============================================================================= Run Date: AUG 31, 2005 Designation: IB*2*260 Package : IB - INTEGRATED BILLING Priority: Mandatory Version : 2 SEQ #281 Status: Released Compliance Date: OCT 01, 2005 ============================================================================= Associated patches: (v)IB*2*266 <<= must be installed BEFORE `IB*2*260' (v)IB*2*267 <<= must be installed BEFORE `IB*2*260' (v)IB*2*275 <<= must be installed BEFORE `IB*2*260' Subject: CLINICAL INDICATOR DATA CAPTURE Category: - Routine - Enhancement (Mandatory) Description: ============ This patch is being distributed to provide enhancements to the Integrated Billing package to take advantage of some of the Clinical Indicator Data Capture (CIDC) enhancements in other packages. Functional Description ---------------------- Claims Tracking: ---------------- The Claims Tracking module of Integrated Billing is being enhanced to evaluate outpatient billable events differently. With the release of CIDC enhancements, data collection of exemptions (SC/AO/IR/EC/MST/HNC/CV) will be done at the purpose of visit (diagnosis) level. Therefore, when the nightly Claims Tracking module evaluates outpatient events to determine if they are billable the following list of items will be reviewed in this order: 1. Purpose of Visit/Diagnosis (V POV # 9000010.07 file) 2. Outpatient Event/Encounter (Visit #9000010 file) If any of the Purpose of Visit(s) for a CPT/Procedure are related to one of the exemptions, then the CPT/Procedure is considered non-billable. If there are no billable CPT/Procedures for a Visit, then the Visit is considered non-billable by Claims Tracking. When the Claims Tracking module is active for prescription billing, the software will now evaluate any exemptions that were specified for the prescription and flag the event as not billable if applicable. When the Claims Tracking module is active for prosthetic billing the software will now pick up prosthetic events at time of shipment instead of waiting for time of delivery. The patient exemptions will also be evaluated. Autobiller: ----------- The Autobiller module of Integrated Billing is being enhanced to utilize CPT/Procedure to Purpose of Visit/Diagnosis association if the association exists. When the Autobiller runs nightly and bills are created, if the association exists in the PCE package, the association will automatically be stored in the bill to assist in data entry of billing information. When a prescription bill is being created in the Autobiller the software will now populate the diagnosis code(s) associated with the prescription as specified by the clinician during the ordering process if they exist, if they do not, the default diagnosis that is currently being used will continue to be used. Enter/Edit Billing Information [IB EDIT BILLING INFO]: ------------------------------------------------------ This option is being enhanced to pick up diagnosis code(s) that were specified in the ordering process of a prosthetic device. When a prosthetic device is selected from Screen 5 the diagnosis code will be automatically added to the bill if it does not already exist. Also if a prosthetic device is flagged as being exempt for SC or one of the treatment factors a message will be displayed to the user indicating such during the selection. When a bill has prescriptions added to claim, the IB software will now automatically associate the diagnosis codes specified at time of order if they exist, if they do not exist the default diagnosis code will continue to be associated with the claim. Additionally if there is an exemption reason identified in the Outpatient Pharmacy package the list of prescriptions to add to a bill will display the first exemption reason found. When a bill has a procedure that is added to where anesthesia minutes would normally be entered, a look up of anesthesia start and stop times from the Surgery Package for the bill from/to date will be displayed for selection. Assuming one or more of the start/stop times are selected the total minutes of the selection will be automatically populated in the minutes on the bill for review by the billing staff. Screen 5, Option 3 is enhanced to display the REASON NOT BILLABLE (CLAIMS TRACKING #356 file, field #.19) if an Outpatient Encounter is already marked as not billable to assist with not selecting an outpatient visit. Screen 5, option 4 has been enhanced. Billers have the option of selecting procedures for a bill. If the bill is a professional bill and the associated diagnosis is known; the diagnosis will be automatically added to the bill if it is not already there and the diagnosis to CPT associations will be populated. Observation Start/Stop Times: ----------------------------- Observation Institutional charges require the number of hours the patient was in observation for the charge to calculate. However, in most cases the observation data is displayed in start and stop times rather than total hours. Therefore, when entering Observation procedures that require hours the following updates were made: - Displays any Observation Discharge that was discharged within 72 hours of the procedure's date. - Asks for the observation start date/time and end/date time, using the last observation discharge admit/discharge dates as the defaults. - Calculates the total hours and uses that as the Observation Procedure's Hours default. An Observation Discharge is any inpatient stay discharged from one of the following Treating Specialties: 18 NEUROLOGY OBSERVATION 23 SPINAL CORD INJURY OBSERVATION 24 MEDICAL OBSERVATION 36 BLIND REHAB OBSERVATION 41 REHAB MEDICINE OBSERVATION 65 SURGICAL OBSERVATION 94 PSYCHIATRIC OBSERVATION CIDC Question Switch: --------------------- A new parameter switch has been included to control how CIDC functions in all the applications when appropriate. A new menu option "Edit the CIDC Insurance Switch [IB CIDC INSURANCE SWITCH]" is included in this patch attached to the "System Manager's Integrated Billing Menu [IB SITE MGR MENU]." It is locked with the IB SUPERVISOR security key. The choices for the CIDC switch are: 0 = Don't ask any patients 1 = Ask for patients only with active billable insurance 2 = Ask for all patients With installation of the patch this parameter is already set to 0; Don't Ask (CIDC related questions) for any patients. Great care should be exercised when changing this option as it will effect how other CIDC related applications interact with both providers and back door users. This switch should remain in the "off" position, as delivered. Sites in VISN 10 that are testing the Patient Financial Services (PFSS) application may change the setting to best meet testing requirements of PFSS. PFSS Status Switch: ------------------- As a precursor to the PFSS project a new file PFSS SITE PARAMETERS (#372) is being added with a supported API of $$SWSTAT^IBBAPI to return the status of PFSS at the current site. The post install will automatically set the PFSS switch to off and no menu option is currently being provided to change this status as the status needs to be set to off for all sites. It is important that sites do not locally try to modify the switch status stored in the new file. A menu option will be provided in a subsequent patch when it is appropriate. Technical Description -------------------- IB20P260 is the post init routine that will set the CIDC switch to 0 during the post install process. The post init will also set the PFSS switch to OFF and record the date/time in the new PFSS SITE PARAMETERS (#372) file. This routine will automatically be deleted after the install is completed. IBBAPI is the main API entry point for applications and is being updated to include a new entry point ($$CIDC(DFN)) to allow other packages to determine if CIDC questions should be prompted for the patient. This API evaluates the switch status and the patient's current active billable insurance status. Also included is the new entry point for checking the current status of PFSS at the local site ($$SWSTAT). IBBASCI is the processing routine for the $$CIDC^IBBAPI(DFN) call. IBBASWCH is the processing routine for the $$SWSTAT^IBBAPI call. IBBDOC is updated to document the new CIDC and PFSS Status API. IBTRKR3 is being enhanced to evaluate the billing exemptions now being collected when the Claims Tracking module runs for pharmacy events and flag the appropriate reason not billable if applicable. IBTRKR41 is being enhanced to use the new billable evaluation when the claims tracking module runs evaluating outpatient events. IBTRKR5 is being enhanced to pick up prosthetic billable events at time if shipment and to use new CIDC data captured in the evaluation of those events. IBCCPT is being modified to provide the CPT to diagnosis association for when outpatient events are being looked up. IBCCPT1 is being added to provide the CPT to diagnosis association for IBCCPT and to evaluate if a certain CPT is billable or not. IBCD3 is being modified to utilize the enhanced procedure evaluation from IBCU81 and utilize the CPT to diagnosis relationship being provided by IBCCPT. IBCOPV and IBCOPV1 are being modified to display the reason not billable if one exists for an outpatient encounter in Screen 5, Option 3. IBCU81 is being modified to provide enhanced billable visit evaluation to determine if the visit is billable or not. IBCSC5B is being modified to display a billing exemption if specified and automatically populate the diagnosis code from the RECORD OF PROS APPLIANCE/REPAIR (#660) file. IBCSC5C is being modified to associate the diagnosis codes from the PRESCRIPTION (#52) file if they exist in place of the default diagnosis. If they do not exist then the default will continue to be utilized if it exists. Additionally if an exemption reason exists in the PRESCRIPTION (#52) file, the first exemption reason found will be displayed. IBCU7 is being modified to call SROMIN^IBCU74 when a procedure could have anesthesia minutes associated. Additionally it is being modified to call the new line tag OBSHOUR^IBCU74 to support the observation enhancements included. IBCU74 is being modified to include a new line tag of SROMIN. This new line tag will utilize a new Surgery API to look up anesthesia start and stop times. The time(s) selected will be populated in the minutes field of the bill. Also a new line tak of OBSHOUR is being added for the observation enhancements included. Test Sites ---------- Loma Linda, CA Cleveland, OH Dayton, OH Boston, MA Memphis, TN Charleston, SC COMPONENTS SENT WITH PATCH: --------------------------- DATA DICTIONARY CHANGES: UP SEND DATA USER DATE SEC. COMES SITE RSLV OVER FILE # NAME DD CODE W/FILE DATA PTS RIDE ------------------------------------------------------------------------------- 372 PFSS SITE PARAMETERS YES YES NO NEW GLOBAL: To assist in planning for system growth and placement of new global in your appropriate volume(s), the following information is provided. No global growth is expected with this release and installation as the file that occupies this global is static with only one entry. New estimates for the global growth will be available in future software releases. This version will require less than 1 MB of disc space. ^IBBAS - MOSTLY STATIC ROUTINE SUMMARY: ================ The following is a list of the routine(s) included in this patch. The second line of each of these routine(s) will look like: ;;2.0;INTEGRATED BILLING;**[patch list]**;21-MAR-94 CHECK^XTSUMBLD results Routine name Before Patch After Patch Patch List ============ ============ =========== ========== * IB20P260 N/A 1734948 260 IBBAPI 369261 411020 256,228,267,260 IBBASCI N/A 1591335 260 IBBASWCH N/A 6718587 260 IBBDOC 208954 211310 267,260 IBCCPT 22355407 24736464 55,62,52,91,106 125,51,148,174,182 245,266,260 IBCCPT1 N/A 7373545 260 IBCD3 14112591 14738667 14,55,52,91,106 125,51,148,160,137 210,245,260 IBCOPV 8466890 8503634 27,91,106,124,174 260 IBCOPV1 10446196 11114803 106,260 IBCSC5B 9513585 11043503 4,52,260 IBCSC5C 13593377 16183490 27,52,130,51,160 260 IBCU7 21559976 22022081 62,52,106,125,51 137,210,245,228,260 IBCU74 8920693 16856816 228,260 IBCU81 6185277 6543848 55,91,106,124,160 174,260 IBTRKR3 12752380 10362215 13,43,121,160,247 275,260 IBTRKR41 6135683 10233989 43,55,91,132,174 247,260 IBTRKR5 8601810 10733437 13,260 * Routine is automatically deleted at the completion of the install. Total number of routines - 18 OPTION: IB CIDC INSURANCE SWITCH SEND TO SITE IB SITE MGR MENU USE AS LINK FOR MENU ITEMS PARAMETER DEFINITION: IB CIDC INSURANCE CHECK SEND TO SITE NOTE: Some sites have DSS QuadraMed Interface software, if your site does not you may see "Reference to routine '^VEJDIBE1' That isn't in this UCI," when running XINDEX. This error message will not cause any problems as the software checks for the existence of the routine prior to trying to call it. SOFTWARE AND DOCUMENTATION RETRIEVAL ==================================== The software for this patch is being distributed in host file PX_CLINICAL_INDICATOR_DATA_CAPTURE.KID. The host file will contain six KIDS builds. The builds contained in the CIDC multi-package distribution are: Package Patch ------- --------- PCE PATIENT CARE ENCOUNTER PX*1.0*124 INTEGRATED BILLING IB*2.0*260 RADIOLOGY/NUCLEAR MEDICINE RA*5.0*41 SURGERY SR*3.0*119 PROSTHETICS RMPR*3.0*78 OUTPATIENT PHARMACY PSO*7.0*143 Please refer to the 'Software and Documentation Retrieval' section of the PX*1.0*124 patch description for instructions on how to acquire the patch software and install instructions. The documentation for this patch 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 File Name Description Format FTP Protocol -------------- ------------- ------- ------------ IB_20_P260_UM_CP.PDF User Manual Change Pages PDF Binary IB_P260_RN.PDF Release Notes PDF Binary Routine Information: ==================== Routine Name: - IBTRKR5 Routine Checksum: Routine Name: - IBTRKR41 Routine Checksum: Routine Name: - IBCCPT Routine Checksum: Routine Name: - IBCCPT1 Routine Checksum: Routine Name: - IBCD3 Routine Checksum: Routine Name: - IBCU81 Routine Checksum: Routine Name: - IBTRKR3 Routine Checksum: Routine Name: - IBCSC5B Routine Checksum: Routine Name: - IBCSC5C Routine Checksum: Routine Name: - IBCU7 Routine Checksum: Routine Name: - IBCU74 Routine Checksum: Routine Name: - IBCOPV Routine Checksum: Routine Name: - IBCOPV1 Routine Checksum: Routine Name: - IBBAPI Routine Checksum: Routine Name: - IBBASCI Routine Checksum: Routine Name: - IBBDOC Routine Checksum: Routine Name: - IB20P260 Routine Checksum: Routine Name: - IBBASWCH Routine Checksum: ============================================================================= User Information: Entered By : ZEIGLER,EDWARD L Date Entered : DEC 23, 2003 Completed By: LYNCH,MARY F. Date Completed: AUG 26, 2005 Released By : BOTTINI,STEVE Date Released : AUG 31, 2005 ============================================================================= Packman Mail Message: ===================== No routines included