============================================================================= Run Date: OCT 29, 2004 Designation: PRCA*4.5*138 Package : PRCA - ACCOUNTS RECEIVABLE Priority: Mandatory Version : 4.5 SEQ #194 Status: Released Compliance Date: NOV 29, 2004 ============================================================================= Associated patches: (v)PRCA*4.5*49 <<= must be installed BEFORE `PRCA*4.5*138' (v)PRCA*4.5*136<<= must be installed BEFORE `PRCA*4.5*138' (v)PRCA*4.5*172<<= must be installed BEFORE `PRCA*4.5*138' (v)PRCA*4.5*208<<= must be installed BEFORE `PRCA*4.5*138' (v)PRCA*4.5*220<<= must be installed BEFORE `PRCA*4.5*138' Subject: Medicare Supplemental Receivables Category: - Routine - Data Dictionary - Informational Description: ============ VHA has historically had a problem estimating its true accounts receivable because most receivables are overstated when they are established. Due to this problem of overstatement, Congress and other oversight authorities have extreme difficulty trying to assess the amount that is actually owed to the VHA. To assist with accurate reporting of receivable amounts, changes have been made to capture adjustments returned by Medicare payer. These amounts are determined through the MRA (Medicare Remittance Advice) project and passed to the Accounts Receivable application. These adjustments account for 1. the portions of the claim that extend beyond the amount of the bill that is approved for reimbursement by Medicare ( Contractual Adjustments) 2. the actual amount that Medicare would have paid on the claim, if Medicare reimbursed VHA (Unreimbursable Medicare expense) Only secondary claim amounts will be reported to the AR module. No MRA request claims will be reported. Functional Description ---------------------- IB passes two data elements to AR to be captured; the Medicare Contractual Adjustment and the Unreimbursable Medicare Expense. The value of the ORIGINAL AMOUNT field (#3) in the ACCOUNTS RECEIVABLE file (#430) becomes the original total of the bill and is sent to MEDICARE minus the values of these two new data elements. These two new fields are sent from IB to AR at the time when the secondary claim (from MRA Request) is authorized. They are displayed on the Profile of Accounts Receivable and the Full Account Profile. As a result of the change to the ORIGINAL AMOUNT (#3) field in the ACCOUNTS RECEIVABLE file (#430), the auto-verify logic within the EDI Lockbox Worklist had to be changed to check the payer's reported amount of the claim against the total of the ORIGINAL AMOUNT field (#3) plus the values in the 2 new fields instead of just checking the ORIGINAL AMOUNT field alone. Technical Description --------------------- IB passes two variables, as part of the PRCASV array, to REL^PRCASVC so that AR can capture them; the Medicare Contractual Adjustment and the Unreimbursable Medicare Expense. The routines PRCADR1 and PRCAATR have been modified to print Medicare Contractual Adjustment and Unreimbursed Medicare Expense. The routine PRCASVC has been modified to allow for capture and storing of the two New data elements that are passed from IB. The routine RCDPEV has been modified to use the new logic for calculating the VistA original bill amount to match to the original billed amount from the payer (on the ERA) for auto-verification of EEOB data within the ERA Worklist. ================INSTALLATION INSTRUCTIONS ================= Please see the INSTALLATION INSTRUCTIONS section of IB patch IB*2.0*155. This patch is being distributed in a host file. The host file will contain two KIDS builds. The first build will be for the Integrated Billing patch IB*2.0*155, and the second build will be for the Accounts Receivable patch PRCA*4.5*138. ROUTINES SENT WITH PATCH -------------------------- 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: ;;4.5;Accounts Receivable;**[patch list]**;Mar 20, 1995 CHECK^XTSUMBLD results Routine name Before Patch After Patch Patch List ============ ============ =========== ========== PRCAATR 8946327 9740630 36,104,172,138 PRCADR1 10994768 11808632 49,138 PRCASVC 6286072 6806057 1,21,48,90,136 138 RCDPEV 13879790 14255047 208,138 RCRJRBD 10047529 14222687 101,139,170,193,203 215,220,138 RCRJRBDR 20545698 24572724 101,139,170,191,203 215,220,138 RCRJRBDT 8366895 9957389 101,170,191,138 RCRJRCOC 14782156 18034082 156,170,182,203,220 138 RCRJRCOR 15599832 16801899 68,96,139,103,156 170,174,191,220,138 RCXFMSSV 12246711 12841034 96,101,135,139,98 156,170,191,203,220 138 Total number of routines: 10 New routines: 0 Modified routines: 10 Routine Information: ==================== Routine Name: - PRCASVC Routine Checksum: Routine Name: - PRCAATR Routine Checksum: Routine Name: - PRCADR1 Routine Checksum: Routine Name: - RCRJRBD Routine Checksum: Routine Name: - RCRJRBDR Routine Checksum: Routine Name: - RCRJRBDT Routine Checksum: Routine Name: - RCRJRCOC Routine Checksum: Routine Name: - RCRJRCOR Routine Checksum: Routine Name: - RCXFMSSV Routine Checksum: Routine Name: - RCDPEV Routine Checksum: ============================================================================= User Information: Entered By : BARRICK,DENISE Date Entered : FEB 23, 1999 Completed By: GUSTAFSON,ERIC S Date Completed: OCT 29, 2004 Released By : JACKSON,SHERYL Date Released : OCT 29, 2004 ============================================================================= Packman Mail Message: ===================== No routines included