$TXT Created by WHITE,ELAINE at LAWVAA.FO-BIRM.MED.VA.GOV (KIDS) on Monday, 04/28/03 at 10:25 ============================================================================= Run Date: JUN 03, 2003 Designation: PSO*7*123 Package : PSO - OUTPATIENT PHARMACY Priority: EMERGENCY Version : 7 SEQ #124 Status: Released Compliance Date: JUN 04, 2003 ============================================================================= Associated patches: (v)PSO*7*137 <<= must be installed BEFORE `PSO*7*123' Subject: RENEWAL/COPY NON-SERVICE CONNECTED COPAY BACK-BILLING Category: - Routine Description: ============ One site reported an excessive number of prescriptions getting automatically (incorrectly) changed at release from Copay to No Copay with a reason of "Service Connected". It was determined that this was happening because the Service Connected question does not apply for the patient anymore, but the Computerized Patient Record System (CPRS) V. 1.0 sends the Service Connected question's answer from the renewed from or copied from prescription. For non-service connected veterans, prescription fills that were flagged as Service Connected were not charged a copay when they should have been. Solution: The post-install job for patch PSO*7*137 identified potential prescription fills that should have charged a copay. The starting date for examining whether the released fills should have been charged a copay was 02/04/2002 (the date that the $7 copay amount went into effect). A post-install job for this patch will use the global created by patch PSO*7*137 to do the back-billing for the identified fills. If the global has been removed from the system, the identification portion will be done again by the post-install of this patch before doing the back-billing. A MailMan message with a subject of "Subj: Outpatient Pharmacy Copay Clean-up" will be sent to the patch installer and holders of the PSO COPAY key indicating the number of fills that were successfully billed. If any fills were billed, the MailMan message will contain information on how to print a report by patient name of prescription fills that were billed. Once the back-billing job has completed and you receive this message, if any fills were billed please run the routine RPT^PSOCPIB3 from programmers mode to generate a detailed report for retention by your facility's billing office. This report has a header of Patch PSO*7*123 - COPAY PRESCRIPTION FILLS BILLED and will list patient name, last four digits of the social security number, division, prescription, fill number, and release date. Please produce this report so that your billing office will have it as a reference to use if patients should call with questions regarding the back-billing. The information needed to generate this report will remain on your system for 90 days after the patch is installed, and then will automatically be deleted. After the install of PSO*7*123, sites should review the billed report from the patch with the Held Charges Report [IB OUTPUT HELD CHARGES] option. A comparison will provide information as to which patients have current reimbursable insurance for medication. In most cases, sites should have already billed the 3rd party insurance carrier for these medications based on the original fill date. If the site has received reimbursement for the medications that are on the billed report, then the site should release the medication copayment charge and decrease adjust as appropriate. We are working on patch PSO*7*142 which will list those patients back-billed with this patch who had prescription insurance as of the fill date of their medication. Reviewing this report will aid you in identifying patients who may need to have their medication copayment charge released. This patch will be available for testing as soon as possible. A second MailMan message with a subject of "Subj: 'institution' - AAC DATA" will be sent to the installer of the patch and back to FORUM to some outpatient pharmacy developers. The patch installer does not have to do anything with this second message. The information from the message sent back to FORUM will be compiled with messages from other sites and forwarded to the Austin Automation Center for their use in addressing a billing insert for the veterans affected by the back-billing. Associated NOISs: ================= WPB-0602-33193 DUB-1202-31426 FAR-0403-41866 Test Sites: =========== CLEVELAND, OH DUBLIN, GA EL PASO, TX SPOKANE, WA TUSCALOOSA, AL Routine Summary: ================ The second line now reads as follows: ;;7.0;OUTPATIENT PHARMACY;**[patch list]**;DEC 1997 CHECK^XTSUMBLD results: Routine Before Patch After Patch Patch List ============================================================= PSOCPIB3 N/A 24367605 123 PSOCPIB4 N/A 1963899 123 Installation Instructions: ========================== There are no restrictions on when this patch can be installed. Installation should take no longer than 5 minutes. Please do not queue the job of installing this patch. There is a post-install background job that will prompt for a date@time to run the clean up. You MUST respond with a date and time or NOW to queue the post-install job. During the installation of the patch, you may not be able to see what you are typing when answering the prompt. You will be given an opportunity to see what was entered and must confirm the date and time you selected before the clean up job queues. The post-install job should run fairly quickly if the global from patch PSO*7*137 is still on the system. If not, the post-install could take several hours. If necessary to restart the job, this post-install job can be run again at a later time by calling the entry point D ^PSOCPIB3 from programmer mode. Upon completion of the post-install job, a MailMan message with a subject of "Subj: Outpatient Pharmacy Copay Clean-up" will be sent to the patch installer and holders of the PSO COPAY key with the number of fills that were successfully billed. If any were billed, the MailMan message will include instructions on how to print a listing of patient names and prescription fills that were billed. Once the back-billing job has completed and you receive this message, if any fills were billed please run the routine RPT^PSOCPIB3 from programmers mode to generate a detailed report for retention by your facility's billing office. This report will list patient name, last four digits of the social security number, division, prescription, fill number, and release date. Please produce this report so that your billing office will have it as a reference to use if patients should call with questions regarding the back-billing. The information needed to generate this report will remain on your system for 90 days after the patch is installed, and then will automatically be deleted. A second MailMan message with a subject of "Subj: 'institution' - AAC DATA" will be sent to the installer of the patch and back to FORUM to some outpatient pharmacy developers. The patch installer does not have to do anything with this second message. The information from the message sent back to FORUM will be compiled with messages from other sites and forwarded to the Austin Automation Center for their use in addressing a billing insert for the veterans affected by the back-billing. An example of the install process is included here under the title "Example Installation". 1. Use the INSTALL/CHECK MESSAGE option on the PackMan menu. 2. Review your mapped set. If the routines are mapped, they should be removed from the mapped set at this time. 3. From the Kernel Installation & Distribution System menu, select the Installation menu. 4. From this menu, you may select to use the following options: (when prompted for INSTALL NAME, enter PSO*7.0*123) a. Backup a Transport Global - this option will create a backup message of any routines exported with the patch. It will NOT backup any other changes such as DDs or templates. b. Compare Transport Global to Current System - this option will allow you to view all changes that will be made when the patch is installed. It compares all components of the patch (routines, DDs, templates, etc.). c. Verify Checksums in Transport Global - this option will ensure the integrity of the routines that are in the transport global. 5. Use the Install Package(s) option and select the package PSO*7.0*123. 6. When Prompted "Want KIDS to INHIBIT LOGONs during the install? YES//" respond NO. 7. When Prompted "Want to DISABLE Scheduled Options, Menu Options, and Protocols? YES//" respond NO. 8. The environment check routine will now prompt the installer of the patch for a date@time to run the post-install job. If no start date and time is entered when prompted, the job will be queued to run NOW. 9. If Routines were unmapped as part of step 2, they should be returned to completion. EXAMPLE INSTALLATION: ===================== Select Installation Option: 6 Install Package(s) Select INSTALL NAME: PSO*7.0*123 Loaded from Distribution 4/16/03@22:43:27 => PSO*7*123 This Distribution was loaded on Apr 16, 2003@22:43:27 with header of PSO*7*123 It consisted of the following Install(s): PSO*7.0*123 Checking Install for Package PSO*7.0*123 Install Questions for PSO*7.0*123 Want KIDS to INHIBIT LOGONs during the install? YES// NO Want to DISABLE Scheduled Options, Menu Options, and Protocols? YES// NO Install Started for PSO*7.0*123 : Apr 16, 2003@22:44:01 Build Distribution Date: Apr 16, 2003 Installing Routines: Apr 16, 2003@22:44:01 Running Post-Install Routine: ^PSOCPIB3 Clean up for unbilled, released NON-SERVICE CONNECTED prescription fills. If no start date/time is entered when prompted, the background job will be queued to run NOW. At the following prompt, enter a starting date@time or enter NOW to queue the job immediately. If this prompting is during patch installation, you will not see what you type. PSO*7.0*123 -------------------------------------------------------------------------- ------ Queue copay clean-up Job to run Date@Time: N Task will be queued to run NOW Task will be queued to run NOW. Is that correct? :Y Queuing background job to reprocess unbilled NON-SERVICE CONNECTED fills... Task Queued ! Updating Routine file... Updating KIDS files... PSO*7.0*123 Installed. Apr 16, 2003@22:44:09 Install Message sent #169628 -------------------------------------------------------------------------- ------ [------------------------------------------------------------] 100% | 25 50 75 | Complete [------------------------------------------------------------] Install Completed Routine Information: ==================== Routine Name: - PSOCPIB4 Routine Checksum: Routine Name: - PSOCPIB3 Routine Checksum: ============================================================================= User Information: Entered By : WHITE,ELAINE Date Entered : OCT 03, 2002 Completed By: DAVIS,DOUG Date Completed: JUN 03, 2003 Released By : KIMBLE,BRUCE Date Released : JUN 03, 2003 ============================================================================= Packman Mail Message: ===================== $END TXT