============================================================================= Run Date: JUN 09, 2003 Designation: IB*2*218 Package : IB - INTEGRATED BILLING Priority: Mandatory Version : 2 SEQ #196 Status: Released Compliance Date: JUL 10, 2003 ============================================================================= Subject: MEDICARE DEDUCTIBLE AND PENSION CY 2003 Category: - Informational Description: ============ The purpose of this informational patch is to assist sites in the entry of the Basic Pension rate and the Medicare Deductible value which are both required for use in the Integrated Billing package. 1. Basic Pension rate: ------------------- The Basic Pension rate is used to determine whether a veteran is exempt from the medication co-payment requirement, when the veteran's eligibility for the co-payment is based on income. The new rate for Calendar Year (CY) 2003 (with an effective date of 12/1/02) is defined in VHA Directive 2002-082, dated December 13, 2002 as: * $ 9,690 for a single veteran without dependents * $ 12,692 for a veteran with 1 dependent * An additional $ 1,653 for each additional dependent beyond 1 dependent To enter the new Basic Pension rate, use the Add Income Thresholds [IB RX ADD THRESHOLDS] option of the Medication Copay Income Exemption Menu [IB RX EXEMPTION MENU]. See the example below. **************************** N O T E ************************************** After entering the Basic Pension rate, if your system has any instances where there are Medication Co-payment Exemptions based on prior thresholds, you will see the note 'there are Medication Co-payment Exemptions based on prior thresholds'. If you see this prompt, you will be asked to Select one of the following: 1. IGNORE 2. PRINT 3. UPDATE AND PRINT You should choose #3 to UPDATE AND PRINT these exemptions. You should queue this job to run and print the output to a printer. *************************************************************************** EXAMPLE: (run from the Billing Supervisor Menu [IB BILLING SUPERVISOR MENU]) BI Claims Tracking Menu for Billing ... BILL Enter/Edit Billing Information CATC Automated Means Test Billing Menu ... EDI EDI Menu For Electronic Bills ... LTC LTC Billing Menu ... MRA Medicare Remittance Advice Menu ... OUTP Patient Billing Reports Menu ... REPT Management Reports (Billing) Menu ... RXEX Medication Copay Income Exemption Menu ... SYST MCCR System Definition Menu ... TPJI Third Party Joint Inquiry UB82 Third Party Billing Menu ... NON-VA Facility Data Select Billing Supervisor Option: RXEX Medication Copay Income Exemption Menu CHAR Print Charges Canceled Due to Income Exemption COLE Edit Copay Exemption Letter EXEM Inquire to Medication Copay Income Exemptions HARD Manually Change Copay Exemption (Hardships) LEPR Letters to Exempt Patients LIST List Income Thresholds PATI Print Patient Exemptions or summary REPR Reprint Single Income Test Reminder Letter THRE Add Income Thresholds VERI Print/Verify Patient Exemption Status Select Medication Copay Income Exemption Menu Option:THRE Add Income Thresholds Select BILLING THRESHOLDS DATE: 12/1/02 DEC 1, 2002 ARE YOU ADDING 'Dec 01, 2002' AS A NEW BILLING THRESHOLDS (THE 10TH)? Y(YES) DATE: DEC 1,2002// TYPE: BASIC PENSION// **** PLEASE NOTE: There are two types of rates, BASIC PENSION and PENSION PLUS A&A. Make sure that you choose the BASIC PENSION type to add this new rate to. BASE RATE FOR VETERAN: 9690 BASE RATE WITH 1 DEPENDENT: 12692 ADDITIONAL DEPENDENT AMOUNT: 1653 BASE RATE WITH 2 DEPENDENTS: 14345 BASE RATE WITH 3 DEPENDENTS: 15998 BASE RATE WITH 4 DEPENDENTS: 17651 BASE RATE WITH 5 DEPENDENTS: 19304 BASE RATE WITH 6 DEPENDENTS: 20957 BASE RATE WITH 7 DEPENDENTS: 22610 BASE RATE WITH 8 DEPENDENTS: 24263 There are Medication Copayment Exemptions based on prior thresholds Select one of the following: 1. IGNORE 2. PRINT 3. UPDATE AND PRINT Select ACTION: IGNORE// 3 UPDATE AND PRINT DEVICE: HOME// RIGHT MARGIN: 80// DO YOU WANT YOUR OUTPUT QUEUED? NO// Y (YES) Requested Start Time: NOW//T@2300 (May 13, 2003@23:00:00) Select BILLING THRESHOLDS DATE: You may use the option List Income Thresholds [IB RX PRINT THRESHOLDS] to validate that these values have been entered correctly. 2. Medicare Deductible The Medicare Deductible amount is used for the Means Test Inpatient Co-payment Charge. This value has been defined in VHA Directive 2002-082, dated December 13, 2002 to be $840 for Calendar Year 2003 with an effective date of 1/1/2003. To enter the 2003 Medicare Deductible, use the Enter/Edit Billing Rates [IB BILLING RATES FILE] option of the MCCR System Definition Menu [IB SYSTEM DEFINITION MENU]. See the following example: Select MCCR System Definition Menu Option: ? AUTO Enter/Edit Automated Billing Parameters CHGM Charge Master Menu ... ENTR Enter/Edit Billing Rates FLAG Flag Stop Codes/Dispositions/Clinics FLTP Flag Stop Codes/Clinics for Third Party INSU Insurance Company Entry/Edit LISF List Flagged Stop Codes/Dispositions/Clinics LISP List Flagged Stop Codes/Clinics for Third Party LIST Billing Rates List NVA NON-VA Facility Data PARA MCCR Site Parameter Enter/Edit PBUF Purge Insurance Buffer SITE MCCR Site Parameter Display/Edit Select MCCR System Definition Menu Option: ENTR Enter/Edit Billing Rates Enter/Edit Billing Rates CHOOSE FROM: 1. REVENUE CODE RATES 2. PER DIEM RATES 3. MEDICARE DEDUCTIBLE 4. HCFA AMB. SURG. RATES 5. RX CO-PAYMENT 6. CHAMPVA SUBSISTENCE RATES Select Billing Rate Type: 3 MEDICARE DEDUCTIBLE Select Effective Date: 1/1/03 (JAN 01, 2003) Are you adding 'MEDICARE DEDUCTIBLE' as a new IB ACTION CHARGE? Y (Yes) UNIT CHARGE, FIXED: 840 ADDITIONAL AMOUNT: INACTIVATION DATE: Select Effective Date: You may use the option Billing Rates List [IB LIST OF BILLING RATES] to validate that this rate has been entered correctly. ********Please Note******** It is recommended that the new Medicare deductible rate be added to the system by the effective date of 1/1/2003. Since the rates will be added after the effective date, it is possible that some Means Test veterans could be under-billed. These veterans would be anyone whose Means Test Billing Clock starts on or after 1/1/2003, and who subsequently received inpatient care. Routine Information: ==================== ============================================================================= User Information: Entered By : FERRARESE,MARY ANN Date Entered : MAY 13, 2003 Completed By: ROBBINS,BRADLEY Date Completed: JUN 05, 2003 Released By : GANUS,MAUNETTE Date Released : JUN 09, 2003 ============================================================================= Packman Mail Message: ===================== No routines included