$TXT Created by NAPOLIELLO,GREG at DAYT17.FO-BAYPINES.MED.VA.GOV (KIDS) on Wednesday, 10/12/05 at 09:56 ============================================================================= Run Date: OCT 19, 2005 Designation: PSO*7*217 Package : PSO - OUTPATIENT PHARMACY Priority: EMERGENCY Version : 7 SEQ #191 Status: Released Compliance Date: OCT 21, 2005 ============================================================================= Subject: Outpatient Pharmacy Automated Refill Back Billing Category: - Routine Description: ============ This patch will allow for Outpatient Pharmacy Copay back-billing for refills that were completed through the Outpatient Pharmacy Automated Interface (OPAI v2.4) two way interface only. Executing the back-billing process is optional when installing this patch. Each site can determine if they would be better suited to run this automated back-bill process or correct them manually. If you answer N (No) to running the back-billing and later change your mind and would like to run the back-billing, then you must re-install the patch. This patch will re-examine the Prescription file (#52) for refills that qualify to be back-billed and then bill them. A Mailman message will be sent at the conclusion with a summary of the billing and you may manually run a detailed report option at that point. The data will be stored in the ^XTMP("PSOCPBK3") global for 90 days, and the data will be purged after this time period. Remedy Overview: =============== 1. HD113243 Back Billing of missed RX Copays Problem: -------- When using the new OPAI interface and a refill is dispensed by an External dispensing machine and auto-release is enabled, Co-pays are not being billed. The fill # variable used by the Co-pay Logic was not being initialized and therefore was not billed. Resolution: ----------- Patch PSO*7*209 was released to correct the problem and patch PSO*7*215 produced a Tally report of the unbilled automated refills. This patch re-runs the same logic in PSO*7*215 to determine what refills should be billed and then bills them. Associated Remedy Ticket: ========================= HD113243 Back Billing of missed RX Copays Associated E3R(s): ================== N/A Technical Detail: ================= Features of this patch: 1. Prompts at install whether to run the Back-Bill process. 2. Summary mailman messages. 3. Detailed Results Report by Veteran can be run from Programmer mode. 4. Query Status of job while it is running. 5. Stop Job command. * See samples section below for images of these features. 1. The Back-Bill process will produce a summary mail message of its findings and display instructions on how to print a detailed report by Veteran. This MailMan message will be sent to all users that hold the 'PSO COPAY' security key and the installer of the patch. A summary management mailman message, with the billing results by year and 30, 60, and 90 day fills, will be sent back to individuals to facilitate Management spreadsheet creation. A third mail mailman message will also be sent to Management who will cut and paste this information into a .TXT file to send to AAC personnel, in Austin, for letter generation. 2. A detailed report by Veteran and refill number can be produced on demand by entering D RPT^PSOCPBK4 at the programmer prompt. Reviewing this report will aid you in identifying patients who may need to have their medication copayment charge released. 3. To check the status of the back-billing background job while it is running, then type from the direct programmers prompt the command D STATUS^PSOCPBK3. 4. If you need to stop the back-billing background job for any reason, then from the direct programmers prompt, type the command D STOP^PSOCPBK3. SAMPLES SECTION: ================ SUMMARY MAIL MESSAGE 1 (Overall patch findings) ---------------------- Subj: Outpatient Pharmacy Back Bill [#1174] 09/02/05@11:07 18 lines From: PSO*7*217 BACK BILL In 'IN' basket. Page 1 ---------------------------------------------------------------------- The Rx copay Back Bill job for the Outpatient Pharmacy patch (PSO*7*217) started SEP 14, 2005@13:18:01 and completed SEP 14, 2005@13:38:15. Auto-Released refills have now been Billed There were 4 fills successfully Billed for 3 veterans. Fills back-billing by year: 2004 30-DAY EQUIVALENT FILLS: 0 $ 0 2004 60-DAY EQUIVALENT FILLS: 0 $ 0 2004 90-DAY EQUIVALENT FILLS: 0 $ 0 2005 30-DAY EQUIVALENT FILLS: 3 $ 21 2005 60-DAY EQUIVALENT FILLS: 0 $ 0 2005 90-DAY EQUIVALENT FILLS: 1 $ 21 ========== TOTAL $ 42 To get a report of patients/prescriptions that were billed as part of this Back Billing, enter D RPT^PSOCPBK4 at the programmer's prompt The below message will be sent to Eric Williamson to facilitate management spreadsheets. SUMMARY MAIL MESSAGE 2 ---------------------- Subj: STATION 442 (Prod) BACK BILLED COPAYS FOR PRESCRIPTION REFILLS [#3240] 09/14/05@13:38 16 lines From: PSO*7*217 BACK BILL In 'IN' basket. Page 1 -------------------------------------------------------------------------- Start time: Sep 14, 2005 1:18:01 pm Completed time: Sep 14, 2005 1:38:15 pm Elapsed Time: 20:14 Total RX's processed: 272,939 Total Refills processed: 48,854 Total billable refills: 4 Total billable vets: 3 Excel comma delimited data below, Two heading, one data line Station,Station,,2004,,,2005 Name,#,30 days,60 days,90 days,30 days,60 days,90 days CHEYENNE VAMC,442,0,0,0,3,0,1 This below message will be sent to Eric Williamson to facilitate management spreadheeets. SUMMARY MAIL MESSAGE 3 ---------------------- Subj: 442 (Prod) - BACK BILLED COPAYS AAC DATA [#1175] 09/02/05@11:07 18 lines From: PSO*7*217 BACK BILL In 'IN' basket. Page 1 ---------------------------------------------------------------------- 442^1234ADAM 442^4567AEKI 442^4321BEDF 442^9876BROW 442^7656CHAN 442^8876DEDM DETAILED REPORT --------------- This report shows the patient and the auto-released prescription refill that was unbilled and has subsequently been billed by this patch. The far two columns are patient's prescription insurance status on the release date of the refill and also on the back-billing date. ** sample ** Patch PSO*7*217 -COPAY PRESCRIPTION REFILLS Back Billing Date printed: SEP 2, 2005 Page: 1 ========================================================================== INS ON DTE PATIENT NAME (SSN) DIV RX# (FILL) RELEASE DATE REL BILL -------------- ------- -------------- ----------- ------------ ---- ---- ATEST1,JEANETT (A1737) FORT COLLINS C 1234567 (2) OCT 25,2004 NO NO ATEST2,JAMES (A7773) CHEYENNE VAM& 2345678 (2) MAR 2,2005 NO NO ATEST3,GOLDEN (A4795) GREELEY CLINIC 9876543 (1) NOV 15,2004 YES YES ATEST4,GOLDEN (A4795) GREELEY CLINIC 1111222 (1) NOV 15,2004 NO NO ATEST5,GOLDEN (A4795) GREELEY CLINIC 3333333 (1) DEC 13,2004 NO NO ATSET6,SIDNEY (A8022) CHEYENNE VAM&R 4444555 (3) JAN 7,2005 NO YES ATSET7,CLARK (A0363) CHEYENNE VAM&R 6666555 (1) JAN 4,2005 NO NO ATSET8,JOHN (A4254) CHEYENNE VAM&R 8888999 (2) DEC 7,2004 NO NO STATUS QUERY ------------ >D STATUS^PSOCPBK3 Currently processing: Released Date > 3050728.152716 RX # > 1375666 TOTAL RX's > 272906 STOP COMMAND ------------ >D STOP^PSOCPBK3 Outpatient RX Copay Back-Billing Job - set to STOP Soon Check Status to be sure it has stopped and is not running... (D STATUS^PSOCPBK3) Test Sites: =========== San Juan, PR Jackson, MS New York, NY Oklahoma City, OK Tennessee Valley HCS Alexandria, LA Charleston, SC Birmingham, AL West Palm Beach, FL Salisbury, NC New Jersey HCS Bronx, NY Minneapolis, MN Fargo, ND Togus, ME Sheridan, WY 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: ;;7.0;OUTPATIENT PHARMACY;**[patch list]**;DEC 1997 Using new logic for Integrity Checking tools: CHECK1^XTSUMBLD results Routine name Before Patch After Patch Patch List ============ ============ =========== ========== PSOCPBK3 N/A 42446579 217 PSOCPBK4 N/A 81010442 217 PSOCPBK5 N/A 31112048 217 CHECK^XTSUMBLD results Routine name Before Patch After Patch Patch List ============ ============ =========== ========== PSOCPBK3 N/A 10915066 217 PSOCPBK4 N/A 14940532 217 PSOCPBK5 N/A 10556598 217 Total number of routines - 3 Installation Instructions: ========================== ** Warning, please do not queue this patch to be installed. It has ** Install questions that need to be answered. It is recommended this patch be installed in the early morning hours of the day your sites report is scheduled to run and while no Outpatient Pharmacy users are processing orders. Installation will take less than 2 minutes, but the back-billing job may take several hours. Once the back-billing job has completed and you receive the Mailman messages defined in the above Technical Detail and Samples Sections, if any fills were billed please run the routine RPT^PSOCPBK4 from programmers mode to generate a detailed report for retention by your facility's billing office. See sample of report in above Samples Section. 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 stop command has been provided in case the system needs to be shutdown for an emergency or other reasons such as this. Then when the system is back up and you are ready you may restart the job and it will resume where it left off. You may restart by entering D ^PSOCPBK3 at the programmer's prompt. 1. Use the INSTALL/CHECK MESSAGE option on the PackMan menu. 2. From the Kernel Installation & Distribution System menu, select the Installation menu. 3. From this menu, you may select to use the following options: (when prompted for INSTALL NAME, enter PSO*7.0*217 a. Verify Checksums in Transport Global - This option will allow you to ensure the integrity of the routines that are in the transport global. b. Print Transport Global - This option will allow you to view the components of the KIDS build. c. 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.). d. 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. 4. Use the Install Package(s) option and select the package PSO*7.0*217. 5. When prompted "Do you want to run the Back Bill process?" choose YES or NO. Selecting NO, will still install the patch, but will not perform the back-billing option. If the MailMan message from the tally job from patch PSO*7*215 indicated that there were fills eligible to back-bill, you should answer YES to running the back-billing job, unless your site has already had their billing department bill those fills manually. 6. If you selected YES to run the back-bill process, then you will be prompted when to schedule the job to run. The default is NOW or select a date and time you would like it to begin. 7. When Prompted "Want KIDS to INHIBIT LOGONs during the install? YES//" respond NO. 8. When Prompted "Want to DISABLE Scheduled Options, Menu Options, and Protocols? YES//" respond NO. Example of install question #5 answered YES: -------------------------------------------- Checking Install for Package PSO*7.0*217 Install Questions for PSO*7.0*217 *************************** SELECT JOB OPTION **************************** Do you want to Run the Back-Billing process? YES Enter when to Queue the Job to run in date@time format: NOW// Want KIDS to INHIBIT LOGONs during the install? YES// NO Want to DISABLE Scheduled Options, Menu Options, and Protocols? YES// NO Enter the Device you want to print the Install messages. You can queue the install by enter a 'Q' at the device prompt. Enter a '^' to abort the install. DEVICE: HOME// TELNET TERMINAL Routine Information: ==================== The checksums below are new checksums, and can be checked with CHECK1^XTSUMBLD. Routine Name: PSOCPBK3 Before: After: B42446579 **217** Routine Name: PSOCPBK4 Before: After: B81010442 **217** Routine Name: PSOCPBK5 Before: After: B31112048 **217** ============================================================================= User Information: Entered By : NAPOLIELLO,GREG Date Entered : AUG 15, 2005 Completed By: CROSSMAN,PAM Date Completed: OCT 19, 2005 Released By : PARRIS,CHRIS Date Released : OCT 19, 2005 ============================================================================= Packman Mail Message: ===================== $END TXT