$TXT Created by HARPER,AMY R at DEVFEX.FO-ALBANY.MED.VA.GOV (KIDS) on Monday, 06/06/05 at 19:16 ============================================================================= Run Date: JUL 08, 2005 Designation: IB*2*307 Package : IB - INTEGRATED BILLING Priority: Mandatory Version : 2 SEQ #278 Status: Released Compliance Date: AUG 08, 2005 ============================================================================= Associated patches: (v)IB*2*148 <<= must be installed BEFORE `IB*2*307' (v)IB*2*175 <<= must be installed BEFORE `IB*2*307' Subject: CMAC 2005 Category: - Routine - Enhancement (Mandatory) Description: ============ The CHAMPUS Maximum Allowable Charges (CMAC) charges have been redesigned beginning with 2005. This patch will allow the new CMAC charge structure to be uploaded into the Charge Master, so the charges may be applied to bills. The following are the specific changes included in this patch. Special Note: Implementation of CMAC 2005 is a two step process. The first step is installation of this patch, which is mandatory. The second step is uploading CMAC charges and is optional, depending on if your site uses the CMAC. The effective date of the new CMAC charges is 04/01/05. The CHAMPUS Maximum Allowable Charges (CMAC) charges have been redesigned to define 4 Categories of charges. Two of these categories of charges will be available to sites: Facility/Physician Charges: Services of Medical Doctors (MDs), Doctors of Osteopathy (DOs), optometrists, podiatrists, psychologists, oral surgeons, occupational therapists, speech therapists, physical therapists, and audiologists. Facility/Non-Physician Charges: Services, of all other providers not found in category 1. There are two additional Categories for 'Non-Facility' type sites. All VA sites have been identified as 'Facility' type sites, therefore only the CMAC 'Facility' type charges will be uploaded. Two Charge Sets will be created in the Charge Master to contain all corresponding charges and will be set up as Professional charges: - CMAC xxx FAC/PHYS charges correspond to the first category. These charges will be used as the default when adding charges to bills. - CMAC xxx FAC/NONPHYS charges correspond to the second category. These charges must be manually selected on a bill to be used. The effective date of the CMAC 2005 charges is 04/01/05. If sites have continued billing with the old CMAC charges for care after this effective date, then there may be inconstancies in the charges for the secondary bill. If the primary bill for care after 4/1 was created before this patch, then the old charges were used on that bill. If the secondary bill is created after the new charges are installed, then the new charges will be used on the new bill. This will result in different charges on the primary and secondary bills. To use the same charges for both the primary and secondary bills the charges on the secondary bill will have to be manually changed to the old charges. The CMAC charges may be set up so the charges for specific procedures are associated with specific revenue codes. The instructions to do this are at the end of the charge upload instructions below. The Load Host File into Charge Master [IBCR HOST FILE LOAD] option has been updated to be able to read the new CMAC files and to store them in the Charge Master. The process is similar to the upload of previous versions of the CMAC, except now the required Charge Master elements will be automatically created rather than manual. This includes: Charge Sets, Billing Regions, and linking the Charge Sets to Rate Schedules that are already linked to other CMAC sets. The Load Host File into Charge Master [IBCR HOST FILE LOAD] option has been modified to automatically delete any CMAC Charge Sets and their related elements if the charges are not loaded, so CMAC Charge Sets with no charges are automatically deleted. The Delete Charges from the Charge Master [IBCR DELETE CHARGE ITEMS] option has been modified to allow the deletion of CMAC Charge Sets and their related elements if all the set's charges are being deleted. During the patch installation, all CMAC charges currently defined in the Charge Master will be inactivated. The inactivation date used for a particular charge will be the date of the next valid charge or 03/31/05. This is essentially a clean-up to ensure only the new charges will be effective on/after 04/01/05. This patch addresses the following New Service Request (NSR): ------------------------------------------------------------- 20050304 2005 Update on CMAC Pricing File This patch addresses the following NOIS/Remedy Ticket(s): --------------------------------------------------------- There is no NOIS/Remedy tickets associated with this patch. COMPONENTS SENT WITH PATCH -------------------------- Routines: --------- The following is a list of the routines included in this patch. The second line of each of these routines now looks like: ;;Version;Package;**[patch list]**;Package Release Date CHECK^XTSUMBLD results Routine name Before Patch After Patch Patch List ============ ============ =========== ========== IBCRED 15105867 15140257 52,106,148,307 IBCRHBC 10907766 13422858 52,106,124,307 IBCRHBC3 N/A 9250464 307 IBCRHO 13659827 14031649 52,138,148,307 IBCRHU2 12916302 17579202 106,138,245,175,307 IBYPPL N/A 4465176 307 Number of Routines = 6 Test Sites: ----------- Jackson VAMC Pittsburgh HCS San Antonion (South Texas HCS) Pre/Post Installation Overview ------------------------------ The Post Init will loop through the Charge Master Charge Item file (#363.2) inactivating all old CMAC charges. This will ensure they will not be used inappropriately after the new charges are loaded. Routine: IBYPPL ================INSTALLATION INSTRUCTIONS ================= If installed during the normal workday, it is recommended that the following selection(s) in the OPTION (#19) file be disabled to prevent possible conflicts while running the KIDS Install. Other VISTA users will not be affected. IBCR CHARGE MASTER IRM MENU Charge Master IRM Menu IBCR CHARGE MASTER MENU Charge Master Menu Install Time - less than 10 minutes. The Post-init will loop through the Charge Item file (#363.2) inactivating existing CMAC charges. Therefore, the amount of time required for install will vary from site to site depending on how many CMAC charges are loaded. 1. LOAD TRANSPORT GLOBAL --------------------- Choose the PackMan message containing this patch and invoke the INSTALL/CHECK MESSAGE PackMan option. 2. 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: 3. Select Installation Option: --------------------------- NOTE: The following are OPTIONAL - (When prompted for the INSTALL NAME, enter IB*2*307): 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. 4. 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. When prompted 'Want KIDS to Rebuild Menu Trees Upon Completion of Install? YES//' Answer YES unless your system does this in a nightly TaskMan process. 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: IBCR CHARGE MASTER IRM MENU Charge Master IRM Menu IBCR CHARGE MASTER MENU Charge Master Menu e. When prompted 'Enter protocols you wish to mark as 'Out Of Order':' press . 5. CLEAN UP POST INIT ROUTINE -------------------------- Optional - Once this patch has been successfully installed, you may delete the post init routine: IBYPPL 6. UPLOAD CMAC 2005 Charges ------------------------ Follow the instructions below, if needed. ******* POST-INSTALLATION INSTRUCTIONS: Uploading CMAC Charges ********* Upload of the CMAC charges is required only if your site uses the CMAC. The following are the steps necessary for uploading CMAC 2005 charges. Set-Up Steps: ------------- 1. Determine if CMAC charges are needed at your site. Only continue if your site does use CMAC. 2. Compile the list of Divisions CMAC charges are needed for. This list should include both the Division number and the zip code of the location of the division. 3. Obtain the sets of CMAC charge files required, in ASCII. These files are available at: http://vaww.cf.webdev.va.gov/vadod Select CMAC Rates, then CMAC Rates. Enter the zip code of a primary site that requires CMAC charges. A file of CMAC charges will be created for the Locality which contains the entered zip code. Right click on the 3-digit code in the Locality Code column and save the file to your local system. This 3-digit code is the Locality the charges apply to. The CMAC charges are based on a Locality code. Many zip codes are contained within each Locality. Therefore, it is likely that one set of CMAC charges will be applicable to several divisions. Complete the process for each division zip code charges are needed for. If the same file, as identified by the 3-digit code, is created for multiple division zip codes, then only one is needed, but make note of all the divisions that are contained within that locality. The CMAC files created will be named: 2005CMACxxx.TXT w/xxx is locality. 4. Move the CMAC files to a directory accessible to VISTA. Use ASCII. CMAC Upload into VISTA: ----------------------- 5. Enter Charge Master IRM Menu [IBCR CHARGE MASTER IRM MENU] option, then Load Host File into Charge Master [IBCR HOST FILE LOAD] option. 6. Select 1.1 Load CMAC into XTMP. If there are any CMAC files already loaded, then they will be listed. Delete them and continue. 7. Enter the correct Path where the CMAC files were placed in 4. 8. All available CMAC files will be displayed. Enter the file to load. Note: CMAC 2005 files name format: '2005CMACxxx.TXT' CMAC files pre-2005 format: 'CMACxxx.TXT' 9. If component charges are desired, then enter the appropriate Modifier. Professional Component Modifier: // 26 Technical Component Modifier: // TC 10. Calculate and Compile CMAC charges into Charge Master form. Enter Yes to 'Proceed with upload now' The required Charge Master elements will be automatically created: - Billing Region (there will be a warning about no division) - Charge Sets (2) will be created if not already defined. >> CMAC xxx FAC/PHYS >> CMAC xxx FAC/NONPHYS - The Charge Sets will be added to Rate Schedules that already have other CMAC charges assigned. >> If there are no Rate Schedules with CMAC assigned then these will have to be added manually. (see step 14) - Division will be asked. Enter all Divisions whose zip codes are covered by the Locality, as determined in step 3. >> These charges will only be applied to the divisions added. Therefore if no division or not all needed divisions are added here then they must be added after the upload. (see step 15) The end result of this step is a set of temporary VISTA files containing the CMAC charges in a form appropriate for loading into the Charge Master. 11. Check Data Validity of charges created Select 3 Check Data Validity and print the result. It is expected that there will be one duplicate charge and 14 Wxxxx procedure charges that can not be found. This is ok. 12. Load charges into the Charge Master Select 4 Load into Charge Master. Select a device to print the result. The results should be a clean load except for the 14 Wxxxx procedures which can not be loaded. 13. Repeat Steps 6-12 for each CMAC Locality file needed. 14. Add new Charge Sets to Rate Schedules, if necessary. When the charges are set up in step 10, it will add the new Charge Sets to any Rate Schedule that already has CMAC charges assigned. If none were found, then the following message is displayed and the links must be manually set. *** Warning: CMAC 359 FAC/PHYS not added to any Rate Schedule, set manually using Enter/Edit Charge Master option. Add the new Charge Sets to Rate Schedules for the Billing Rates that should be billed using CMAC: Use the Enter/Edit Charge Master [IBCR DISPLAY CHARGE MASTER] option Select Action RS - Rate Schedule, then add the new Charge Sets to the appropriate Rate Schedule. All 'FAC/PHYS' should be AUTO = Yes. All 'FAC/NONPHYS' should be AUTO = BLANK. 15. Add Divisions to new Billing Regions, if necessary. When the charges are set up in step 10, it will add the new Billing Region that defines the divisions that may use the charges. If no division or not all necessary divisions were added, then they need to be assigned after the upload. Any division not assigned to a CMAC Billing Region will not be able to use the CMAC charges. Add all divisions covered by a CMAC locality to the corresponding Billing Region: Use the Enter/Edit Charge Master [IBCR DISPLAY CHARGE MASTER] option Select Action CS - Charge Set, then Select Action RG - Billing Regions, then add the Divisions to the appropriate CMAC Billing Region. 16. Optional: Add Revenue Code - CPT links for CMAC. The CMAC charges may be set up so the charges for specific procedures are associated with specific revenue codes. To do this use the Revenue Code - CPT links functionality. There are two options: a. Use the Standard Revenue Code Links already defined. If the Revenue Code CPT links already defined will work for the CMAC, then assign the CMAC to the current set. In the Charge Master Main Menu, use the Print Option V-Rev Cd Links to print out the existing links to determine if these will work for the CMAC. If the existing links are ok, then assign the CMAC to the existing special group: in the Enter/Edit Charge Master, SG - Special Groups, ED - Edit Special Groups: Select Action: Quit// ED Edit Special Groups Enter/Edit a Special Group: Select BILLING SPECIAL GROUPS NAME: STANDARD RVCD LINKS REVENUE CODE LINK This was exported Nationally, only the assigned Billing Rates may be edited. This group has associated Revenue Code Links. Type can not be edited. Select BILLING RATE: RC PHYSICIAN MN// CMAC CHARGE SET: ORDER: Select BILLING RATE: b. Create new Revenue Code - CPT Links just for CMAC. If the Revenue Code CPT links already defined will NOT work for the CMAC, then create a new set of links just for the CMAC. Create the new links Special Group: in the Enter/Edit Charge Master, SG - Special Groups, ED - Edit Special Groups: Select Action: Quit// ED Edit Special Groups Enter/Edit a Special Group: Select BILLING SPECIAL GROUPS NAME: LOCAL RVCD LINKS CMAC Are you adding 'LOCAL RVCD LINKS CMAC' as a new BILLING SPECIAL GROUPS (the 4TH)? No// Y (Yes) BILLING SPECIAL GROUPS TYPE: R REVENUE CODE LINK NAME: LOCAL RVCD LINKS CMAC Replace TYPE: REVENUE CODE LINK// Select BILLING RATE: CMAC CHARGE SET: ORDER: Select BILLING RATE: Then set up the actual links, enter RV - Revenue Code Links: Select Action: Next Screen// RV Revenue Code Links Select CPT to display. Select CPT: 80048 BASIC METABOLIC PANEL {any CPT} A new screen will display, enter ED - Edit Link (this is an example, replace with desired CPT's and Revenue Codes) Select Action: Quit// ED Edit Link Enter/Edit a Revenue Code Link: Select BILLING SPECIAL GROUPS NAME: LOCAL RVCD LINKS CMAC REVENUE CODE LINK Select REVENUE CODE: 301 LAB/CHEMISTRY CHEMISTRY ...OK? Yes// (Yes) LOCAL RVCD LINKS CMAC REVENUE CODE: 301// PROCEDURE 1: 80048 BASIC METABOLIC PANEL PROCEDURE 2: 87999 MICROBIOLOGY PROCEDURE Repeat this step for all links needed. Example Upload of CMAC for Locality 348 --------------------------------------- Select OPTION NAME: IBCR CHARGE MASTER IRM MENU Charge Master IRM Menu Load Host File into Charge Master Rate Schedule Adjustment Enter/Edit Select Charge Master IRM Menu Option: Load Host File into Charge Master Select one of the following: 1.1 Load CMAC into XTMP 1.2 Load AWP into XTMP 1.3 Load RC into XTMP 1.4 Load TP into XTMP 2 Assign Charge Set 3 Check Data Validity 4 Load into Charge Master 5 Delete XTMP files Enter response: 1.1 Load CMAC into XTMP Upload CMAC Host File: 'CMACxxx.TXT' or 'yyyyCMACxxx.TXT' w/xxx = locality Enter the file path: USER$:[HARPER]// CMAC Host files available for upload in: USER$:[HARPER] 2005CMAC301.TXT 2005CMAC348.TXT 2005CMAC350.TXT CMAC358.TXT CMAC359.TXT Enter a Host File Name: 2005CMAC348.TXT Professional Component Modifier: // 26 Technical Component Modifier: // TC File: 2005CMAC348.TXT Effective: Apr 01, 2005 Proceed with upload now? YES >> CMAC 348 Billing Region added *** Warning: No MC division defined, no division added to Region >> CMAC 348 FAC/PHYS Charge Set added Charge Set added to Rate Schedule TRICARE OPT Charge Set added to Rate Schedule TRICARE OPT RI Charge Set added to Rate Schedule CHAMPVA OPT >> CMAC 348 FAC/NONPHYS Charge Set added Charge Set added to Rate Schedule TRICARE OPT Charge Set added to Rate Schedule TRICARE OPT RI Charge Set added to Rate Schedule CHAMPVA OPT Enter the Divisions associated with these charges: CMAC 348 Select DIVISION: ALBANY 1 ALBANY 500 2 ALBANY2 500GH 3 ALBANY3 500 CHOOSE 1-3: 1 ALBANY 500 Are you adding 'ALBANY' as a new DIVISION (the 1ST for this BILLING REGION)? No// Y (Yes) Select DIVISION: Loading 2005CMAC348.TXT into ^XTMP ...................................... ........................................ Done. 7837 lines processed. The following files were created, they will be purged in 2 days: IBCR UPLOAD 2005CMAC348.TXT 348 Count = 18389 IB upload of Host file 2005CMAC348.TXT, on 6/6/05@19:43:09 by TEST,AR Subfile Item Count Charge Set ------- ---- ----- ------------------------- 1 CAT 1 FAC/PHYS CPT 7837 CMAC 348 FAC/PHYS 2 CAT 3 FAC/NONPHYS CPT 6746 CMAC 348 FAC/NONPHYS 3 NONPHYS PROF CPT 897 CMAC 348 FAC/NONPHYS 4 NONPHYS TECH CPT 986 CMAC 348 FAC/NONPHYS 5 PHYS PROF CPT 917 CMAC 348 FAC/PHYS 6 PHYS TECH CPT 1006 CMAC 348 FAC/PHYS Select one of the following: 1.1 Load CMAC into XTMP 1.2 Load AWP into XTMP 1.3 Load RC into XTMP 1.4 Load TP into XTMP 2 Assign Charge Set 3 Check Data Validity 4 Load into Charge Master 5 Delete XTMP files Enter response: 4 Load into Charge Master Check files waiting to be loaded into the Charge Master for data validity. IBCR UPLOAD 2005CMAC348.TXT 348 Count = 18389 IB upload of Host file 2005CMAC348.TXT, on 6/6/05@19:43:09 by TEST,AR Subfile Item Count Charge Set ------- ---- ----- ------------------------- 1 CAT 1 FAC/PHYS CPT 7837 CMAC 348 FAC/PHYS 2 CAT 3 FAC/NONPHYS CPT 6746 CMAC 348 FAC/NONPHYS 3 NONPHYS PROF CPT 897 CMAC 348 FAC/NONPHYS 4 NONPHYS TECH CPT 986 CMAC 348 FAC/NONPHYS 5 PHYS PROF CPT 917 CMAC 348 FAC/PHYS 6 PHYS TECH CPT 1006 CMAC 348 FAC/PHYS Load the above files into the Charge Master? YES A summary report of the results will be printed. Report requires 120 columns OUTPUT DEVICE: HOME// UCX/TELNET Loading data into Charge Master: IBCR UPLOAD 2005CMAC348.TXT 348 CAT 1 FAC/PHYS .................... ........................................................... IBCR UPLOAD 2005CMAC348.TXT 348 CAT 3 FAC/NONPHYS.................. .................................................. IBCR UPLOAD 2005CMAC348.TXT 348 NONPHYS PROF ......... IBCR UPLOAD 2005CMAC348.TXT 348 NONPHYS TECH .......... IBCR UPLOAD 2005CMAC348.TXT 348 PHYS PROF .......... IBCR UPLOAD 2005CMAC348.TXT 348 PHYS TECH ........... IB Upload Summary Report of Charge Items Loaded into the Charge Master 6/6/05@19:47:27 Page 1 -------------------------------------------------------------------------- IBCR UPLOAD 2005CMAC348.TXT 348 CAT 1 FAC/PHYS 7837 of 7837 records checked, 1 duplicates, 0 with $=0 14 line/data errors or warnings found .18% error rate 7822 entries added to the Charge Set CMAC 348 FAC/PHYS. 7824 =W0002^3050401^^6.55^ Line/Data Error: Item not found in source file 7825 =W0003^3050401^^8.36^ Line/Data Error: Item not found in source file 7826 =W0004^3050401^^8.82^ Line/Data Error: Item not found in source file 7827 =W0005^3050401^^9.83^ Line/Data Error: Item not found in source file 7828 =W0006^3050401^^9.87^ Line/Data Error: Item not found in source file 7829 =W0007^3050401^^10.28^ Line/Data Error: Item not found in source file 7830 =W0008^3050401^^10.64^ Line/Data Error: Item not found in source file 7831 =W0009^3050401^^10.91^ Line/Data Error: Item not found in source file 7832 =W0010^3050401^^10.91^ Line/Data Error: Item not found in source file 7833 =W0011^3050401^^11.11^ Line/Data Error: Item not found in source file 7834 =W0012^3050401^^11.36^ Line/Data Error: Item not found in source file 7835 =W0016^3050401^^13.29^ Line/Data Error: Item not found in source file 7836 =W0018^3050401^^13.39^ Line/Data Error: Item not found in source file 7837 =W0019^3050401^^13.91^ Line/Data Error: Item not found in source file CAT 3 FAC/NONPHYS 6746 of 6746 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate 6746 entries added to Charge Set CMAC 348 FAC/NONPHYS NONPHYS PROF 897 of 897 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate 897 entries added to the Charge Set CMAC 348 FAC/NONPHYS NONPHYS TECH 986 of 986 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate 986 entries added to the Charge Set CMAC 348 FAC/NONPHYS. PHYS PROF 917 of 917 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate 917 entries added to the Charge Set CMAC 348 FAC/PHYS. PHYS TECH 1006 of 1006 records checked, 0 duplicates, 0 with $=0 0 line/data errors or warnings found for a 0% error rate 1006 entries added to the Charge Set CMAC 348 FAC/PHYS. Select one of the following: 1.1 Load CMAC into XTMP 1.2 Load AWP into XTMP 1.3 Load RC into XTMP 1.4 Load TP into XTMP 2 Assign Charge Set 3 Check Data Validity 4 Load into Charge Master 5 Delete XTMP files Routine Information: ==================== Routine Name: - IBCRED Routine Checksum: Routine Name: - IBCRHBC Routine Checksum: Routine Name: - IBCRHBC3 Routine Checksum: Routine Name: - IBCRHO Routine Checksum: Routine Name: - IBCRHU2 Routine Checksum: Routine Name: - IBYPPL Routine Checksum: ============================================================================= User Information: Entered By : HARPER,AMY R Date Entered : MAY 05, 2005 Completed By: KUREK,STANLEY M Date Completed: JUL 05, 2005 Released By : BOTTINI,STEVE Date Released : JUL 08, 2005 ============================================================================= Packman Mail Message: ===================== $END TXT