$TXT Created by CITTY,WAYNE R at LEXINGTON.MED.VA.GOV (KIDS) on Friday, 04/23/04 at 10:12 ============================================================================= Run Date: MAY 14, 2004 Designation: IB*2*259 Package : IB - INTEGRATED BILLING Priority: Mandatory Version : 2 SEQ #238 Status: Released Compliance Date: JUN 14, 2004 ============================================================================= Subject: PHARMACY COPAY CAP REPORT Category: - Routine Description: ============ This patch will provide a new report to the Patient Billing Reports Menu [IB OUTPUT PATIENT REPORTS MENU] of the VistA Integrated Billing Package. The report will be produced by running the new option Facility Pharmacy Co-Pay Cap Summary Report [IBARXM FACILITY CAP SUMM RPT] which will invoke the new routine, IBARXMO1, released with this patch. This summary report is being requested by the VHA Chief Business Office (CBO) to satisfy five metrics calculated at each site on an annual basis that will be sent back to the CBO for manual compilation. Each facility will run the report at the end of each calendar year during the month of January and submit the results to the designated Business Implementation Manager (BIM) at the VISN. Each BIM will submit the end of calendar year report for each station in their VISN by the close of business on January 31 of each year. The CBO will notify the VISNs as to the Point of Contact to submit the report in advance of the due date. Last year's Congressional hearing stated that the VistA software will track and record the number of occurrences where Enrollment Priority Group 2-6 veterans reached and may have potentially exceeded the annual maximum billing cap. There is a need to collect national statistics on the medication co-payment to determine: how many veterans reached the cap and how many days on average it took to reach the cap; average amount billed to veterans who did not reach the cap and the amount which could potentially have been billed had the cap not been in place. This information will help identify the impact of the cap on collections in the last year and for the current year. Determining how close veterans were to reaching the cap as well as how much money could have been collected if no cap were in place will also help in understanding the impact of the cap on collections. The following identifies the five data elements the Facility Pharmacy Co-Pay Cap Report should capture from VistA: 1. Total Vets Billed: This is the total number of Enrollment Priority Group 2-6 veterans from a site who were billed the medication co-payment in the calendar year selected by the user. This number does not include those veterans who were billed at another facility whose station number is less than that of the current facility (such veterans will be counted on the report of the "low-station number" facility). 2. Total Vets At or Above the Cap: From the veterans in (1) above, this is the total number of veterans who were billed the cap amount and then never received another prescription/fill, plus those veterans who were billed the cap amount and continued to receive prescriptions/fills. 3. Average Number of Days to Reach Cap: For those veterans in (2) above, this is the average number of days, from the beginning of the calendar year, that elapsed before the veteran was billed a co-payment charge that caused him/her to reach the annual billing cap amount. 4. Average Amount Charged to Those Not Reaching Cap: For those veterans in (1) that are not counted in (2), this is the average amount that was billed to the veteran in the selected calendar year. 5. Potential Billable Amount: For those veterans in (2) who received prescriptions/fills that were not billed, this is the total amount that could have been charged for those prescriptions if the cap were not in place. This patch addresses the following New Service Request (NSR): ------------------------------------------------------------- 20030402 - Pharmacy Copay Cap Report This patch addresses the following NOIS message(s): --------------------------------------------------- There are no NOIS messages associated with this patch. Test Sites: ----------- Lexington (DSM/VMS) Louisville (DSM/VMS) Lebanon (DSM/VMS) Pittsburgh (DSM/VMS) Clarksburg (Cache/VMS) St. Cloud (Cache/NT) 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: ;;2.0;INTEGRATED BILLING;**[patch list]**;21-MAR-94 CHECK^XTSUMBLD results Routine Before Patch After Patch Patch List -------- ------------ ----------- ---------- IBARXMO1 new 11806027 259 Total number of routines: 1 The following new option is included in this patch: Menu Text Option Name ----------------------------- --------------------- Facility Pharmacy Co-pay Cap IBARXM FACILITY CAP Summary Report SUMM RPT 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*259): 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 IB*2.0*259 : Jan 09, 2004@06:17:53 Build Distribution Date: Jan 08, 2004 Installing Routines: Jan 09, 2004@06:17:53 Installing PACKAGE COMPONENTS: Installing OPTION Jan 09, 2004@06:17:54 Updating Routine file... Updating KIDS files... IB*2.0*259 Installed. Jan 09, 2004@06:17:54 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: - IBARXMO1 Routine Checksum: ============================================================================= User Information: Entered By : MINARDI,CHRISTOPHER P Date Entered : DEC 16, 2003 Completed By: GOLDSMITH,JAMES H Date Completed: MAY 12, 2004 Released By : GANUS,MAUNETTE Date Released : MAY 14, 2004 ============================================================================= Packman Mail Message: ===================== $END TXT