$TXT Created by HARTIN,JAMES at MNTVBB.FO-ALBANY.MED.VA.GOV  (KIDS) on Thursday, 09/16/04 at 19:52
=============================================================================
Run Date: DEC 08, 2004                     Designation: FB*3.5*84
Package : FB - FEE BASIS                      Priority: Mandatory
Version : 3.5        SEQ #75                    Status: Released
                  Compliance Date: JAN 08, 2005
=============================================================================

Associated patches: (v)FB*3.5*71   <<= must be installed BEFORE `FB*3.5*84'

Subject: UNABLE TO DETERMINE A FEE SCHEDULE AMOUNT

Category: 
  - Routine

Description:
============

 This patch addresses the problem encountered when using Medical Fee to 
 enter a payment with modifier SG for ASC Facility Service. The  "SG"
 modifier entered to get the (separate) facility charge is not recognized
 and the charge is processed from the physician fee schedule giving that
 amount unadjusted.
         
 ASSOCIATED E3R(s):
 -----------------
 N/A
     
 ASSOCIATED NOIS:
 ---------------
 1. WWW-0804-50728     Problem after FB*3.5*71
  
 PARTICIPATING TEST SITES:
 ------------------------
 VA Greater Los Angeles HCS
 Tomah,WI 
 Walla-Walla,WA 
      
 NOIS OVERVIEW:
 -------------
 1. WWW-0804-50728     Problem after FB*3.5*71
  
   
    Problem:
    -------
 When using Medical Fee to enter a payment with modifier SG for ASC 
 Facility Service the amount is not adjusted for the SG modifier and 
 returns the physician fee amount as if no modifier is entered. 
  
    Resolution:
    ----------
 The process will test for SG modifier and if found will not use the RBRVS 
 fee schedule and returning the message "Unable to determine a FEE 
 schedule amount.".  In that case, the fee clerk would enter a usual &
 customary amount.
  
 Background: 
  
 The RBRVS fee schedule is the Medicare Physician Fee Schedule.  This fee
 schedule does not cover facility charges.
  
 VA also obtains information from the Department of Labor OWCP fee schedule
 to adjust the physician fee schedule amount when certain CPT/HCPCS
 modifiers are present.  In past years, DOL included the SG modifier in 
 the modifier level tables with a percentage adjustment.  This was
 intended to indicate a maximum amount for a facility charge as a
 percentage (e.g. 175%) of the physician fee schedule amount.
  
 In reviewing the OWCP 2004 fee schedule and DOL appears to have revised
 it's methodology for the SG modifier.  That modifier was removed from all
 their modifier level tables.  Instead a separate list of Ambulatory
 Surgical Center Allowable Procedures was published. Each of these have a
 multiplier of 1.75.
  
 As usual, VA did import the DOL modifier level tables when the RBRVS fee
 schedule was built.  However, the SG modifiers are no longer in those
 tables so the software is not applying a percentage adjustment when that
 modifier is entered for dates of service in 2004.
      
 ROUTINE SUMMARY
 ===============
 The following is a list of the routines included in this patch. The 
 second line of each of these routines now looks like: 
    
   <tab>;;3.5;FEE BASIS;**[PATCH LIST]**;JAN 30 1995
    
                        CHECK^XTSUMBLD results
   Routine name    Before Patch     After Patch    Patch List
   ------------    ------------     -----------    ----------
   FBAAFSR           4917590          4931145      4,53,71,84
   
  
 INSTALLATION INSTRUCTIONS
 =========================
 This patch can be loaded with users in the system.  Installation time
 will be less than 1 minute.
    
  1.  Choose the PackMan message containing this patch and invoke the 
      INSTALL/CHECK MESSAGE PackMan option.  
    
  2.  (DSM for Open VMS sites only) Disable routine mapping on all systems
      for the routines listed in the Routine Summary.
    
      NOTE:  If the routines included in this patch are not currently
      in your mapped routine set, please skip this step.
   
  3.  Start up the Kernel Installation and Distribution System Menu
      [XPD MAIN]: 
   
           Edits and Distribution ...  
           Utilities ...  
           Installation ...  
   
      Select Kernel Installation & Distribution System Option: Installation
                                                               ---
           1      Load a Distribution
           2      Verify Checksums in Transport Global
           3      Print Transport Global
           4      Compare Transport Global to Current System
           5      Backup a Transport Global
           6      Install Package(s)
                  Restart Install of Package(s)
                  Unload a Distribution
   
  4.  From this menu, you may elect to use the following options
      (When prompted for the INSTALL NAME, enter FB*3.5*84):
      
      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.
   
  5.  Use the Install Package(s) option and select the package
      FB*3.5*84. 
  
       a.  When prompted 'Want KIDS to INHIBIT LOGONs during the
           install? YES//', answer NO.
       b.  When prompted 'Want to DISABLE Scheduled Options, Menu
           Options, and Protocols? YES//' answer NO.
        
    
  6.  (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:
  - FBAAFSR


Routine Checksum:

=============================================================================
User Information:
Entered By  : HARTIN,JAMES                  Date Entered  : SEP 15, 2004
Completed By: BOWEN,MARY JANE               Date Completed: DEC 08, 2004
Released By : GANUS,MAUNETTE                Date Released : DEC 08, 2004
=============================================================================


Packman Mail Message:
=====================

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