$TXT Created by HARPER,AMY R at DEVFEX.FO-ALBANY.MED.VA.GOV (KIDS) on Wednesday, 04/28/04 at 15:40 ============================================================================= Run Date: MAY 11, 2004 Designation: IB*2*270 Package : IB - INTEGRATED BILLING Priority: Mandatory Version : 2 SEQ #237 Status: Released Compliance Date: JUN 11, 2004 ============================================================================= Associated patches: (v)IB*2*245 <<= must be installed BEFORE `IB*2*270' Subject: REASONABLE CHARGES 2.1 Category: - Routine Description: ============ Reasonable Charges version 2.1 is a charge update to the existing Reasonable Charges billed to Third Party Payers. The Integrated Billing Charge Master, and Bill/Claims functionality have been modified to support the requirements of billing with Reasonable Charges v2.1. The primary update with this patch is to the charges, which will be implemented when the new RC v2.1 charges are uploaded. Effective Date of Reasonable Charges v2.1 is 04/15/04. The Reasonable Charge v2.0 loaded on your system will be inactivated with an inactivation date of 04/14/04 when this patch is installed. BUNDLED PROCEDURE CODES ----------------------- There was a set of procedures exported with RC v2.0 where the separate technical procedure code and professional procedure code components should be billed rather than the global procedure. This list has been updated. Procedure 93786 has been added as a technical component of the global procedure 93784. The updated complete list of procedures split: Global Technical Professional ------ --------- ------------ 93000 93005 93010 93015 93017 93016 & 93018 93040 93041 93042 93224 93225 & 93226 93227 93230 93231 & 93232 93233 93235 93236 93237 93268 93270 & 93271 93272 93720 93721 93722 93784 93786 & 93788 93790 94014 94015 94016 At Provider Based sites, the global procedure should not be billed. The technical component procedure(s) should be billed on the UB-92, and the professional component procedure(s) should be billed on the HCFA 1500. At Non-Provider Based (Freestanding) sites, if both the technical and professional components are preformed, then the global procedure should be billed. PRESCRIPTION BILLING -------------------- When a prescription is billed, the procedure in the IB Site Parameter Default Rx Refill CPT field is automatically added to the bill. With RC v2.1, many of the procedures that could be used as this default Rx procedure now have charges of their own. This would result in both the $45 for the prescription, and the additional charge for the procedure, which is incorrect. Therefore, procedures assigned to a bill that meet the following criteria will not receive their RC charge: - The bill has Prescriptions assigned. - The procedure is the IB Site Parameter Default Rx Refill CPT - The procedure was not transferred from PCE (Patient Care Encounter). Therefore, billing for prescriptions should not change. The prescription will be billed the $45, regardless of the procedure used to identify the prescription on the bill. MULTIPLE SURGICAL PROCEDURE DISCOUNT ------------------------------------ If multiple surgical procedures from a single encounter are assigned to a bill, then a discount is applied to the Reasonable Charges facility charges. The list of procedures the Multiple Surgical Procedure Discount applies too has been changed slightly with v2.1. This is the complete list of procedures the discount is applied to in RC v2.1. Multiple Surgical Procedures in v2.1 (3469) 10021-11976, 12001-15851, 15876-19260, 19316-20650, 20670-20950, 20975, 20982-21300, 21325-21355, 21390-27087, 27097-27532, 27538-28760, 28810- 28899, 29800-30220, 30310-31205, 31231-31420, 31502-33244, 33284-35903, 36260-36262, 36420-36425, 36468-36471, 36550-36571, 36580-36585, 36590- 36596, 36640-36870, 37200-37209, 37500-38129, 38220-38221, 38300-38760, 39400-40801, 40805-42808, 42810-44799, 44970-46500, 46604-47011, 47370- 48999, 49080-49659, 49999-50562, 50590-51797, 51880-52281, 52283-53431, 53442, 53446, 53449-54385, 54406-54408, 54415, 54420-58145, 58301-58679, 58800-61623, 61626-61791, 61880, 61886-62230, 62263-62365, 63001-63615, 63660-64530, 64585-65175, 65235-65426, 65435-65436, 65600-65770, 65772- 67450, 67505-67810, 67825-67935, 67950-68020, 68100-68135, 68320-68750, 68770, 68810-69150, 69205, 69220-69979, 91122, 92018-92019, 92230-92235, 92502, 92511, 92973-92977, 92980-92998, 93501-93533, 93580-93623, 93631, 93650-93652, 95250, 95990-95991, 96520-96530, 96567-96571, 96920-96999, 99170, Q0081, Q0091, G0105, G0121, G0127, G0166, C9701, G0186, 0009T- 0016T, C9703, 0027T, G0247, G0260, G0290-G0291, 0046T-0047T, C9704, G0297-G0300, PRIMARY/SECONDARY BUNDLED DISCOUNT ---------------------------------- There are certain sets of procedures that are defined as primary and secondary. If both are performed, then the cost of the secondary procedure is bundled into the cost of the primary procedure. If only primary or only secondary are performed, then the full cost is billed. Beginning with RC v2.0, both primary and secondary procedures are exported with a full charge. Therefore, if both primary and secondary procedures are performed during an encounter, then the charges of each will be discounted to equal the total of the primary charge. The list of Primary/Secondary Bundled procedures has been changed slightly with v2.1. This is the complete list of procedures the discount is applied to in RC v2.1. Primary Bundled Procedures in v2.1 (5217) 10021-20950, 20975, 20982-27087, 27097-36262, 36420-36522, 36550-38206, 38220-58145, 58301-64530, 64553-65770, 65772-71552, 72010-72158, 72170- 72197, 72200-73223, 73500-73723, 74000-74183, 74190-74327, 74340-75891, 75894-75984, 75992-75996, 76000, 76006-76082, 76086-76091, 76095-76150, 76355-76380, 76393-76936, 76940-77295, 77300-77470, 77520-77789, 77799- 78264, 78270-78350, 78399-78483, 78494-78607, 78610-78807, 78999-79440, 79999, 80500-80502, 85060-85097, 86485-86586, 86850-86906, 86920-86932, 86945-86999, 88104-88125, 88160-88162, 88172-88173, 88180-88182, 88299- 88365, 89100-89105, 89130-89141, 89220, 89230, 89250-89291, 89335-89356, 90375-90376, 90379, 90385, 90393-90396, 90586, 90636, 90675-90676, 90693, 90716, 90723-90725, 90740-90748, 90782-90870, 90880-90899, 90911, 90935, 90945, 91000-92014, 92018-92371, 92499-92502, 92511-92520, 92541-92548, 92552-92557, 92561-92589, 92596, 92601-92604, 92700-93005, 93017-93313, 93315-93316, 93318-93533, 93580-93662, 93701-93744, 93786, 93797-94750, 94770-95117, 95144-95829, 95857-96100, 96110-96155, 96520-96530, 96567- 96900, 96910-96999, 98925-98942, 99170, 99190-99195, 99201-99215, 99241- 99291, 99431-99440, D0240, J0130, J0350, J0850, J1190, J1440, J1570, J1830, J1950, J2020, J2260, J2430, J2790, J2820, J2995, J3100, J3240, J7190, J7310, J9000, J9060, J9070, J9100, J9130, J9150, J9200, J9219, J9270, J9300, P9010, J7502, J9093, J0256, Q0035, J9045, J0585, J9031, J3365, M0064, Q0081, Q0091, J0205, J1245, J9211, J1441, J7192, A4642, G0010, J1785, J7507, J8560, J9065, Q0136, A9500, G0030, J3305, J9015, J9390, A9502, G0101, G0120, J0207, J1565, J1825, A9507, G0125, G0130, J2355, Q0166, Q0180, D0277, G0166, J1327, J3245, J7517, J8510, J9001, Q0187, A9508, C1079, G0173, G0186, J1563, J2993, J7520, P9031, Q2003, Q2005, Q2013, Q2017, Q2022, Q3002, Q3005, Q3011, 0003T-0018T, A9511, C8900, C9703, G0117, G0204, J2941, J7511, J9017, P9045, 0027T, A9517, D7111, G0245, G0253, G0267, G0288, J0637, J1564, J2788, J7317, Q3025, Q3000, 0046T-0059T, A9528, C9202, C9704, G0296, G0338, J2353, J9098, P9059, Secondary Bundled Procedures in v2.1 (405) 36400-36410, 36540, 74328-74330, 75893, 75989, 75998, 76001-76005, 76350, 76937, 77790, 78890-78891, 79900, 80103, 90389, 90471-90472, 90476-90585, 90632-90634, 90645-90648, 90665, 90680-90692, 90700-90713, 90717-90721, 90727, 90733-90735, 90749, 90939-90940, 93012, 93314, 93317, 93555-93562, 93770, 94760-94762, 97602, 99175, 99185-99186, A4300, E0749, E0782, E1399, J0120, J0170, J0280, J0360, J0900, J1200, J1450, J1580, J1840, J1960, J2060, J2270, J2440, J2800, J2910, J3000, J3105, J3250, J7030, J9050, J9120, J9190, J9212, J9230, J9360, J9999, P9615, V2630, J7500, J9165, J1631, A4647, J0696, J0698, J0694, J7197, J0743, J1455, Q0092, A4220, A4641, J0475, J7051, A4643, E0783, J0295, J2725, J8530, J8600, L8603, A4301, J0713, J2597, J3475, J9266, A9503, J1645, J0735, J1742, L8699, E0785, J0285, J1956, P9612, Q0167, Q0169, Q0171, Q0173, Q0177, Q0179, Q0183, A9504, J0456, J2543, J7515, Q1001, A4561, A9510, E0756, E0786, J0282, J2795, J3485, L8606, Q2002, Q2004, Q2012, Q2014, Q2021, Q3001, Q3004, Q3009, V2790, E0752, J0692, J1655, J7308, J0592, J1051, J1652, J2501, J2916, J7342, Q4075, This patch addresses the following New Service Request (NSR): ------------------------------------------------------------- There is no NSR associated with this patch. This patch addresses the following NOIS message(s): --------------------------------------------------- There are no NOIS messages associated with this patch. Test Sites: ----------- Dublin VAMC (557) El Paso VAMC (756) Phoenix VAMC (644) West Palm Beach VAMC (548) Wilmington VAMC (460) Technical Description ===================== This patch exports 7 routines, and one is the post-init (IBYPSB). The post init will complete the following: 1. Inactivate all existing Reasonable Charges defined in the Charge Master. Reasonable Charges v2.0 will be inactivated on 04/14/04. The following is an example of the post-init portion of the installation. Reasonable Charges v2.1 Post-Install ..... >> Inactivating Existing Reasonable Charges, Please Wait... Done. 77435 existing charges inactivated Reasonable Charges v2.1 Post-Install Complete Note: The actual number of charges inactivated will vary based on the number of divisions billed at your site. This will also determine the time required for the installation. ================INSTALLATION INSTRUCTIONS ================= If installed during the normal workday, it is recommended that the following selections in the OPTION (#19) file 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] Load Host File into Charge Master [IBCR HOST FILE LOAD] Install Time - less than 30 minutes. This time will vary from site to site depending on the size of the Charge Item file. 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 above. 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: 2.0;INTEGRATED BILLING;**[patch list]**;21-MAR-94 CHECK^XTSUMBLD results Routine Before Patch After Patch Patch List ------- ------------ ----------- ---------- IBCRBC1 14459351 14982672 52,80,106,138,51, 148,245,270 IBCRBCA1 8195471 11307705 245,270 IBCRBCA2 15779122 5861003 245,270 IBCRBCAP N/A 20927721 270 IBCRHBRV 18478627 20513280 148,169,245,270 IBCU7A1 6733061 6741352 245,270 IBYPSB N/A 4426335 270 Number of Routines = 7 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 IB*2.0*270): 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 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: Enter/Edit Billing Information [IB EDIT BILLING INFO] Load Host File into Charge Master [IBCR HOST FILE LOAD] e. When prompted 'Enter protocols you wish to mark as 'Out Of Order':' press . 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. 8. CLEAN UP POST INIT ROUTINE -------------------------- Optional - Once this patch has been successfully installed you may delete the post init routines: IBYPSB 9. UPLOAD REASONABLE CHARGES V2.1 ------------------------------ Follow the instructions below. ============== Reasonable Charges v2.1 Upload Instructions ============== After patch installation, the RC v2.1 (Reasonable Charges v2.1) charges for each division billed at a site will need to be loaded into the Charge Master. The charges for each Division will require approximately 1.1-1.3Mb of disk space. Files Required for Upload: ========================== The charge files are available on the following CIO Field Offices' Anonymous.Software directories. Use the appropriate FTP capability to retrieve the files (ASCII). OI FIELD OFFICE FTP ADDRESS DIRECTORY =============== =========== ========= ALBANY ftp.fo-albany.med.va.gov anonymous.software HINES ftp.fo-hines.med.va.gov anonymous.software SALT LAKE ftp.fo-slc.med.va.gov anonymous.software FIRST AVAILABLE SERVER download.vista.med.va.gov anonymous.software The Reasonable Charge v2.1 Host Files, effective 04/15/04: IBRC0404A.TXT Inpatient Facility Charges (DRG) IBRC0404B.TXT Facility Charge (CPT) IBRC0404C.TXT Physician Charges (CPT) IBRC0404D.TXT Service Category Codes IBRC0404E.TXT Area Factors IBRC0404F.TXT Site Identification Upload Instructions: ==================== Step 1: Get Host Files ----------------------- Retrieve the 6 Reasonable Charges v2.1 Host Files in ASCII format (see previous section). Step 2: Determine Divisions ---------------------------- Use the Print Charge Master [IBCR REPORTS FOR CHARGE MASTER] option and print the Billing Region report to find which Billing Regions and Divisions have charges loaded onto your system. These are the divisions that will need new charges loaded. Step 3: Begin Upload Process ----------------------------- Use the Load Host File into Charge Master [IBCR HOST FILE LOAD] option to load Reasonable Charges onto your system for every division for which care is billed at your site. Steps 4-7 Step 4: Select 1.3 - Load RC into XTMP --------------------------------------- This loads the Host Files into temporary storage and calculates charges for individual Divisions. - If there are no previously existing host files loaded, it will ask which version of Reasonable Charges to load. Select 2.1 - If there exists any charges previously calculated for a division, they will be displayed, and it will ask if they should be deleted. Select Yes - delete the previously calculated charges. - If there exists any previously loaded host files for an RC version, they will be displayed, and it will ask if they should be deleted. Select Yes - only if the files are not for the correct version. - When loading Reasonable Charges v2.1, the IBRC0404x.TXT files may be used multiple times without reloading. Select No - if the files are IBRC0404x.TXT and you are loading RC v2.1 - Select Division: Select the division number to load charges for. This should correspond to the Divisions associated with the Billing Regions determined previously. Once the correct division is selected, answer Yes to Calculate Charges. Step 5: Select 3 - Check Data Validity -------------------------------------- This is optional, but it is suggested that it be run at least once, for the first division loaded. If the resulting report has any Line Data Errors, then check that the latest version of CPT and DRG has been installed. Step 6: Select 4 - Load into Charge Master ------------------------------------------ Moves the charges calculated in selection 1.3 to permanent storage in the Charge Master. The results report should match the examples below. It is important that this option completes before continuing. Allow the upload of a division's charges to finish before attempting to upload another division. A summary report will be printed when the upload is complete. This option uses the same temporary files to calculate the charges for all divisions, therefore they must be calculated and loaded serially. Step 7: Repeat steps 4-6 for each Division needed ------------------------------------------------- Steps 4-6 must be repeated for each division billed at your site. Refer to the Divisions that already have charges assigned using the Billing Region Report list determined previously. In most cases, simply using the above options for loading Reasonable Charges will result in the correct set up in the Charge Master. o Option 1.3, selection 2, to calculate RC v2.1 charges for a division o Option 4, to load those calculated charges into the Charge Master permanent files. However, if you are loading charges for a new site, or a site that may have changed it's division number, then extra care is needed to ensure the setup of the Charge Master is correct. The following sections provide some additional information about the upload. ================ Reasonable Charges v2.1 Upload Examples ================ The Charge Host Files should load with the following counts: IBRC0404A.TXT RC v2.1 Host File Upload, 4/15/04@17:40 by SMITH,J 519 IBRC0404B.TXT RC v2.1 Host File Upload, 4/15/04@17:40 by SMITH,J 5349 IBRC0404C.TXT RC v2.1 Host File Upload, 4/15/04@17:40 by SMITH,J 13312 IBRC0404D.TXT RC v2.1 Host File Upload, 4/15/04@17:40 by SMITH,J 30 IBRC0404E.TXT RC v2.1 Host File Upload, 4/15/04@17:40 by SMITH,J 915 IBRC0404F.TXT RC v2.1 Host File Upload, 4/15/04@17:40 by SMITH,J 816 Example Reasonable Charges v2.1 Upload Summary Report (CBOC): ------------------------------------------------------------- Loading Reasonable Charges v2.1 for any division with Non-Provider Based Freestanding Care Only should always result in a summary with these exact numbers: Calculated Charges array: (step 4) IBCR UPLOAD RC 528GX TROY, NY Count = 14450 IB Upload RC v2.1 528GX TROY, NY, 4/15/04@17:29 by HARPER,AMY R Subfile Item Count Charge Set ------- ---- ----- ------------------------- 1 FS Phys 1 CPT 13020 RC-PHYSICIAN FS PR 528GX 2 FS Phys 3 CPT 270 RC-PHYSICIAN FS MN 528GX 3 FS Phys/Add 00 1 CPT 966 RC-PHYSICIAN FS PR 528GX 4 FS Phys/Opt 1 CPT 163 RC-PHYSICIAN FS PR 528GX 5 FS Phys/Opt 4 CPT 5 RC-PHYSICIAN FS ML 528GX 6 FS Phys/Opt TC 1 CPT 26 RC-PHYSICIAN FS PR 528GX IB Upload Summary Report Charge Items Loaded into Charge Master: (step 6) IBCR UPLOAD RC 528GX TROY, NY FS Phys 1 13020 of 13020 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate 13020 entries added Charge Set RC-PHYSICIAN FS PR 528GX FS Phys 3 270 of 270 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate 270 entries added to Charge Set RC-PHYSICIAN FS MN 528GX FS Phys/Add 00 1 966 of 966 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate 966 entries added to Charge Set RC-PHYSICIAN FS PR 528GX FS Phys/Opt 1 163 of 163 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate 163 entries added to Charge Set RC-PHYSICIAN FS PR 528GX FS Phys/Opt 4 5 of 5 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate 5 entries added to Charge Set RC-PHYSICIAN FS ML 528GX FS Phys/Opt TC 1 26 of 26 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate 26 entries added to Charge Set RC-PHYSICIAN FS PR 528GX Note: The summary description of the possible errors at the end of the report does not indicate an error occurred. They are information only. If an error occurs, it will be associated with the subfile and line where the error occurred. Example Reasonable Charges v2.1 Upload Summary Report (Outpatient Site): ------------------------------------------------------------------------ Loading Reasonable Charges v2.1 for any Provider Based division that provides Outpatient Care should always result in a summary with these exact numbers: Calculated Charges array: (step 4) IBCR UPLOAD RC 528G4 ELMIRA, NY Count = 17270 IB Upload RC v2.1 528G4 ELMIRA, NY, 4/15/04@17:23 by HARPER,AMY R Subfile Item Count Charge Set ------- ---- ----- ---------- 1 Opt Fac 1 CPT 5336 RC-OPT FAC PR 528G4 2 Opt Fac 2 CPT 7 RC-OPT FAC HR 528G4 3 Opt Fac 4 CPT 5 RC-OPT FAC ML 528G4 4 Opt Fac/Phys 1 CPT 4554 RC-OPT FAC PR 528G4 5 Opt PD PHosp MISCE 1 RC-OPT MISC 528G4 6 Opt Phys 1 CPT 7097 RC-PHYSICIAN OPT PR 528G4 7 Opt Phys 3 CPT 270 RC-PHYSICIAN OPT MN 528G4 IB Upload Summary Report Charge Items Loaded into Charge Master: (step 6) IBCR UPLOAD RC 528G4 ELMIRA, NY Opt Fac 1 5336 of 5336 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate 5336 entries added to Charge Set RC-OPT FAC PR 528G4 Opt Fac 2 7 of 7 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate 7 entries added to Charge Set RC-OPT FAC HR 528G4 Opt Fac 4 5 of 5 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate 5 entries added to Charge Set RC-OPT FAC ML 528G4 Opt Fac/Phys 1 4554 of 4554 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate 4554 entries added to Charge Set RC-OPT FAC PR 528G4 Opt PD PHosp 1 of 1 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate 1 entries added to Charge Set RC-OPT MISC 528G4 Opt Phys 1 7097 of 7097 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate 7097 entries added Charge Set RC-PHYSICIAN OPT PR 528G4 Opt Phys 3 270 of 270 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate 270 entries added Charge Set RC-PHYSICIAN OPT MN 528G4 Example Reasonable Charges v2.1 Upload Summary Report (Inpatient Site): ----------------------------------------------------------------------- Loading Reasonable Charges v2.1 for any division that provides Inpatient Care should always result in a summary with these exact numbers: Calculated Charges array: (step 4) IBCR UPLOAD RC 528 BUFFALO, NY Count = 45096 IB Upload RC v2.1 528 BUFFALO, NY, 4/15/04@17:06 by HARPER,AMY R Subfile Item Count Charge Set ------- ---- ----- ---------- 1 Inpt Fac 1 CPT 11 RC-INPT FAC PR 528 2 Inpt Fac 2 CPT 7 RC-INPT FAC HR 528 3 Inpt Fac 4 CPT 5 RC-INPT FAC ML 528 4 Inpt Fac/Phys 1 CPT 2291 RC-INPT FAC PR 528 5 Inpt PD Anc DRG 518 RC-INPT ANC 528 6 Inpt PD Anc ICU DRG 518 RC-INPT ANC ICU 528 7 Inpt PD R&B DRG 518 RC-INPT R&B 528 8 Inpt PD R&B ICU DRG 518 RC-INPT R&B ICU 528 9 Inpt Phys 1 CPT 7081 RC-PHYSICIAN INPT PR 528 10 Inpt Phys 3 CPT 270 RC-PHYSICIAN INPT MN 528 11 Opt Fac 1 CPT 5336 RC-OPT FAC PR 528 12 Opt Fac 2 CPT 7 RC-OPT FAC HR 528 13 Opt Fac 4 CPT 5 RC-OPT FAC ML 528 14 Opt Fac/Phys 1 CPT 4554 RC-OPT FAC PR 528 15 Opt PD PHosp MISCE 1 RC-OPT MISC 528 16 Opt Phys 1 CPT 7097 RC-PHYSICIAN OPT PR 528 17 Opt Phys 3 CPT 270 RC-PHYSICIAN OPT MN 528 18 SNF Fac 1 CPT 5164 RC-SNF FAC PR 528 19 SNF Fac 2 CPT 7 RC-SNF FAC HR 528 20 SNF Fac 4 CPT 5 RC-SNF FAC ML 528 21 SNF Fac/Phys 1 CPT 3544 RC-SNF FAC PR 528 22 SNF PD INC BEDSE 2 RC-SNF INC 528 23 SNF Phys 1 CPT 7097 RC-PHYSICIAN SNF PR 528 24 SNF Phys 3 CPT 270 RC-PHYSICIAN SNF MN 528 IB Upload Summary Report Charge Items Loaded into Charge Master: (step 6) IBCR UPLOAD RC 528 BUFFALO, NY Inpt Fac 1 11 of 11 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate 11 entries added to the Charge Set RC-INPT FAC PR 528. Inpt Fac 2 7 of 7 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate 7 entries added to the Charge Set RC-INPT FAC HR 528. Inpt Fac 4 5 of 5 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate 5 entries added to the Charge Set RC-INPT FAC ML 528. Inpt Fac/Phys 1 2291 of 2291 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate 2291 entries added to the Charge Set RC-INPT FAC PR 528. Inpt PD Anc 518 of 518 records checked, 0 duplicates, 2 with $=0 0 line/data errors or warnings found for a 0% error rate 516 entries added to the Charge Set RC-INPT ANC 528. Inpt PD Anc ICU 518 of 518 records checked, 0 duplicates, 2 with $=0 0 line/data errors or warnings found for a 0% error rate 516 entries added to the Charge Set RC-INPT ANC ICU 528. Inpt PD R&B 518 of 518 records checked, 0 duplicates, 2 with $=0 0 line/data errors or warnings found for a 0% error rate 516 entries added to the Charge Set RC-INPT R&B 528. Inpt PD R&B ICU 518 of 518 records checked, 0 duplicates, 2 with $=0 0 line/data errors or warnings found for a 0% error rate 516 entries added to the Charge Set RC-INPT R&B ICU 528. Inpt Phys 1 7081 of 7081 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate 7081 entries added Charge Set RC-PHYSICIAN INPT PR 528 Inpt Phys 3 270 of 270 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate 270 entries added to Charge Set RC-PHYSICIAN INPT MN 528 Opt Fac 1 5336 of 5336 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate 5336 entries added to the Charge Set RC-OPT FAC PR 528. Opt Fac 2 7 of 7 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate 7 entries added to the Charge Set RC-OPT FAC HR 528. Opt Fac 4 5 of 5 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate 5 entries added to the Charge Set RC-OPT FAC ML 528. Opt Fac/Phys 1 4554 of 4554 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate 4554 entries added to the Charge Set RC-OPT FAC PR 528. Opt PD PHosp 1 of 1 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate 1 entries added to the Charge Set RC-OPT MISC 528. Opt Phys 1 7097 of 7097 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate 7097 entries added to Charge Set RC-PHYSICIAN OPT PR 528 Opt Phys 3 270 of 270 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate 270 entries added to Charge Set RC-PHYSICIAN OPT MN 528 SNF Fac 1 5164 of 5164 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate 5164 entries added to the Charge Set RC-SNF FAC PR 528. SNF Fac 2 7 of 7 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate 7 entries added to the Charge Set RC-SNF FAC HR 528. SNF Fac 4 5 of 5 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate 5 entries added to the Charge Set RC-SNF FAC ML 528. SNF Fac/Phys 1 3544 of 3544 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate 3544 entries added to the Charge Set RC-SNF FAC PR 528. SNF PD INC 2 of 2 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate 2 entries added to the Charge Set RC-SNF INC 528. SNF Phys 1 7097 of 7097 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate 7097 entries added to Charge Set RC-PHYSICIAN SNF PR 528 SNF Phys 3 270 of 270 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate 270 entries added to Charge Set RC-PHYSICIAN SNF MN 528 ====== Reasonable Charges Upload General Information and Criteria ====== o Versions of Reasonable Charges: v1, v1.1, v1.2, v1.4., 2.0, 2.1 There was no v1.3 of Reasonable Charges. o Reasonable Charges v1 Host files are named: 'IBRCVx.TXT' w/x=A-I Reasonable Charges v1.1 Host files are named: 'IBRC0011x.TXT' w/x=A-I Reasonable Charges v1.2 Host files are named: 'IBRC0105x.TXT' w/x=A-I Reasonable Charges v1.4 Host files are named: 'IBRC0304x.TXT' w/x=A-I Reasonable Charges v2.0 Host files are named: 'IBRC0312x.TXT' w/x=A-F Reasonable Charges v2.1 Host files are named: 'IBRC0404x.TXT' w/x=A-F o The effective date of Reasonable Charges v1 is 09/01/99. The effective date of Reasonable Charges v1.1 is 11/02/00. The effective date of Reasonable Charges v1.2 is 05/08/01. The effective date of Reasonable Charges v1.4 is 04/29/03. The effective date of Reasonable Charges v2.0 is 12/19/03. The effective date of Reasonable Charges v2.1 is 04/15/04. o The Host files for all versions of Reasonable Charges are still available, with instructions provided in the associated patches: Reasonable Charge v1.0 released in patch IB*2*106 Reasonable Charge v1.1 released in patch IB*2*138 Reasonable Charge v1.2 released in patch IB*2*148 Reasonable Charge v1.4 released in patch IB*2*169 Reasonable Charge v2.0 released in patch IB*2*245 Reasonable Charge v2.1 released in patch IB*2*270 o The Host files contain charges for all geographic areas in the country, except version 1, which contained charges only for those areas where a VA site existed. o The versions of Reasonable Charges must be loaded in version order. o Each Division must be assigned to the correct Billing Region, based on the division's physical location. o Charges will be uploaded with an inactivation date, if one exists for the version. o After loading a set of Reasonable Charges into the Charge Master, any remaining RC Charge Sets that have no charges assigned will be deleted. General Upload Instructions: ---------------------------- Retrieve the Reasonable Charges Host Files in ASCII format for the version desired. Use the Print Charge Master [IBCR REPORTS FOR CHARGE MASTER] option and print the Billing Region report to find which Billing Regions and Divisions have charges loaded onto your system. Use the Load Host File into Charge Master [IBCR HOST FILE LOAD] option to load Reasonable Charges onto your system for every division for which care is billed at your site: 1.3 Load RC into XTMP Load the host files and calculate the charges for a division at your site. Possible Selections: 1 Reasonable Charges version 1.0 1.1 Reasonable Charges version 1.1 1.2 Reasonable Charges version 1.2 1.4 Reasonable Charges version 1.4 2 Reasonable Charges version 2.0 2.1 Reasonable Charges version 2.1 2 Assign Charge Set Assign or re-assign the charges calculated to the correct Charge Sets. This option is only needed if the charges calculated are assigned to a Division number in the new version that is different than the Division number used in previous versions of RC. 3 Check Data Validity Runs through the load into the Charge Master without actually making any changes and reports any problems found. 4 Load into Charge Master Load the updated charges into the Charge Master for the site requested. 5 Delete XTMP files Deletes all temporary files created for the upload process. This selection is optional, all temporary files are deleted automatically after 2 days. In most cases, simply using the above options for loading Reasonable Charges will result in the correct set up in the Charge Master. o Option 1.3, to calculate charges for a division o Option 4, to load those calculated charges into the Charge Master permanent files. However, if you are loading charges for a new site or a site that may have changed its division number, then extra care is needed to ensure the set up of the Charge Master is correct. Following sections provide some additional information about the upload. List of Charges Sets for Reasonable Charges v2.0 and v2.1 ========================================================= Each Charge Set now indicates which type of care it applies to: - INPT: the facility and professional charge is only applied to an Inpatient Provider Based bill (excluding SNF) - SNF: the facility and professional charge is only applied to SNF care as defined on the bill (screen 4, option 1) on an Inpatient Provider Based bill - OPT: the facility and professional charge is only applied to an Outpatient Provider Based Bill - FS: the professional charge is only applied to an Outpatient Non-Provider Based bill In each of the above cases, the Provider Based and Non-Provider Based designation for the bill is determined by the Bill Division. In the Charge Sets Name: - HR indicates CPT/HCPCS charges based on Hours, Observation care - ML indicates CPT/HCPCS charges based on Miles, Ambulance transportation - MN indicates CPT/HCPCS charges based on Minutes, Anesthesia - PR indicates all other CPT/HCPCS charges Charge Set Billing Rate Item Type RvCD Bedsection ------------------------------------------------------------------------- VAMC Inpatient Facility (Provider Based) ---------------------------------------- RC-INPT ANC RC INPATIENT FACILITY DRG INST 240 GENERAL MED RC-INPT ANC ICU RC INPATIENT FACILITY DRG INST 240 ICU RC-INPT R&B RC INPATIENT FACILITY DRG INST 101 GENERAL MED RC-INPT R&B ICU RC INPATIENT FACILITY DRG INST 200 ICU RC-INPT FAC HR RC FACILITY HR CPT INST 240 GENERAL MED RC-INPT FAC ML RC FACILITY ML CPT INST 240 GENERAL MED RC-INPT FAC PR RC FACILITY PR CPT INST 240 GENERAL MED RC-PHYSICIAN INPT MN RC PHYSICIAN MN CPT PROF 960 GENERAL MED RC-PHYSICIAN INPT PR RC PHYSICIAN PR CPT PROF 960 GENERAL MED RC-OPT MISC RC MISCELLANEOUS UNA INST 912 PARTIAL HOSP RC-OPT FAC HR RC FACILITY HR CPT INST 510 OUTPATIENT RC-OPT FAC ML RC FACILITY ML CPT INST 510 OUTPATIENT RC-OPT FAC PR RC FACILITY PR CPT INST 510 OUTPATIENT RC-PHYSICIAN OPT MN RC PHYSICIAN MN CPT PROF 510 OUTPATIENT RC-PHYSICIAN OPT PR RC PHYSICIAN PR CPT PROF 510 OUTPATIENT RC-SNF INC RC FACILITY PER DIEM BEDS INST 101 SNF/SA RC-SNF FAC HR RC FACILITY HR CPT INST 240 SNF/SA RC-SNF FAC ML RC FACILITY ML CPT INST 240 SNF/SA RC-SNF FAC PR RC FACILITY PR CPT INST 240 SNF/SA RC-PHYSICIAN SNF MN RC PHYSICIAN MN CPT PROF 960 SNF/SA RC-PHYSICIAN SNF PR RC PHYSICIAN PR CPT PROF 960 SNF/SA Outpatient Facility (Provider Based) ------------------------------------ RC-OPT MISC RC MISCELLANEOUS UNA INST 912 PARTIAL HOSP RC-OPT FAC HR RC FACILITY HR CPT INST 510 OUTPATIENT RC-OPT FAC ML RC FACILITY ML CPT INST 510 OUTPATIENT RC-OPT FAC PR RC FACILITY PR CPT INST 510 OUTPATIENT RC-PHYSICIAN OPT MN RC PHYSICIAN MN CPT PROF 510 OUTPATIENT RC-PHYSICIAN OPT PR RC PHYSICIAN PR CPT PROF 510 OUTPATIENT Freestanding (Non-Provider Based) --------------------------------- RC-PHYSICIAN FS ML RC PHYSICIAN ML CPT PROF 510 OUTPATIENT RC-PHYSICIAN FS MN RC PHYSICIAN MN CPT PROF 510 OUTPATIENT RC-PHYSICIAN FS PR RC PHYSICIAN PR CPT PROF 510 OUTPATIENT RC-INPT ANC and RC-INPT R&B are previously existing Charge Sets, all other Charge Set Names are new with version 2.0. Routine Information: ==================== Routine Name: - IBCRHBRV Routine Checksum: Routine Name: - IBCU7A1 Routine Checksum: Routine Name: - IBYPSB Routine Checksum: Routine Name: - IBCRBCA1 Routine Checksum: Routine Name: - IBCRBCA2 Routine Checksum: Routine Name: - IBCRBCAP Routine Checksum: Routine Name: - IBCRBC1 Routine Checksum: ============================================================================= User Information: Entered By : HARPER,AMY R Date Entered : APR 06, 2004 Completed By: KUREK,STANLEY M Date Completed: MAY 06, 2004 Released By : BOTTINI,STEVE Date Released : MAY 11, 2004 ============================================================================= Packman Mail Message: ===================== $END TXT