ============================================================================= Run Date: SEP 03, 2003 Designation: FB*3.5*62 Package : FB - FEE BASIS Priority: Mandatory Version : 3.5 SEQ #55 Status: Released Compliance Date: OCT 04, 2003 ============================================================================= Subject: MILL BILL EMERGENCY CARE SUMMARY REPORT Category: - Routine Description: ============ IRM SHOULD PROVIDE THE FEE STAFF WITH A COPY OF THIS PATCH DESCRIPTION. This patch will provide a new report to the Unauthorized Claims module of the VistA Fee Basis application. The report will print statistics for 38 U.S.C. 1725 emergency care claims that were entered into the system within a user specified date range. The purpose of the report is to automate the development of emergency care claim summary statistics that sites must report to the Chief Business Office (CBO) on a monthly basis. The CBO uses the monthly input from sites to prepare the Millennium Act Emergency Care report, which is required by Congress. This patch will greatly benefit sites by providing a mechanism to systematically generate the required statistics, which save local facility staff time. This report will only benefit those sites that are entering all non-VA emergency care claims data into the VistA Fee Basis application. This patch adds the new option Millennium Act Emergency Care Summary Report [FBUC MILL ACT SUMMARY] to the Outputs for Unauthorized Claims [FBUC OUTPUTS] menu. This patch releases the new routine FBUCMBS which is invoked by running the Millennium Act Emergency Care Summary Report [FBUC MILL ACT SUMMARY] option. This new routine will prompt the user for a Start Date and End Date. These dates are based on the .01 field of file 162.7 (FEE BASIS UNAUTHORIZED CLAIMS FILE) and is the DATE CLAIM RECEIVED. After the user has entered a Start Date, End Date, and Device to print the report, the routine will: A. Determine if the claim is being considered under Millennium Act 38 U.S.C. 1725 based on field 31 of file 162.7 equaling 'YES' or this field being set to 1. B. Count each claim and add to a running total equaling Total Number Claims Received. C. Determine the Amount Claimed based on field 8 of file 162.7 and add to a running total equaling Total Dollars Claims Received. D. Determine the claimant based on CLAIM SUBMITTED BY, field 23 of file 162.7. This claimant is then temporarily stored in ^TMP($J,"FBUCMBS","CLMT" keeping claimants unique. Unique claimants are counted equaling Total Claimants. E. Determine the DISPOSITION, field 10 of file 162.7. This field is a pointer to file 162.91, FEE BASIS UNAUTHORIZED CLAIMS DISPOSITIONS file. Valid dispositions are: 1. APPROVED 2. APPROVED TO STABILIZATION 3. ABANDONED 4. CANCELLED/WITHDRAWN 5. DISAPPROVED a. If the claim was not dispositioned it will be counted as a Pending claim and both the AMOUNT CLAIMED and each Pending claim will be added to running totals equaling Total Number Claims Pending and Total Dollars Claims Pending. b. If the claim was dispositioned as Approved or Approved to Stabilization the AMOUNT APPROVED is computed using Fee Basis batch payment data and each claim will be added to running totals equaling Total Claims Paid and Total Dollars Claims Paid. After counting these claims and the dollars associated these claims will be calculated for Average Processing Time. c. All remaining claims with dispositions of Abandoned, Cancelled/Withdrawn, and Disapproved will be processed to ascertain the reason for denial as in the case of claims which have been Disapproved. Claims Disapproved will be added to a running total equaling Total Number Claims Rejected with the Amount Claimed added to Total Dollars Claims Rejected. Each reason for denial is added to a temporary array stored in ^TMP($J,"FBUCMBS","REAS". REASON FOR DISAPPROVAL, field 15 of file 162.7, is a multiple field which points to file 162.94 (FEE BASIS UNAUTHORIZED DISAPPROVAL REASONS). In this case only the first reason entered is collected for the Millennium Act Emergency Care Summary Report. Valid Reasons For Denial are: 1. 1725 INFO NOT REC'D TIMELY 2. 1725 NON-EMERGENT CARE 3. 1725 NOT TIMELY FILED 4. ADJUDICATION REQUESTED 5. DENIAL OF TRAVEL 6. HAS OTHER INS. BENEFITS 7. NO VA TX, PAST 24 MTHS 8. NON-EMERGENT CARE 9. NOT LIABLE FOR PAYMENT 10. NOT TIMELY FILED 11. NSC CONDITION 12. NSC VETERAN 13. PREVIOUSLY AUTHORIZED 14. VA FACILITIES AVAILABLE 15. VETERAN NOT ENROLLED Further processing continues determining the Average Processing Time of the claim. d. Finally after processing the last record for a given date range the summary report is produced. For example: MILLENNIUM ACT EMERGENCY CARE SUMMARY REPORT MAY 29, 2000 THROUGH MAY 31, 2003 RUN DATE: JUL 08, 2003 Total Number Claims Received: 4603 Total Dollars Claims Received: $5,837,876.71 Total Claimants: 579 Total Claims Paid: 1287 Total Dollars Claims Paid: $489,910.57 Total Dollars Suspended: $1,028,145.36 Total Number Claims Rejected: 2503 Total Dollars Claims Rejected: $2,678,629.57 REASONS REJECTED 1725 INFO NOT REC'D TIMELY: 169 1725 NON-EMERGENT CARE: 225 1725 NOT TIMELY FILED: 69 ADJUDICATION REQUESTED: 1 HAS OTHER INS. BENEFITS: 1490 NO VA TX, PAST 24 MTHS: 110 NON-EMERGENT CARE: 93 NOT LIABLE FOR PAYMENT: 7 NOT TIMELY FILED: 14 NSC CONDITION: 16 NSC VETERAN: 3 OTHER: 63 VA FACILITIES AVAILABLE: 215 VETERAN NOT ENROLLED: 28 ------ 2503 Total Number Claims Pending: 788 Total Dollars Claims Pending: $1,641,191.21 Average Processing Time: 156.86 Days Instructions to sites: ====================== The Millennium Act Emergency Care Summary Report Option [FBUC MILL ACT SUMMARY], allows you to run "Mill Bill" activity for any selected period, however for Central Office reporting purposes the report must be run three times. First, cumulative data is obtained by running it from 5/29/00 through the end of the month being reported. Second, fiscal year to date is obtained by running it from October 1st of the current fiscal year through the end of the month being reported. Third, run it from the first to the last day of the month being reported to obtain monthly data. Enter the three sets of figures into an Excel spreadsheet and send them, through appropriate channels, to the VISN Business Office. The VISN will compile the statistics for all their facilities and submit them to the Program Analyst, Fee Basis Program, Chief Business Office (16), VACO. Install Instructions: ===================== Install Time - The estimated install time for this patch is approximately 1 minute. 1. LOAD TRANSPORT GLOBAL --------------------- Choose the PackMan message containing this patch and invoke the INSTALL/CHECK MESSAGE PackMan option. 2. DISABLE ROUTINE MAPPING (DSM for Open VMS sites only) ----------------------- Disable routine mapping on all systems for the routines listed in step 3 below. NOTE: If the routines included in this patch are not currently in your mapped routine set, please skip this step. 3. COMPONENTS SENT WITH PATCH -------------------------- The following is a list of the routines included in this patch. The second line of each of these routines now looks like: ;;3.5;FEE BASIS;**[patch list]**;JAN 30, 1995 CHECK^XTSUMBLD results Routine Before Patch After Patch Patch List -------- ------------ ----------- ---------- FBUCMBS new 13400936 62 Total number of routines: 1 The following new option is included in this patch: Menu Text Option Name ----------------------------- --------------------- Millennium Act Emergency Care FBUC MILL ACT SUMMARY Summary Report 4. 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: 5. Select Installation Option: -------------------------- NOTE: The following are OPTIONAL - (When prompted for the INSTALL NAME, enter FB*3.5*62): 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. 6. 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. b. When prompted 'Want KIDS to Rebuild Menu Trees Upon Completion of Install? YES//' answer per your site's normal procedures. c. When prompted 'Want KIDS to INHIBIT LOGONs during the install? YES//' answer NO. d. When prompted 'Want to DISABLE Scheduled Options, Menu Options, and Protocols? YES//' answer NO. e. A sample installation is shown below. Install Started for FB*3.5*62 : Jul 08, 2003@14:31:50 Build Distribution Date: Jul 08, 2003 Installing Routines: Jul 08, 2003@14:31:50 Installing PACKAGE COMPONENTS: Installing OPTION Jul 08, 2003@14:31:50 Updating Routine file... Updating KIDS files... FB*3.5*62 Installed. Jul 08, 2003@14:31:51 Install Message sent #765034 ------------------------------------------------------------------------ +------------------------------------------------------------+ 100% | 25 50 75 | Complete +------------------------------------------------------------+ Install Completed 7. REBUILD MAPPED ROUTINE(S) (DSM for Open VMS sites only) ------------------------- (Optional) Include the routines distributed with this patch in the mapped routine set. NOTE: This step is only necessary if you performed step 2 or if you wish to include the routines in your mapped set. Routine Information: ==================== Routine Name: - FBUCMBS Routine Checksum: ============================================================================= User Information: Entered By : MINARDI,CHRISTOPHER P Date Entered : JUL 01, 2003 Completed By: MOHSENE,DIANA Date Completed: SEP 03, 2003 Released By : JACKSON,SHERYL Date Released : SEP 03, 2003 ============================================================================= Packman Mail Message: ===================== $END TXT