$TXT Created by SHAMUKHAMEDOV,SHAVKAT at MNTVMM.FO-ALBANY.MED.VA.GOV (KIDS) on Wednesday, 03/10/04 at 14:54 ============================================================================= Run Date: JUN 09, 2004 Designation: IB*2*247 Package : IB - INTEGRATED BILLING Priority: Mandatory Version : 2 SEQ #241 Status: Released Compliance Date: JUL 10, 2004 ============================================================================= Associated patches: (v)IB*2*159 <<= must be installed BEFORE `IB*2*247' (v)IB*2*160 <<= must be installed BEFORE `IB*2*247' (v)IB*2*171 <<= must be installed BEFORE `IB*2*247' (v)IB*2*174 <<= must be installed BEFORE `IB*2*247' (v)IB*2*234 <<= must be installed BEFORE `IB*2*247' (v)DG*5.3*576 <<= must be installed BEFORE `IB*2*247' Subject: COMBAT VETERANS PHASE II Category: - Routine - Other Description: ============ ************************************************************************* ** NOTE: ** ** This patch IB*2.0*247 should be installed after PSO*7*157 and ** ** PSX*2*50 patches. ** ** The PIMS portion of CV2 project - the PIMS Host file ** ** COMBAT_VET_PHASE_II_PIMS.KID with patches PX*1.0*130, SD*5.3*325, ** ** DG*5.3*565 and EC*2.0*54 should be installed as soon as it is ** ** available after IB*2.0*247 in order to provide full COMBAT VETERAN ** ** (CV) functionality. ** ** Please be aware that the new CV functionality with regard to ** ** outpatient encounters will not be fully functional until the PIMS ** ** Host file has been released and installed. Billing staff should ** ** continue to process bills for CV patients as instructed prior to ** ** this patch (IB*2.0*247). ** ************************************************************************* CV2 project Overview -------------------- The Chief Business Office (CBO) is requesting modifications to several Veterans Health Information Systems and Technology Architecture (VistA) packages to support implementation of VHA Directive 2002-049 - "Combat Veterans Are Eligible For Medical Services For 2-Years After Separation From Military Service Notwithstanding Lack Of Evidence For Service Connection", which iterates VA's policy to provide medical care and other medical services to combat veterans despite the absence of proof of service connection. Software to support the Combat Veteran (CV) initiative is being developed and introduced in a phased implementation strategy. The reason for this type of deployment is due to the complexity of the functionality and the number of product line dependencies. Phase I: Combat Veteran Interim Solution (CVIS) was a VistA only solution that involved development in the Integrated Billing (IB) and Registration/Enrollment product lines. It provided the logic to identify those veterans who met the criteria for the combat veteran eligibility and provided billing reports cross-referenced against this identifier to aid in the copayment billing process. Phase II of this initiative will involve multiple product lines and additional VistA only development. The main goals of Phase II will be to fully automate the copayment billing processing of combat vets based on episode of care by providing the appropriate questions at check-out as supplied by CPRS. Product lines that have a stake in Phase II development include Enrollment/Registration (VistA), IB, Outpatient Pharmacy, Consolidated Mail Outpatient Pharmacy (CMOP), CPRS/TIU, Patient Care Encounter (PCE), Ambulatory Care, Event Capture, Scheduling and PTF. The National Patient Care Database (NPCD) will also require modifications to capture workload reporting. The patches are listed below in the order that they must be installed: Outpatient Pharmacy PSO*7*157 released 5/13/04 PSX*2*50 released 5/13/04 Integrated Billing IB*2.0*247 PCE/PTF/Event Capture/Scheduling - PIMS Host file PX*1.0*130 \ SD*5.3*325 \ not yet DG*5.3*565 / released EC*2.0*54 / Product Features There are three main areas addressed by this enhancement: a. Identification/Notification of a CV Status veteran seeking medical care -The clinical applications shall obtain the CV Status for those veterans who qualify as such per the directive -The CV Status identification shall be displayed to the appropriate audience (pharmacist, clinician providing care, intake personnel, schedulers, etc.) -Provider shall be able to identify whether care provided CV veteran was for a condition potentially related to combat service in the same manner as identification of exposure related care; care for SC conditions, etc. b. Assistance in the communication of a treatment being determined as Combat Related -Provide a means for the billing and pharmacy software package to identify these patients and services provided care for a combat related condition c. Automatically precludes inpatient and outpatient medical care, prescription and Long-term care copayments for CV Status veterans whose treatment/service has been deemed combat related by provider or unless changed by pharmacist. This patch IB*2.0*247 is the IB portion of the Combat Veterans (CV)-Phase II project. CV2 Patch Overview ------------------ A. Inpatient Encounters ----------------------- 1. Preclude appropriate CV related 1st party copays. All necessary modifications have been made in the CVIS patch IB*2.0*234. 2. Preclude appropriate CV related 3rd party bills. All necessary modifications have been made in the CVIS patch IB*2.0*234. 3. Preclude 1st party copays for O&E OBSERVATION and EXAMINATION admissions. The CV patients will be shown in [IB OUTPUT EVENTS REPORT]. 4. The discharge bulletin for special cases will contain a warning message if COMBAT VETERAN status has expired during inpatient stay. B. Outpatient Encounters. ------------------------ 1. Preclude 1st party copays for CV Outpatient Appointments (non-pharmacy) -Modifications have been made to preclude 1st party copays if treatment is related to CV. -Modifications have been made to display CV classification result in [IB OUTPUT EVENTS REPORT] "Outpatient/Registration Events Report" -Modifications have been made to create or cancel copays due to editing of classification questions in "EC Edit Classification" option of "Appointment Management" [SDAM APPT MGT] and "Make Appointment" [SDM] (check-out screen) menu options. -If the stop code for the clinic prevents asking classification questions then the outpatient encounter will be billed even if the patient has an active CV status. In this case the user will be notified by e-mail bulletin about the charges made to that CV veteran. IB staff needs to consider the case and cancel the copay if necessary. 2. Preclude 3rd party billing for CV Outpatient Appointments (non-pharmacy) -Modifications have been made to Claims Tracking to preclude the 3rd party bill by flagging with CV status [IB MT NIGHT COMP] "Queue Means Test Compilation of Charges". The same modification should be made for "Head Neck Cancer" cases. -The text regarding CV and Head Neck Cancer has been added to the bulletin that is sent by [IBT SUP MANUALLY QUE ENCTRS] "Manually Add Opt. Encounters to Claims Tracking" -Modifications have been made to preclude appearance of CV treatments in [IBT RE-GEN UNBILLED REPORT] "Re-Generate Unbilled Amounts Report". -Modifications have been made to display CV condition in [IBT OUTPUT BILLING SHEET] "Print CT Summary for Billing" menu option. C. Outpatient Pharmacy. ----------------------- 1. The Alert message to the mail group IB COMBAT VET RX COPAY for Pharmacy staff was introduced by the CVIS project (IB*2.0*234). The decision has been made to keep this message in the CV2 project and enhance this functionality including Prescription number (RX#) in its text. 2. CV related pharmacy prescription entries in Claims Tracking will be marked as "NEEDS SC DETERMINATION" if the veteran doesn't have Service Connected status and has Combat Veteran status active to preclude 3rd party billing. D. Updating files ----------------- 1. The new charge removal reason "COMBAT VETERAN" has been added in file #350.3 . 2. The new non-billable reasons "HEAD/NECK CANCER" and "COMBAT VETERAN" have been added in file #356.8 . E. CV Billing Verification Report --------------------------------- There was a problem with the Registration API that was delivered in the CV-Interim Solution project. The problem is that if a veteran gets treatment that is CV related on the FINAL day of the two year coverage period, the Registration API returned that the veteran is NOT covered. Therefore there is a chance that IB created co-payment charges and sent out bills for the FINAL day of a patient's CV status. This error in the Registration API has been corrected but this report should be run after the patch installation to provide the site with a list of veterans that potentially could be billed incorrectly (if any). PLEASE NOTE that copayment charges and/or insurance bills printed in the report are not necessarily related to the COMBAT VETERAN status. Before making a decision about their cancellation, IB personnel needs to review these copayments/bills to check whether they were related to the COMBAT VETERAN status or not. The CV Billing Verification Report is a one-time report to assist billing clerks in finding potential bills generated by mistake. The report will include Patient Name, SSN, bill number and PATIENT/INSURANCE indicator (PATIENT - for copayment, INSURANCE - for 3-rd party). To run the report the user needs to execute the subroutine RPT^IB20P247 from programmer mode manually. Here is an example: >D RPT^IB20P247 ...Please wait... >> CV Billing Verification Report << ----------------------------- ------------ ----------- ------------------ Name SSN Date Bill # ----------------------------- ------------ ----------- ------------------ PATIENT,AAAAAA 000-00-0000 JAN 14,2004 K3008T5 PATIENT PATIENT,BBBBBB 000-00-0000 JAN 25,2004 K300C51 PATIENT PATIENT,CCCCCC 000-00-0000 JAN 23,2004 K300C5W INSURANCE ----------------------------- ------------ ----------- ------------------ Total: 3 bills/copays > Note: The probability of a veteran inappropriately receiving copayments/ bills on the FINAL day of CV status is quite small so most sites will generate a blank report. However, if bills are reported and they were related to CV, the user should use the existing manual process for reversing the ramifications of sending an inappropriate bill. DOCUMENTATION RETRIEVAL ======================= The Release Notes document IB_2_P247_RN.pdf for the IB portion of Combat Veteran Phase II project can be found in the following [ANONYMOUS.SOFTWARE] directories: Preferred Address ------------------------- First available FTP server download.vista.med.va.gov Specific Field Office FTP Address --------------------- ------------------------ Albany ftp.fo-albany.med.va.gov Hines ftp.fo-hines.med.va.gov Salt Lake City ftp.fo-slc.med.va.gov TECHNICAL DESCRIPTION ===================== IB20P247 Adds a new charge removal reason "COMBAT VETERAN" in file #350.3 . Adds a new non-billable reasons "HEAD/NECK CANCER" and "COMBAT VETERAN" in file #356.8 . The subroutine RPT^IB20P247 has been designed to provide a report for CV expiration date problem. The new Integration Agreement #4312 between Registration and IB was introduced to support the report. IBAMTI Additional text has been added to discharge notification for COMBAT VETERAN patients regarding expiration of CV status. IBAMTS Modifications have been made to send a bulletin regarding billing CV patient for the outpatient encounter that has stop code, which is exempt from classification questions. The order of priorities for special conditions has been changed to "SC,CV,AO,IR,EC,MST,HNC". IBAMTS1 New comments have been added to emphasize that if the outpatient encounter is related to CV, the bill will be precluded. IBAMTS2 Modifications have been made to preclude billing for O&E OBSERVATION and EXAMINATION cases and preclude the 3rd party bill for outpatient encounters by flagging with CV status. Modifications have been made to check changes in CV the classification question during editing of classification questions in "EC Edit Classification" option of " Appointment Management" [SDAM APPT MGT] and "Make Appointment" [SDM] menu options. IBARX1 Modifications have been made to add RX# to the Alert e-mail to IB COMBAT VET RX COPAY mail group. IBACV Modifications have been made to add RX# to the Alert e-mail to IB COMBAT VET RX COPAY mail group. IBECEAU5 Modifications have been made to preclude billing and display classification results in [IB OUTPUT EVENTS REPORT] for O&E OBSERVATION and EXAMINATION cases and for outpatient encounters. IBOVOP2 Modifications have been made to display classification results in [IB OUTPUT EVENTS REPORT] for outpatient encounters: Care related to CV? YES IBTRED Modifications have been made to display MST, HNC and CV condition in "Print CT Summary for Billing" menu option on the OUTPATIENT visit screen in "Special Cond:" field. IBTRKR3 Modifications have been made to preclude 3rd party billing for pharmacy prescriptions. IBTRKR41 Modifications have been made to preclude the 3rd party bill for outpatient encounters by flagging with CV status. The same modifications have been made for "Head/Neck Cancer" as well. IBTUBO1 New comments have been added to emphasize the appearance of MST,HNC and CV treatments in the Unbilled Amounts Report. ================ INSTALLATION INSTRUCTIONS ================= NOTE: This patch IB*2.0*247 should be installed after PSO*7*157 and PSX*2*50 patches which were released 5/13/04. The PIMS portion of CV2 (to be released later this month) - the PIMS Host file with patches PX*1.0*130, SD*5.3*325, DG*5.3*565 and EC*2.0*54 should be installed after IB*2.0*247 to complete the Combat Vet 2 functionality as described above. It is recommended this patch be installed outside of normal business hours to avoid any complications resulting from users on the system. It should also NOT be installed or queued when the [IB MT NIGHT COMP] job is running. Installation will take less than 5 minutes. 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. ROUTINES 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 -------- ------------ ----------- ---------------------- IB20P247 N/A 5567437 **247** IBACV 3459551 3683050 **234,247** IBAMTI 9290043 11013314 **52,132,153,156,234, 247** IBAMTS 6541242 7420820 **52,115,132,153,164, 156,171,247** IBAMTS1 5314283 5314283 **20,52,132,153,166, 156,167,247** IBAMTS2 3650781 3687338 **52,91,117,132,153, 156,167,247** IBARX1 10331103 10371964 **34,101,150,158,156, 234,247** IBECEAU5 8454112 7205929 **132,153,156,167,247** IBOVOP2 8694934 8955438 **52,132,153,156,167, 234,247** IBTRED 8401368 8580697 **71,91,160,247** IBTRKR3 9535924 11841855 **13,43,121,160,247** IBTRKR41 5759002 6135683 **43,55,91,132,174, 247** IBTUBO1 8655342 8741070 **19,31,32,91,123,159, 247** Total number of routines - 13 New routines - 1 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:INS tallation --- 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*247): 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: [IB OUTPUT EVENTS REPORT] Outpatient/Registration Events Report [DG ADMIT PATIENT] Admit a Patient [DG DISCHARGE PATIENT] Discharge a Patient [SDM] Make Appointment [SDAM APPT MGT] Appointment Management [IBT SUP MANUALLY QUE ENCTRS] Manually Add Opt. Encounters to Claims Tracking [IBT OUTPUT BILLING SHEET] Print CT Summary for Billing [IBT UNBILLED MENU] Unbilled Amounts Menu 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. Run the CV Billing Verification Report by executing the subroutine RPT^IB20P247 from the programmer mode manually. Here is an example: >D RPT^IB20P247 You can run the report as many times as you need. Alert IB staff of any patients that show up on this report. The staff will have to research and potentially cancel bills. Routine Information: ==================== Routine Name: - IBAMTS Routine Checksum: Routine Name: - IBAMTS1 Routine Checksum: Routine Name: - IBAMTS2 Routine Checksum: Routine Name: - IBECEAU5 Routine Checksum: Routine Name: - IBOVOP2 Routine Checksum: Routine Name: - IBARX1 Routine Checksum: Routine Name: - IBTRED Routine Checksum: Routine Name: - IBTUBO1 Routine Checksum: Routine Name: - IBTRKR41 Routine Checksum: Routine Name: - IB20P247 Routine Checksum: Routine Name: - IBTRKR3 Routine Checksum: Routine Name: - IBAMTI Routine Checksum: Routine Name: - IBACV Routine Checksum: ============================================================================= User Information: Entered By : SHAMUKHAMEDOV,SHAVKAT Date Entered : SEP 29, 2003 Completed By: LANIGAN,VASSER Date Completed: JUN 09, 2004 Released By : GANUS,MAUNETTE Date Released : JUN 09, 2004 ============================================================================= Packman Mail Message: ===================== $END TXT