============================================================================= Run Date: DEC 16, 2002 Designation: IB*2*183 Package : IB - INTEGRATED BILLING Priority: EMERGENCY Version : 2 SEQ #178 Status: Released Compliance Date: DEC 19, 2002 ============================================================================= Associated patches: (v)EAS*1*13 install with patch `IB*2*183' (c)PRCA*4.5*181 install with patch `IB*2*183' (c)DG*5.3*456 install with patch `IB*2*183' (v)IVM*2*62 install with patch `IB*2*183' (v)IB*2*179 <<= must be installed BEFORE `IB*2*183' (v)IB*2*187 <<= must be installed BEFORE `IB*2*183' (v)IB*2*188 <<= must be installed BEFORE `IB*2*183' Subject: GEOGRAPHIC MEANS TEST, IB PART II Category: - Informational - Routine - Data Dictionary - Enhancement () - Other Description: ============ The software for this patch, IB*2.0*183, and associated patches, EAS*1*13, DG*5.3*456, IVM*2*62 and PRCA*4.5*181, are not being distributed through the National Patch Module. These patches are being distributed as a single KIDS software distribution (host file). This patch contains the informational portion of IB*2.0*183 and provides field personnel with instructions on how to acquire, install, and implement the patch software. Overview -------- On January 23, 2002, President Bush signed into law H.R. 3477, The Department of Veterans Affairs Health Care Programs Enhancement Act of 2001. Section 202 of this Act requires the implementation of HUD indices to determine geographic income thresholds in support of more discrete means testing. Veterans in Priority Group 7 are eligible for treatment as a low-income family under section 3(b) of the United States Housing Act of 1973 (42 U.S.C. 1437a(b)) for the area in which such veterans reside, regardless of whether such veterans are treated as single person families under paragraph (3)(A) of such section 3(b) or as families under paragraph (3)(b). This Act also established Priority Group 8 for any veterans described in section 1710(a)(3) of titles 38 U.S.C. who are not covered by Priority Group 7. A new GMT Copayment status will identify veterans that qualify for a reduced inpatient GMT copayment rate. The effective date of the regulation to support the legislation is 10/01/02. Functional Description ---------------------- The patch IB*2.0*183 provides all new functionality and modifications, related to the GMT requirements: 1) Inpatient Per Diem/Copayment Charges for patients with GMT Copayment Required Status will be calculated as 20% of Means Test charges. 2) Two new reports come with the patch: - GMT SINGLE PATIENT REPORT - GMT MONTHLY TOTALS REPORT Accordingly, two new menu options provided. 3) The existing report - MT SINGLE PATIENT PROFILE was modified to mark GMT-related charges. 4) The estimator of MT Charges [IB MT ESTIMATOR] was modified to make correct estimations for patients with GMT Copayment Required Status. 5) The menu option [IB MT REL HELD (RATE) CHARGES] now can be used to release held (rate) charges for selected patient. That would be possible only if the Patient GMT/MT Copayment Status has been defined. This is emergency procedure and normally will not have to be executed. 6) The existing report IB MT LIST HELD (RATE) CHARGES may be used to identify MT Charges, placed ON HOLD by the GMT IB Part 1 software. The previous version of the report was intended for Outpatient Charges only. The report has been modified to work with both Inpatient and Outpatients charges. 7) All IB reports/screen forms, which need to print/output patient Means Test Status, were modified to be able to display/print/output Information about GMT Status. 8) The patch provides API call, which can be called by the Enrollment Package at the moment, when the patient's MT/GMT Copayment Status will be defined. The call will re-calculate all patient's MT charges, placed ON HOLD (RATE) by the GMT IB software, because of unknown GMT Copayment Status. All charges, decreased because of patient's GMT Copayment Status, will be marked as 'GMT RELATED'. Technical Description --------------------- There are twenty-nine routines and two new menu options contained in this patch. Also, the Data Dictionary for the file # 350 (INTEGRATED BILLING ACTION) has been modified. New/modified routines: 1) IBAGMT - The routine contains GMT-related utilities. The modified version of the routine provides the following new/modified functions: - $$ISGMTPT^IBAGMT(DFN,IBDT) Description: The function returns value (1, 0, or -1), indicating, does the Patient have GMT Copayment Status or not? If GMT/MT Copayment is unknown because of uncompleted conversion process, the function returns '-1'. The function calls DG API (GMT^DGMTUB), if the DG patch was installed, otherwise it returns '-1' (unknown). Input: DFN - IEN of PATIENT file, IBDT - Date in FM format, Output: 1 - 'YES', 0- 'NO', '-1' - 'UNKNOWN' The procedure will send Mailman messages to MEANS TEST BILLING mail group, if an error happens. The error messages will contain detailed diagnostic information. - $$HOLD^IBAGMT(IBACT) Description: This function defines, does the charge need to be placed on hold because of unknown rate. If the patient's GMT/MT Copayment Status will be defined, the function will always exit and return '0' (False). Otherwise the function will return '1' (True) if the charge is Potentially GMT-related and should be placed on hold (rate). If the function returns 'True', it also modifies the record of IB ACTION file (#350), setting the field STATUS to 20 (HOLD-RATE), forcing placing ON HOLD. When the GMT conversion process will be completed, the function will always return '0' (false), and will perform no action. Input: IBACT - IEN of INTEGRATED BILLING ACTION file (#350) Output: 1 - place ON HOLD (action performed), 0 - no. - $$REDUCE^IBAGMT(IBCRG) - The function will contain the rule for recalculation MT Charge to GMT amount. Currently it calculates 20% and rounds the result. Input: IBCRG - the amount of MT charge Output: The function returns GMT rate for the given MT rate. - $$RELHOLD^IBAGMT(DFN) - the API call to be called by the Enrollment software, responsible for the GMT conversion. The function will scan Inpatient MT IB charges, being 'INCOMPLETE' or 'ON HOLD-RATE' (status code 20) starting from the GMT Effective Date, and check the GMT Copayment Status for the patient. If the Patient has GMT Status, all corresponding charges will be re-calculated (reduced to 20%). All such charges ON HOLD - RATE (status code 20) will be passed to the AR package. All reduced charges will be marked as 'GMT RELATED' - field #.21 will be set to 1 - 'YES'. The function will store the Patient's DFN in temporary global node ^XTMP("IB GMT CONVERSION") to guarantee that the procedure will not be executed within the next 90 days. The procedure will also adjust the latest MT Billing Clock for the patient, if the reduced charge is for GMT Copayment. In order to determine, which 90-days period the particular Charge belongs to, the procedure will use the temporary global node ^IB("AGMT"), supported by GMT 1 software. Input: DFN - Patient's IEN Output: Number on Charges released (or negative if error) This procedure will also be called from [IB MT REL HELD (RATE) CHARGES] option, for a selected patient. - AGMTP^IBAGMT - the procedure to restore "AGMTP" index. It will look for all 'Incomplete' or 'Hold - Rate' inpatient charges "billed to" after the GMT effective date. If such charges present for the patient, the global node will be set: ^IB("AGMTP",DFN)="". That will indicate, that the patient will require the "Release off Hold" procedure to be executed after the GMT/MT status will be defined. That will allow to perform the "Release off Hold" procedure automatically by the IB software, if the Enrollment will fail to call it for some reason. 2) IBAUTL2 - CHADD and CHUPD entry calls will be modified. One more input variable (IBGMTR) provided [optional]. Now if the local variable IBGMTR defined and not zero, the procedure will set 'GMT RELATED' flag of the charge to 1 - 'YES'. 3) IBAUTL4 - the routine will call $$ISGMTPT^IBAGMT() and $$REDUCE^IBAGMT() for both Per Diem and Deductible charges to adjust amount values, if needed, according to new business rules. If the Patients GMT/MT Copayment Status is unknown, the routine will work the same way as in GMT IB Part 1 patch. 4) IBAMTD1 - the routine will call $$ISGMTPT^IBAGMT() and $$REDUCE^IBAGMT()for both Per Diem and Deductible charges to adjust amount values, if needed, according to new business rules. If the Patients GMT/MT Copayment Status is unknown, the routine will work the same way as in GMT IB Part 1 patch. 5) IBECEA21 - the routine will call $$ISGMTPT^IBAGMT() and $$REDUCE^IBAGMT() to adjust calculated charge amount, if needed, according to new business rules. If the GMT Copayment Status is unknown (conversion not completed), the routine will write a warning message. Also it will write a message, if the Medicare Deductible was reduced due to GMT Copayment Status of the Patient. 6) IBECEA3 - the routine calls $$ISGMTPT^IBAGMT() and $$REDUCE^IBAGMT() to adjust calculated charge amount, if needed, according to new business rules. If the GMT Copayment Status is unknown (conversion not completed), the routine will write a warning message. Also it will write a message, if the Medicare Deductible was reduced due to GMT Copayment Status of the Patient, 7) IBECEA22 - the UPD entry call will be modified. One more input variable provided [optional]. Now if the local variable IBGMTR defined and not zero, the procedure will set 'GMT RELATED' flag of the charge to 1 - 'YES' 8) IBECEAU3 - the ADD entry call was modified. One more input variable provided [optional]. Now if the local variable IBGMTR defined and not zero, the procedure will set 'GMT RELATED' flag of the charge to 1 - 'YES' 9) IBECEAU4 - the CANC entry call was modified.Now, when cancellind the charge with 'GMT RELATED' flag, the corresponding cancellation charge will be created with 'GMT RELATED' flag as well. 10) IBOMTE - the routine calls $$ISGMTPT^IBAGMT() to define patient's GMT Copayment Status and will set IBGMT variable. Also it will write a message to user if the patient is GMT. The patient lookup procedure turns off the "fuzzy" lookup by setting DPTNOFZY=1. 11) IBOMTE1 - the routine adjusts calculated Per Diem charges amount, for GMT Patients, using $$REDUCE^IBAGMT(). 12) IBOMTE2 - the routine performs adjust calculated Deductible Copayment charges amount, for GMT Patients, using $$REDUCE^IBAGMT(). 13) IBOMTP1 - The 'SINGLE PATIENT MT PROFILE REPORT' is modified to mark GMT-related charges with asterisk. 14) IBJTEA - The "IBJ PATIENT ELIGIBILITY SCREEN" was modified to indicate GMT Copayment Status. 15) IBAGMR - The entry point, user's dialogs and queuing-related code for the new "GMT SINGLE PATIENT REPORT". User will enter Patient, Beginning and Ending dates. The default Beginning Date will be GMT Effective Date. The default Ending Date will be current date. 16) IBAGMR1 - Main body of the "GMT SINGLE PATIENT REPORT". The report will scan all events in the specified dates range for the patient. If the patient will have any GMT related charges (reduced due to GMT Status), the report will indicate GMT-related Savings (Difference) as Charge Amount x 4. 17) IBAGMM - The entry point, user's dialogs and queuing-related code for the new "GMT MONTHLY TOTALS REPORT". 18) IBAGMM1 - Main body of the "GMT MONTHLY TOTALS REPORT". The report will scan all GMT events in the specified dates range. It will print totals for GMT charges, and total MT/GMT Difference for each month in the specified data range. 19) IBRFN - The function TYP^IBRFN() will be fixed for Billing Group 8 (LTC Outpatient). It must return "O", because the Billing Group 8 is "Outpatient". 20) IBEMTO - The 'BILL MT CHARGES AWAITING NEW COPAY RATE' option will allow to release held charges for a selected patient, but only if the patient has GMT/MT Copayment Status defined. Also the routine will suggest printing the report "LIST CHARGES ON HOLD AWAITING NEW COPAY RATE". 21) IBEMTO1 - The report "LIST CHARGES ON HOLD AWAITING NEW COPAY RATE" will be modified, as it will print both Inpatient and Outpatient charges. 22) IBAMTV3, IBOBCR6, IBATOP, IBCNBLL, IBCOMC1, IBJTLA1, IBOSTUS1 These routines were modified because the DG API $$LST^DGMTU(DFN,DT) has been changed. Now the field 3 of the API call output may have one of the following values: - MT COPAY EXEMPT - MT COPAY REQUIRED - GMT COPAY REQUIRED - NO LONGER REQUIRED - PENDING ADJUDICATION - REQUIRED The field 4 of the API call output may have one of values: A - MT COPAY EXEMPT C - MT COPAY REQUIRED G - GMT COPAY REQUIRED N - NO LONGER REQUIRED P - PENDING ADJUDICATION R - REQUIRED Data Dictionary Modification ---------------------------- DD of the file #350 (INTEGRATED BILLING ACTION) was modified: New field # .21 added: 350, .21 GMT RELATED 0;21 SET '1' FOR YES; LAST EDITED: JUL 24, 2002 HELP-PROMPT: Is this charge related to the GMT Copayment Status DESCRIPTION: This is a flag indicating that this charge was decreased due to the patient's GMT Copayment status The field .21 will be used to mark charges, reduced due to Patient's GMT Copayment Status. The flag will be used by GMT reports (GMT SINGLE PATIENT REPORT, GMT MONTHLY TOTALS REPORT), and to improve reliability of GMT Conversion process, to avoid decreasing GMT - related charges more than once. New Menu Options ---------------- The GMT IB Part 2 patch will add two new options to print two new reports respectively: 'IB GMT SINGLE PATIENT REPORT' option will print 'GMT SINGLE PATIENT REPORT', 'IB GMT MONTHLY TOTALS' option will print 'GMT MONTHLY TOTALS REPORT'. These new menu options are included to menu "IB OUTPUT PATIENT REPORT MENU" (this option was modified and included to the patch.) No security keys provided for these two reports. Routines Information -------------------- The following is a list of the routines included in this patch. The second line of each of these routines now looks like: ;;2.0;INTEGRATED BILLING;**[patch list]**;21-MAR-94 Routine Before Patch After Patch Patch List ------- ------------ ----------- ---------- IBAGMM n/a 3812352 183 IBAGMM1 n/a 8311692 183 IBAGMR n/a 3414929 183 IBAGMR1 n/a 9278282 183 IBAGMT 1485964 17752001 179,183 IBAMTD1 3840699 5790609 45,153,179,183 IBAMTV3 4767675 4702076 15,153,183 IBATOP 9529210 9592387 115,153,183 IBAUTL2 4115995 4375593 52,153,167,187,183 IBAUTL4 12324932 12287364 45,153,171,176,179,183 IBCNBLL 16963289 17085018 82,149,153,183 IBCOMC1 6226404 6300956 103,183 IBECEA2 11544190 11585885 57,52,150,176,183 IBECEA21 10310605 14456905 7,57,167,183 IBECEA22 4164351 4265849 150,183 IBECEA3 17237734 20688658 7,57,52,132,150,153,166, 156,167,176,198,188,183 IBECEAU3 3504210 3599373 132,150,167,183 IBECEAU4 6667463 6922909 52,167,183 IBOMTE 5481552 6395698 153,183 IBOMTE1 7629098 8795623 153,183 IBOMTE2 3031067 3508500 153,183 IBEMTO 7207765 12737722 179,183 IBEMTO1 6889786 6570944 183 IBOMTP1 8516689 8960916 15,153,176,183 IBOBCR6 5232745 5201314 153,183 IBJTEA 6330334 6232731 39,153,183 IBJTLA1 3894356 4009027 39,80,61,51,153,137,183 IBOSTUS1 9923991 10006612 31,118,128,153,137,161,183 IBRFN 3991903 4021093 52,130,183 Total number of routines - 29 INSTALLATION INSTRUCTIONS ========================= Please refer to the 'Installation Instructions' section of the EAS*1*13 patch description for instructions on how to install the patch software. Routine Information: ==================== Routine Name: - IBAUTL4 Routine Checksum: Routine Name: - IBAGMT Routine Checksum: Routine Name: - IBAMTD1 Routine Checksum: Routine Name: - IBECEA21 Routine Checksum: Routine Name: - IBECEA3 Routine Checksum: Routine Name: - IBOMTE1 Routine Checksum: Routine Name: - IBOMTE2 Routine Checksum: Routine Name: - IBJTEA Routine Checksum: Routine Name: - IBAGMR Routine Checksum: Routine Name: - IBAGMR1 Routine Checksum: Routine Name: - IBAUTL2 Routine Checksum: Routine Name: - IBECEA22 Routine Checksum: Routine Name: - IBECEAU3 Routine Checksum: Routine Name: - IBEMTO Routine Checksum: Routine Name: - IBEMTO1 Routine Checksum: Routine Name: - IBOMTE Routine Checksum: Routine Name: - IBOMTP1 Routine Checksum: Routine Name: - IBAGMM Routine Checksum: Routine Name: - IBAGMM1 Routine Checksum: Routine Name: - IBAMTV3 Routine Checksum: Routine Name: - IBOBCR6 Routine Checksum: Routine Name: - IBATOP Routine Checksum: Routine Name: - IBCNBLL Routine Checksum: Routine Name: - IBCOMC1 Routine Checksum: Routine Name: - IBJTLA1 Routine Checksum: Routine Name: - IBOSTUS1 Routine Checksum: Routine Name: - IBRFN Routine Checksum: Routine Name: - IBECEA2 Routine Checksum: Routine Name: - IBECEAU4 Routine Checksum: ============================================================================= User Information: Entered By : TUSEYEV,ANDREY Date Entered : JUN 03, 2002 Completed By: ZEIGLER,EDWARD L Date Completed: DEC 10, 2002 Released By : GANUS,MAUNETTE Date Released : DEC 16, 2002 ============================================================================= Packman Mail Message: ===================== No routines included