$TXT Created by ZEIGLER,EDWARD L at MNTVBB.FO-ALBANY.MED.VA.GOV (KIDS) on Tuesday, 08/16/05 at 16:12 ============================================================================= Run Date: OCT 20, 2005 Designation: IB*2*317 Package : IB - INTEGRATED BILLING Priority: Mandatory Version : 2 SEQ #283 Status: Released Compliance Date: NOV 20, 2005 ============================================================================= Associated patches: (v)IB*2*210 <<= must be installed BEFORE `IB*2*317' (v)IB*2*249 <<= must be installed BEFORE `IB*2*317' Subject: CLAIMS TRACKING ENHANCEMENT Category: - Routine - Input Template - Data Dictionary - Print Template - Enhancement (Mandatory) Description: ============ This is an enhancement to the Integrated Billing (IB) Claims Tracking Module. The IB Claims Tracking Module is used to capture Episodes of Care for the purpose of determining if the encounters can be billed. The Episode Data is collected through several different processes. Certain events, such as admissions, are captured in real time. Other events, such as Outpatient Encounters, are captured through a sweeping process that runs daily in the background. Coding Clerks or Coders review the entries in the Claims Tracking File and determine if they should be billed. This enhancement will allow the Coder to enter additional data that will streamline the billing process. The Billing Clerks will be able to see what action was previously taken on an event: when it was taken, and the coder that took the action. This will institute a more efficient follow-up process. Functional Description ---------------------- The editing of entries in Claims Tracking has been enhanced to provide new prompts for data capture. The new prompts allow for input of multiple Billable Findings. Billable Findings are possible adjustments to the coding of an event that may change the results when the claim is actually billed to the Insurance Carrier. Possible choices for Billable Findings are: 1 NO CHANGE 2 UPCODED 3 DOWNCODED 4 WRONG CPT CODE 5 WRONG DIAGNOSIS CODE 6 SC TO NSC 7 NSC TO SC 8 BILL INSTITUTIONAL ONLY 9 WRONG PROVIDER 10 NO INPT PRO FEES 11 BILLER CONTACT UR 12 OLD INCORRECT SC/NSC 13 CODES ADDED 14 E&M CODES LEVEL 1&2 UNREVIEWED 15 LAB/XRAY 16 BILL TC ONLY 17 RESEQUENCED CODES 18 NO REVIEW DONE Claims Tracking Edit [IBT EDIT BI TRACKING ENTRY] ------------------------------------------------- When the user selects a Claims Tracking Event using View/Edit Episode (VE), Claims Tracking Edit will now display any Billable Findings under the Billing Information Section. When the user selects the Billing Info Edit (BI) Option, they will be able to enter/edit the Billable Findings. Along with the entry of the Billable Findings is the availability of three new reports. The reports are: Un-reviewed Claims for Coders Report [IBT UNREVIEWED CODING REPORT] ------------------------------------------------------------------- This new report is designed to be run by coding staff to determine which Claims Tracking Events still require review. The new report is added to a new menu named CODING VALIDATION MENU[IBT UNREVIEWED CODING REPORT], selected from the PATIENT BILLING REPORTS [IB OUTPUT PATIENT REPORT MENU] Menu. Users will be prompted for the OUTPATIENT ENCOUNTER START DATE and OUTPATIENT ENCOUNTER END DATE. Entered/Not Reviewed Report [IBT ENTERED NOT REVIEWED] ------------------------------------------------------ This new report will allow the MCCF Staff to identify encounters that have been: 1. Reviewed by the coders and are ready to bill (indicated by a non-blank findings type); and 2. Not reviewed by the coders (indicated by a blank findings type). The report prints all Outpatient Reimbursable Insurance Claims in the BILL/CLAIMS (#399) file with a status of Entered/Not Reviewed. Users will be prompted for the Event Date Range. The new report is added to a new menu named CODING VALIDATION MENU, selected from the PATIENT BILLING REPORTS Menu. Quick Review Coding Status Report [IBT QUICK REV CODING STAT] ------------------------------------------------------------- This new report provides the MCCF Staff ability to select a specific patient to see the status of the patient's claims so that they know at a glance whether or not they are ready for billing. Users will be able to specify a patient and an Encounter Date Range. The new report is added to a new menu named CODING VALIDATION MENU, selected from the PATIENT BILLING REPORTS Menu. Technical Description --------------------- A new file, CLAIMS TRACKING BILLABLE FINDINGS (#356.85), is being exported with this patch that is pre-populated with the entries listed in the Functional Description. Along with this new file, 6 new fields are being added to the CLAIMS TRACKING (#356) File. Most of the new fields are automatically populated based on a user's input choices utilizing the updated input template [IBT BILLING INFO]. IBBFAPI is being updated. During testing of this software, there was an issue found in this routine that prevented it from making the proper determination of what an insurance policy will cover. This incorrect determination can be used by any other application since it is part of a supported API Call in the IB Package. IBTOECT is being added as a new routine to support two of the report options included in this patch. IBTRED0 has been enhanced to display the Billable Findings, if any. Test Sites: ----------- Memphis Tennessee Valley Lexington ================ INSTALLATION INSTRUCTIONS ================= This patch can be installed at any time with minimal interruptions to users. 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. 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 ============ ============ =========== ========== IBBFAPI 10006809 10015619 267,297,249,317 IBTOECT n/a 16627638 317 IBTRED0 9111836 10072792 160,210,317 Total number of routines: 3 UP SEND DATA USER DATE SEC. COMES SITE RSLV OVER FILE # NAME DD CODE W/FILE DATA PTS RIDE -------------------------------------------------------------------------- 356 CLAIMS TRACKING YES NO NO NO Partial DD: subDD: 356 fld: 2.01 fld: 2.02 fld: 2.03 fld: 2.04 fld: 2.05 subDD: 356.03 DATA SCREEN: 356.85 CLAIMS TRACKING BILLABLE FINDINGSYESYES YES OVER NO NO PRINT TEMPLATE: IBT QUICK REV CODING STAT FILE #356 SEND TO SITE INPUT TEMPLATE: IBT BILLING INFO FILE #356 SEND TO SITE OPTION: IB OUTPUT PATIENT REPORT MENU USE AS LINK FOR MENU ITEMS IBT CODING VALIDATION MENU SEND TO SITE IBT ENTERED NOT REVIEWED SEND TO SITE IBT QUICK REV CODING STAT SEND TO SITE IBT UNREVIEWED CODING REPORT SEND TO SITE 3. 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: 4. Select Installation Option: --------------------------- NOTE: The following are OPTIONAL - (When prompted for the INSTALL NAME, enter IB*2.0*317): 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. 5. 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 NO 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 YES e. When prompted 'Enter options you wish to mark as 'Out Of Order':', enter the following option: Claims Tracking Edit [IBT EDIT BI TRACKING ENTRY] f. When prompted 'Enter protocols you wish to mark as 'Out Of Order':', press . Routine Information: ==================== Routine Name: IBBFAPI Routine Name: IBTOECT Routine Name: IBTRED0 ============================================================================= User Information: Entered By : ZEIGLER,EDWARD L Date Entered : JUN 13, 2005 Completed By: LYNCH,MARY F. Date Completed: OCT 20, 2005 Released By : NEWLIN,JARED Date Released : OCT 20, 2005 ============================================================================= Packman Mail Message: ===================== $END TXT