$TXT Created by ADES,ROBERT at MNTVBB.FO-ALBANY.MED.VA.GOV (KIDS) on Thursday, 08/31/06 at 10:54 ============================================================================= Run Date: OCT 06, 2006 Designation: IB*2*355 Package : IB - INTEGRATED BILLING Priority: Mandatory Version : 2 SEQ #320 Status: Released Compliance Date: NOV 06, 2006 ============================================================================= Associated patches: (v)IB*2*334 <<= must be installed BEFORE `IB*2*355' Subject: REASONABLE CHARGES UPDATE V2.7 Category: - Routine Description: ============ *********************** Please Take Note ***************************** Until the following steps are completed, the charges that are currently being used are the latest active charges. For new (v2.7) charges, you need to load the charges that come with this patch. 1) The installation of this patch from the KIDS menu (see below) will inactivate Reasonable Charges V2.6, effective 08/24/06. This will leave the billing department with no valid charges for Event Dates after 08/24/06. 2) Then, after this patch is installed, IRM or the Billing department needs to load the new charges for each division. The effective date will be 08/25/06. Step 2 needs to be done as soon as possible after Step 1, or billing will likely have problems getting rates to drop on a claim. To facilitate this, you should have already retrieved and placed the 6 rates files noted in the UPLOAD INSTRUCTIONS portion of this document, prior to installing the patch. All of the Installation and Update instructions are contained in this patch description. ************************************************************************ Reasonable Charges version 2.7 is a charge update to the existing Reasonable Charges billed to Third Party Payers. The Integrated Billing Charge Master, and Bill/Claims functionality have been modified to support the requirements of billing with Reasonable Charges v2.7. The primary update with this patch is to the charges, which will be implemented when the new RC v2.7 charges are uploaded. Effective Date of Reasonable Charges v2.7 is 08/25/2006. The Reasonable Charge v2.6 loaded on your system will be inactivated with an inactivation date of 08/24/2006 when this patch is installed. ASSOCIATED NOIS/REMEDY: ======================= 1. HD143256 V2.7 Reasonable Charges for Medical Care of Services ASSOCIATED E3R(s): ================== N/A PARTICIPATING TEST SITES: ========================= DUBLIN, GA MONTANA HCS PHOENIX, AZ WEST PALM BEACH, FL NORTH FLORIDA/SOUTH GEORGIA NOIS/REMEDY OVERVIEW: ===================== 1. HD143256 V2.7 Reasonable Charges for Medical Care of Services Problem: -------- Changes in the national CPT rates need to be distributed to all hospitals so that proper billing can take place. Resolution: ----------- This patch updates the Reasonable Charges files and distributes them with a new version number and a new effective date. Technical Description ===================== This patch exports 6 routines, one of which is the post-init (IBYPSH). The post-init will complete the following: 1. Inactivate all existing Reasonable Charges defined in the Charge Master. Reasonable Charges v2.6 will be inactivated on 08/24/2006. The following is an example of the post-init portion of the installation. Reasonable Charges v2.7 Post-Install ..... >> Inactivating Existing Reasonable Charges, Please Wait... Done. 999999 existing charges inactivated Reasonable Charges v2.7 Post-Install Complete Note: The actual number of charges inactivated will vary based on the number of divisions billed at your site. This will also determine the time required for the installation. MULTIPLE SURGICAL PROCEDURE DISCOUNT ------------------------------------ If multiple surgical procedures from a single encounter are assigned to a bill, then a discount is applied to the Reasonable Charges facility charges. The list of procedures the Multiple Surgical Procedure Discount applies to has been changed slightly with v2.7. This is the complete list of procedures the discount is applied to in RC v2.7. Multiple Surgical Procedures in v2.7 (3578) 0008T-0017T, 0027T, 0046T-0047T, 0062T-0063T, 0071T-0072T, 0084T, 0088T, 0099T-0102T, 0120T-0137T, 10021-11976, 12001- 15851, 15876-19260, 19316-20650, 20670-20950, 20982-27087, 27097-28899, 29800-30220, 30310-31420, 31502-31615, 31622-33244, 33284-35903, 36260-36262, 36420-36425, 36468-36479, 36550- 36597, 36640-37209, 37500-38129, 38220-38221, 38300-38760, 39400-40801, 40805-42808, 42810-43750, 43760-46505, 46604-51797, 51880-53431, 53442, 53446, 53449-54385, 54406-54408, 54415, 54420-55250, 55400-58145, 58301-59030, 59070-61791, 61880, 61886-62230, 62263-62287, 62292-62365, 63001-63615, 63660-64530, 64585-65175, 65235-65426, 65435-65436, 65600-65770, 65772- 67450, 67505-67810, 67825-67935, 67950-68020, 68100-68135, 68320-68750, 68770, 68811-68815, 69000-69150, 69205, 69220- 69979, 91110-91122, 92018-92019, 92230, 92502, 92511, 92973- 92977, 92980-92998, 93501-93533, 93580-93631, 93650-93652, 95990-95991, 96521-96522, 96567-96571, 96920-96999, 97605-97606, 99170, C9724, G0105, G0121, G0127, G0166, G0186, G0247, G0260, G0290-G0291, G0297-G0300, Q0091, 0155T-0156T PRIMARY/SECONDARY BUNDLED DISCOUNT ---------------------------------- There are certain sets of procedures that are defined as primary and secondary. If both are performed, then the cost of the secondary procedure is bundled into the cost of the primary procedure. If only primary or only secondary are performed, then the full cost is billed. Beginning with RC v2.0, both primary and secondary procedures are exported with a full charge. Therefore, if both primary and secondary procedures are performed during an encounter, then the charges of each will be discounted to equal the total of the primary charge. The list of Primary/Secondary Bundled procedures has been changed slightly with v2.7. This is the complete list of procedures the discount is applied to in RC v2.7. Primary Bundled Procedures in v2.7 (5321) 0003T-0017T, 0027T, 0046T-0059T, 0062T-0064T, 0067T-0073T, 0084T-0088T, 0089T-0102T, 0106T-0110T, 0120T-0137T, 0144T- C8950, 10021-20950, 20975, 20982-27087, 27097-36262, 36420- 36522, 36550-38129, 38205-38206, 38220-55250, 55400-58145, 58301-59030, 59070-62287, 62292-64530, 64553-65770, 65772-68840, 68899-71552, 72010-72158, 72170-72197, 72200-73223, 73500- 73723, 74000-74183, 74190-74327, 74340-75891, 75894-75946, 75953-75984, 75992-75996, 76000, 76006-76080, 76086-76088, 76095-76150, 76355-76380, 76393-76936, 76940-77295, 77300-77470, 77520-77789, 77799-78264, 78270-78350, 78399-78491, 78494- 78607, 78610-78807, 78999-79999, 80500-80502, 85097, 86077- 86079, 86485-86580, 86850-86906, 86920-86932, 86945-86999, 88104-88125, 88160-88162, 88172-88173, 88182-88189, 88299-88368, 88384-88386, 89049, 89100-89105, 89130-89141, 89220, 89230, 89250-89291, 89335-89356, 90375-90376, 90396, 90636, 90675- 90676, 90714-90716, 90734, 90772-90773, 90779-90870, 90880- 90899, 90911, 90935, 90945, 91000-92014, 92018-92502, 92511- 92520, 92541-92548, 92552-92557, 92561-92588, 92596, 92601- 92604, 92620, 92625-93005, 93017-93313, 93315-93316, 93318- 93533, 93571-93662, 93701-93745, 93786-94750, 94770-95117, 95144-95250, 95805-95829, 95857-96103, 96110-96154, 96401-96402, 96416, 96521-96522, 96567-96900, 96910-96999, 97605-97606, 98925-98942, 99170, 99190-99195, 99201-99215, 99241-99291, 99431-99440, A4642, A9500-D6920, A9502-A9600, A9507-A9605, A9508, A9517-A9524, A9526-C8920, A9535-C9725, C1178-C9003, C8900-C8914, C8952-C8954, C8957-C9228, C9121-D7261, C9220- C9716, C9723-Q9964, D0240-D0460, D0277, D1510-D9952, G0008- G0009, G0101-G0106, G0117-G0118, G0120-G0121, G0127, G0130, G0166, G0173-G0175, G0186, G0237-J0587, G0245-G0257, G0260, G0267-G0268, G0288-G0294, G0297-G0305, G0339-J0215, G0344- G0367, G0375-G0376, G0378-G0379, J0128-J7518, J0130-J0150, J0180, J0205, J0207, J0256, J0287-J0289, J0350, J0395, J0585, J0637, J0850, J1190, J1327-J1745, J1330, J1440, J1441, J1565-J1626, J1785, J1830, J1950, J2020, J2353, J2355-J9151, J2430, J2505-J2783, J2788, J2790, J2820, J2941-J7193, J2993-J2997, J2995, J3100, J3240, J3305, J3315-J7317, J3365, J3465, J7190-J7195, J7192-J9268, J7198, J7310- J7320, J7350, J7502-J7505, J7507, J7511, J7517, J7520-J8700, J8501, J8510-J8520, J8560, J9001-J9357, J9010-J9040, J9015, J9017, J9031- D4268, J9035-J9305, J9045-J9293, J9065-J9245, J9098-J9395, J9130, J9150-J9170, J9200, J9201-J9600, J9211-J9216, J9219, J9270-J9280, J9300-J9350, J9390, M0064, P9010-P9023, P9031-P9044, P9045- P9050, P9051-P9060, Q0035, Q0091, Q0166, Q0180, Q2009-Q2017, Q3025, Q9945-Q9957, Secondary Bundled Procedures in v2.7 (478) 0028T, 0042T, 0044T, 0045T, 36400-36410, 36540, 38204, 55300, 62291, 68850, 74328-74330, 75893, 75989, 75998, 76001-76005, 76350, 76937, 77790, 78890-78891, 80103, 90385, 90389-90393, 90471-90472, 90476-90585, 90632-90634, 90645-90648, 90665, 90680-90713, 90717-90721, 90725-90727, 90733, 90735, 90749, 90940, 93012, 93314, 93317, 93555-93562, 93770, 94760-94762, 96523, 97602, 99175, 99185-99186, A4220-A4263, A4300, A4301, A4561-A4562, A4641, A9503, A9504, A9510, C1713-C2628, C1783-C1900, C8951, C8955, C9113, E0749, E0782, E0783, E0785, E0786-E0830, E1399, G0259, J0120, J0133, J0170, J0200-J0210, J0280-J0330, J0282-J2795, J0285, J0295-J1644, J0360-J0470, J0456, J0475, J0500-J0800, J0583-J2185, J0592-J0636, J0692-J0744, J0694-J0895, J0696-J1436, J0698-J3303, J0713, J0735-J1325, J0743-J3364, J0900-J1180, J1051-J2501, J1200-J1320, J1380-J1410, J1435, J1450-J1460, J1570-J1630, J1631-J7506, J1645, J1650-J1800, J1655-J1835, J1742, J1840-J1940, J1956-J2271, J1960-J2010, J2060-J2410, J2354, J2440-J2780, J2543, J2597-J3265, J2725, J2800-J2810, J2910-J2950, J2916, J3000-J3070, J3105, J3120-J3230, J3250-J3350, J3360-J3490, J3411-J3415, J3475-J7599, J3485, J3486, J3530, J7030-J7130, J7197-L8614, J7308, J7342-J7633, J7500- J7501, J7515-J7516, J7674, J7799, J8530, J8600-J8610, J9000, J9050-J9060, J9070, J9093, J9100, J9120, J9165, J9181, J9190, J9212, J9230-J9250, J9266, J9360-J9370, J9999, L8603, L8606, L8630-L8670, L8699, P9612-Q0164, P9615-R0076, Q0092, Q0167, Q0169, Q0171, Q0173-Q0175, Q0177, Q0179, Q2004, Q3001, Q3031, V2630-V2632, V2790 ================INSTALLATION INSTRUCTIONS ================= This patch can be installed with users on the system, however two options will need to be disabled (see step 4). Install Time - less than 30 minutes. This time will vary from site to site depending on the size of the Charge Item (#363.2) file. Loading the Charge Master (step 4 of the Upload process) is separate from the patch installation and will take additional time per division. 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 3. Select Installation Option: --------------------------- NOTE: The following are OPTIONAL - (When prompted for the INSTALL NAME, enter IB*2.0*355): 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. 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: Enter/Edit Billing Information [IB EDIT BILLING INFO] Load Host File into Charge Master [IBCR HOST FILE LOAD] 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: IBYPSH 6. UPLOAD REASONABLE CHARGES V2.7 ------------------------------ Follow the instructions below. RC Version 2.7 UPLOAD INSTRUCTIONS ================================== After patch installation, the RC v2.7 (Reasonable Charges v2.7) charges for each division billed at a site will need to be loaded into the Charge Master. The charges for each Division will require approximately 1.8 - 2.0 MB of disk space. Other files will be searched, but the updates will be made to the Charge Item (#363.2) file. Files Required for Upload: ========================== The charge files are available on the following CIO Field Offices' Anonymous.Software directories. Use the appropriate FTP capability to retrieve the files (ASCII). ============================================================================= OI FIELD OFFICE FTP ADDRESS DIRECTORY =============== =========== ========= ALBANY ftp.fo-albany.med.va.gov anonymous.software HINES ftp.fo-hines.med.va.gov anonymous.software SALT LAKE ftp.fo-slc.med.va.gov anonymous.software FIRST AVAILABLE SERVER download.vista.med.va.gov anonymous.software The Reasonable Charge v2.7 Host Files, effective 08/25/06: IBRC0608A.TXT Inpatient Facility Charges (DRG) IBRC0608B.TXT Facility Charge (CPT) IBRC0608C.TXT Physician Charges (CPT) IBRC0608D.TXT Service Category Codes IBRC0608E.TXT Area Factors IBRC0608F.TXT Site Identification Upload Steps: ============= Step 1: Get Host Files ----------------------- Retrieve the 6 Reasonable Charges v2.7 Host Files in ASCII format (see previous section). Step 2: Determine Divisions ---------------------------- Use the Print Charge Master [IBCR REPORTS FOR CHARGE MASTER] option and print the Billing Regions report to find which Billing Regions and Divisions have charges loaded onto your system. These are the divisions that will need new charges loaded. Step 3: Begin Upload Process ----------------------------- Use the Load Host File into Charge Master [IBCR HOST FILE LOAD] option to load Reasonable Charges onto your system for every division for which care is billed at your site. Carefully follow the instructions below, for each Billing Region. You will see the prompt: 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 Below, in more detail, the steps will guide you through the process of selecting first 1.3, then 3, then 4, and waiting until 4 stops before continuing on to the next division (and capturing or printing all output for future reference). Step 4: Load the Reasonable Charges --------------------------------------- From the menu, select option 1.3 - Load RC into XTMP This loads the Host Files into temporary storage and calculates charges for individual Divisions. - If there are no previously existing host files loaded, it will ask which version of Reasonable Charges to load. Select 2.7 - When loading Reasonable Charges v2.7, the IBRC0608x.TXT files may be used for multiple divisions without reloading. - If there exist any previously calculated charges (files) for a division, they will be displayed, and you will get the prompt: The above files already exist in XTMP. Delete the above files and continue with upload? Select Yes to delete the previously calculated charges. - If there exist any previously loaded host files for any RC version, they will be displayed, and it will ask if they should be deleted. Select No if the files are IBRC0608x.TXT since these are the correct files for v2.7 and you would not want to delete them. Select Yes only if the files are from a different version. - Select Division: Select the division number to load charges for. This should correspond to the Divisions associated with the Billing Regions determined previously. Once the correct division is selected, answer Yes to Calculate Charges. Step 5: Check Data Validity -------------------------------------- This is optional, but it is suggested that it be run at least once, for the first division loaded. From the menu, select option 3 - Check Data Validity. If the resulting report has any Line Data Errors, then check that the latest version of CPT and DRG has been installed. The Error key at the end of the report does not mean that errors have occurred. It simply provides definitions of the types of errors that might occur. Check the individual line items in the report to see if any of the listed errors have been detected. Step 6: Load into Charge Master ------------------------------------------ From the menu, select option 4 - Load into Charge Master Moves the charges calculated in selection 1.3 to permanent storage in the Charge Master. The results report should match the examples below. It is important that this option completes before continuing. Allow the upload of a division's charges to finish before attempting to upload another division. A summary report will be printed when the upload is complete. This option uses the same temporary files to calculate the charges for all divisions, therefore they must be calculated and loaded serially. Step 7: Repeat steps 4-6 for each Division needed ------------------------------------------------- Steps 4-6 must be repeated for each division billed at your site. Refer to the Divisions that already have charges assigned using the Billing Region Report list determined previously. In most cases, simply using the above options for loading Reasonable Charges will result in the correct set up in the Charge Master. - Option 1.3, selection 2, to calculate RC v2.7 charges for a division - Option 4, to load those calculated charges into the Charge Master permanent files. However, if you are loading charges for a new site, or a site that may have changed it's division number, then extra care is needed to ensure the setup of the Charge Master is correct. The following sections provide some additional information about the upload. ================ Reasonable Charges v2.7 Upload Information ============== The Charge Host Files should load with the following counts: IBRC0608A.TXT RC v2.7 Host File Upload, 8/29/06@17:46 by DAWSON,TIM 525 IBRC0608B.TXT RC v2.7 Host File Upload, 8/29/06@17:46 by DAWSON,TIM 5695 IBRC0608C.TXT RC v2.7 Host File Upload, 8/29/06@17:47 by DAWSON,TIM 13769 IBRC0608D.TXT RC v2.7 Host File Upload, 8/29/06@17:48 by DAWSON,TIM 30 IBRC0608E.TXT RC v2.7 Host File Upload, 8/29/06@17:48 by DAWSON,TIM 915 IBRC0608F.TXT RC v2.7 Host File Upload, 8/29/06@17:49 by DAWSON,TIM 840 Any division that provides Inpatient Care should result in a summary with the following counts: Subfile Item Count Charge Set ------- ---- ----- ------------------------- 1 Inpt Fac 1 CPT 12 RC-INPT FAC PR 552 2 Inpt Fac 2 CPT 7 RC-INPT FAC HR 552 3 Inpt Fac 4 CPT 5 RC-INPT FAC ML 552 4 Inpt Fac/Phys 1 CPT 2109 RC-INPT FAC PR 552 5 Inpt PD Anc DRG 524 RC-INPT ANC 552 6 Inpt PD Anc ICU DRG 524 RC-INPT ANC ICU 552 7 Inpt PD R&B DRG 524 RC-INPT R&B 552 8 Inpt PD R&B ICU DRG 524 RC-INPT R&B ICU 552 9 Inpt Phys 1 CPT 7341 RC-PHYSICIAN INPT PR 552 10 Inpt Phys 3 CPT 272 RC-PHYSICIAN INPT MN 552 11 Opt Fac 1 CPT 5682 RC-OPT FAC PR 552 12 Opt Fac 2 CPT 7 RC-OPT FAC HR 552 13 Opt Fac 4 CPT 5 RC-OPT FAC ML 552 14 Opt Fac/Phys 1 CPT 4613 RC-OPT FAC PR 552 15 Opt PD PHosp MISCE 1 RC-OPT MISC 552 16 Opt Phys 1 CPT 7361 RC-PHYSICIAN OPT PR 552 17 Opt Phys 3 CPT 271 RC-PHYSICIAN OPT MN 552 18 SNF Fac 1 CPT 5450 RC-SNF FAC PR 552 19 SNF Fac 2 CPT 7 RC-SNF FAC HR 552 20 SNF Fac 4 CPT 5 RC-SNF FAC ML 552 21 SNF Fac/Phys 1 CPT 3607 RC-SNF FAC PR 552 22 SNF PD INC BEDSE 2 RC-SNF INC 552 23 SNF Phys 1 CPT 7379 RC-PHYSICIAN SNF PR 552 24 SNF Phys 3 CPT 272 RC-PHYSICIAN SNF MN 552 Any Provider based division that provides Outpatient Care should result in a summary with the following counts: Subfile Item Count Charge Set ------- ---- ----- ------------------------- 1 Opt Fac 1 CPT 5682 RC-OPT FAC PR 552GA 2 Opt Fac 2 CPT 7 RC-OPT FAC HR 552GA 3 Opt Fac 4 CPT 5 RC-OPT FAC ML 552GA 4 Opt Fac/Phys 1 CPT 4613 RC-OPT FAC PR 552GA 5 Opt PD PHosp MISCE 1 RC-OPT MISC 552GA 6 Opt Phys 1 CPT 7361 RC-PHYSICIAN OPT PR 552GA 7 Opt Phys 3 CPT 271 RC-PHYSICIAN OPT MN 552GA Any division with Non-Provider Based Freestanding Care should result in a summary with the following counts: Subfile Item Count Charge Set ------- ---- ----- ------------------------- 1 FS Phys 1 CPT 13468 RC-PHYSICIAN FS PR 552GB 2 FS Phys 3 CPT 272 RC-PHYSICIAN FS MN 552GB 3 FS Phys/Add 00 1 CPT 927 RC-PHYSICIAN FS PR 552GB 4 FS Phys/Opt 1 CPT 259 RC-PHYSICIAN FS PR 552GB 5 FS Phys/Opt 4 CPT 5 RC-PHYSICIAN FS ML 552GB 6 FS Phys/Opt TC 1 CPT 19 RC-PHYSICIAN FS PR 552GB ========================================================================= ROUTINE SUMMARY =============== 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 ------- ------------ ----------- ---------- IBCRBCA1 17585398 20639187 245,270,298,334,355 IBCRBCAP 22274506 22496140 270,298,334,355 IBCRBCAR N/A 11497797 355 IBCRHBRV 23214848 23900027 148,169,245,270,285,298,325, 334,355 IBCRHBV1 2255506 3280168 334,355 IBYPSH N/A 4426947 355 Number of Routines = 6 Routine Information: ==================== The checksums below are new checksums, and can be checked with CHECK1^XTSUMBLD. Routine Name: IBCRBCA1 Before: B48550766 After: B59262500 **245,270,298,334,355** Routine Name: IBCRBCAP Before: B50459320 After: B51182194 **270,298,334,355** Routine Name: IBCRBCAR Before: n/a After: B18065635 **355** Routine Name: IBCRHBRV Before: B74260469 After: B75569293 **148,169,245,270,285,298,325, 334,355** Routine Name: IBCRHBV1 Before: B3148819 After: B4955402 **334,355** Routine Name: IBYPSH Before: n/a After: B8381474 **355** ============================================================================= User Information: Entered By : ADES,ROBERT Date Entered : JUL 12, 2006 Completed By: DAWSON,TIM Date Completed: OCT 05, 2006 Released By : BOTTINI,STEVE Date Released : OCT 06, 2006 ============================================================================= Packman Mail Message: ===================== $END TXT