$TXT Created by HARPER,AMY R at DEVFEX.FO-ALBANY.MED.VA.GOV (KIDS) on Thursday, 02/17/05 at 12:14 ============================================================================= Run Date: MAR 02, 2005 Designation: IB*2*287 Package : IB - INTEGRATED BILLING Priority: Mandatory Version : 2 SEQ #273 Status: Released Compliance Date: APR 02, 2005 ============================================================================= Associated patches: (v)IB*2*288 <<= must be installed BEFORE `IB*2*287' Subject: UPDATE FOR REASONABLE CHARGES (2.2) Category: - Routine - Enhancement (Mandatory) Description: ============ This patch contains several updates to bill processing and reports related to Reasonable Charges. No charges are updated or exported with this patch. Combine Evaluation & Management (E&M) Charges --------------------------------------------- Many E&M procedures have both an institutional and professional charge. The normal billing process is to bill these two charges separately on two bills. However, some insurance companies will only pay the first charge they receive for these procedures and deny the second charge as a duplicate. These are not duplicate charges. To accommodate this issue with insurance companies, functionality has been included in this patch to combine both the Institutional and Professional charges for certain procedures onto one bill. Use of the Combine Charges function is optional and intended for those cases where combining charges is currently done manually. Also, note that charges should not be combined for MRA bills as Medicare requires the Institutional and Procedure charges to be sent to Part A and Part B separately. Procedures Potentially Combined: 90801-90815, 90845-90899, 99201-99215, 99241-99245, 99271-99288, 99385-99387, 99395-99429, 99499 When re-calculating the charges on a bill (screens 6/7 option 6), a new question has been added: 'Combine Institutional and Professional Charges for E&M Procedures? NO//' If answered Yes, then the charges for the applicable procedures will be combined by adding both the facility and professional charge for the procedure to one charge line item on the bill. This function is only available if one of the above procedures is on the bill and the site is Provider Based with both Facility and Professional charges. On bill's defined as either Institutional or Professional, then the combined procedure charge will be added to the existing procedure charge line item. On bill's with no Charge Type defined, the combined charge will be added to the first procedure charge line item. The second procedure charge line item will be deleted. Bill Procedure Modifications ---------------------------- Beginning with Reasonable Charges v2.0, certain procedures must be identified in a specific way on the bill for the correct charge to be applied. A function exists that will automatically apply changes to the procedures when the bill is auto created or when the Bill Charge Type is changed on screen 6/7 option 1. To help ensure these changes are applied and the correct charges calculated, this function will now be available after entering or editing procedures. After procedures are entered/edited on a bill (screen 4/5 option 4), a new question has been added: 'Apply Procedure Updates for Charges? YES//' If answered Yes, then the Current Procedure Terminology (CPT) codes will be modified to correspond to the procedure's charges in the following ways: For CPT codes, whose professional charge is associated with Modifier 26: - On Institutional bills, modifier 26 will be removed - On Professional bills, modifier 26 will be added. Primary Secondary Bundled procedures (EKG Split) - Procedures whose component CPT codes are different from the global CPT code (primarily EKG procedures): - On Institutional bills, if the global code is defined in Patient Care Encounter (PCE) and on the Institutional bill, then the global code is replaced by the facility component codes of the procedure. - On Professional bills, if the global code is defined in PCE and the facility component codes are defined on the professional bill, then the facility component codes will be replaced by the professional component codes. - On bills for Freestanding Sites, if all the component codes are defined on the bill, then they will be replaced by the global code. Bill Insurance Help (?INX) -------------------------- A new expanded Insurance help screen has been added to the bill. '?INX' will display all the insurance information included in '?INS' plus: - Plan Filing Time Frame - Patient Policy Last Verified Date - Patient Policy Comments - Insurance Plan Comments Revenue Code - Common Procedure Terminology (CPT) Links ------------------------------------------------------- There is a function within the Charge Master that allows the linking of Revenue Codes to CPT codes. When charges are added to a bill, these links are used to assign revenue codes to charges based on the procedure being charged. This list of Standard Revenue Code - CPT links has been updated with this patch. To view the list of defined Revenue Code - CPT links, use the Charge Master Print [IBCR REPORTS FOR CHARGE MASTER] option and select V (Rev Cd Links). Note that it is possible to set up a local list of linked Revenue Codes and CPT codes if the Standard list does not contain all the links needed locally. However, a new Special Group must be used. The STANDARD RVDC LINKS group is deleted before it is updated by a national patch. So if local links are desired, then use a LOCAL RVCD LINKS Special Group. Activate Revenue Code --------------------- The Revenue Code - CPT links have been updated in this patch. Revenue code 900 has now been linked to CPT codes and will be Activated on patch installation. Procedure Charge Report ----------------------- A new report has been added to the Print Charge Master [IBCR REPORTS FOR CHARGE MASTER] option, IP - Charge Items - Procedures. This report will print charges for selected procedures based on Billing Rate, Division, and effective dates. Auto Biller Results Report -------------------------- This report contains results of the activity from the Third Party Auto Biller. The Third Party Auto Biller processes Claims Tracking entries and may create a bill. This report will provide detail for all processed entries, including the bill number if a bill was created or the reason a bill could not be created. This report has been updated to allow sorting and selecting by: - Event Date or Auto Biller Date - Type of Event: Inpatient, Outpatient or Prescription - Auto Bill Created or No Bill Created - Patient Name Note it is suggested that the Delete Auto Biller Results [IB CLEAN AUTO BILLER LIST] be run periodically. If the auto biller creates a bill, then the entry will be removed from the auto biller results report when the auto created bill is printed, transmitted, or cancelled. However, entries for Claims Tracking events for which the auto biller could not create a bill are only deleted by this option and will therefore continue to accumulate. For example, if all events from a year ago have been processed to completion, then enter 1 year ago in this option and any entries for events older than 1 year will be removed from the report. Update Select Rate Schedules ---------------------------- The Enter/Edit Billing Information [IB EDIT BILLING INFO], Screens 6/7 selection 6 - Rate Schedules, has been updated. If a site has a large number of divisions with charges, the entire set of the default charge sets may not be applied. If the default selection is larger than 30, then only the first 30 charge sets are used, resulting in the user being required to select the individual sets to apply. This has been updated so the default will be applied regardless of the number of sets available. Technical Description: ====================== The Post Install of this patch will complete the following: - Activate Revenue Code 900, if it is Inactive. - 251 Old Revenue Code - CPT links will be deleted (#363.33) - 251 New Revenue Code - CPT links will be added (#363.33) This patch addresses the following New Service Request (NSR): ============================================================= There are no NSRs associated with this patch. This patch addresses the following NOIS/Remedy Ticket(s): ========================================================= There are no NOIS/Remedy tickets associated with this patch. Test Sites: =========== Chillicothe, OH Columbia, SC Dublin, GA South Texas HCS, San Antonio, TX Wilmington, DE ================= DOCUMENTATION RETRIEVAL ================== Additional documentation can be found in the User Manual for the Integrated Billing package located in the VistA Document Library (www.va.gov/vdl) under Financial Administration. The User Manual is available in .doc and .pdf formats. The specific pages updated: Page 98 for Print Auto Biller Results Page 237 for Print Charge Master The direct links to the User Manual are: For a Microsoft Word version: http://www.va.gov/vdl/VistA_Lib/Financial_Admin/Integrated_Billing_(IB) /IB_20_U.doc For a PDF version: http://www.va.gov/vdl/VistA_Lib/Financial_Admin/Integrated_Billing_(IB) /IB_20_U.pdf ================ INSTALLATION INSTRUCTIONS ================= If installed during the normal workday, it is recommended that the following selection(s) in the OPTION (#19) file, and all of their descendants 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] Print Charge Master [IBCR REPORTS FOR CHARGE MASTER] Print Auto Biller Results [IB OUTPUT AUTO BILLER] Enter/Edit Charge Master [IBCR DISPLAY CHARGE MASTER] Install Time - 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. 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 name Before Patch After Patch Patch List ============ ============ =========== ========== IBCDE 7284522 7287856 55,287 IBCDP N/A 19886863 287 IBCNS3 N/A 14594022 287 IBCRBE 12755539 12875751 52,106,245,287 IBCROI1 5217688 5358988 52,106,245,287 IBCROIP N/A 8586213 287 IBCROR 6463979 7220530 52,106,287 IBCSC4 11468089 11586185 52,51,210,245,155 287 IBCSC5 9901214 10019310 52,125,51,210,266 288,287 IBCSCE 7525031 7627937 52,80,91,106,51 137,236,245,287 IBCSCH 30141913 30947532 52,80,106,124,138 51,148,137,161,245 232,287 IBCU2 4708330 4946541 137,287 IBCU65 N/A 10764970 287 IBCU7A 10763009 13357262 245,287 IBYPSC N/A 2322614 287 IBYPSC1 N/A 7281430 287 Number of Routines = 16 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*287): 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 (unless otherwise indicated) c. When prompted 'Want to DISABLE Scheduled Options, Menu Options, and Protocols? YES//' answer YES (unless otherwise indicated) 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] Print Charge Master [IBCR REPORTS FOR CHARGE MASTER] Print Auto Biller Results [IB OUTPUT AUTO BILLER] Enter/Edit Charge Master [IBCR DISPLAY CHARGE MASTER] 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: IBYPSC* Routine Information: ==================== Routine Name: - IBCDE Routine Checksum: Routine Name: - IBCNS3 Routine Checksum: Routine Name: - IBCROI1 Routine Checksum: Routine Name: - IBCROIP Routine Checksum: Routine Name: - IBCROR Routine Checksum: Routine Name: - IBCSC4 Routine Checksum: Routine Name: - IBCSC5 Routine Checksum: Routine Name: - IBCSCE Routine Checksum: Routine Name: - IBCSCH Routine Checksum: Routine Name: - IBCU2 Routine Checksum: Routine Name: - IBCU65 Routine Checksum: Routine Name: - IBCU7A Routine Checksum: Routine Name: - IBYPSC Routine Checksum: Routine Name: - IBYPSC1 Routine Checksum: Routine Name: - IBCDP Routine Checksum: Routine Name: - IBCRBE Routine Checksum: ============================================================================= User Information: Entered By : HARPER,AMY R Date Entered : OCT 06, 2004 Completed By: KUREK,STANLEY M Date Completed: MAR 01, 2005 Released By : BOTTINI,STEVE Date Released : MAR 02, 2005 ============================================================================= Packman Mail Message: ===================== $END TXT