source: FOIAVistA/tag/r/INTEGRATED_BILLING-IB-PRQ--IBD--IBQ--PRQS/IBCBB3.m@ 636

Last change on this file since 636 was 636, checked in by George Lilly, 14 years ago

WorldVistAEHR overlayed on FOIAVistA
File size: 7.1 KB
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1IBCBB3 ;ALB/TMP - CONTINUATION OF EDIT CHECKS ROUTINE (MEDICARE) ;06/23/98
2 ;;2.0;INTEGRATED BILLING;**51,137,155,349**;21-MAR-94;Build 46
3 ;;Per VHA Directive 2004-038, this routine should not be modified.
4 ;
5EDITMRA(IBQUIT,IBER,IBIFN,IBFT) ;
6 ; Requires execution of GVAR^IBCBB, IBIFN defined
7 ; File IB ERROR (350.8) contains error codes/text
8 ;
9 N IBMRATYP,Z,IBZP,IBZP1,IBOK
10 S IBQUIT=0 ;Flag to say we have too many errors - quit edits
11 ;
12 S IBMRATYP=$$MRATYPE^IBEFUNC(IBIFN,"C")
13 ;
14 I IBFT=3 D
15 . D PARTA
16 ;
17 I IBFT=2 D PARTB^IBCBB9
18 ;
19 K IBXDATA D F^IBCEF("N-ADMITTING DIAGNOSIS",,,IBIFN)
20 ; Req. for UB-04 type of bills 11x!18x
21 I $G(IBXDATA)="",IBFT=3 D Q:IBQUIT
22 . N Z
23 . I "^11^18^"[(U_IBTOB12_U) S IBQUIT=$$IBER^IBCBB3(.IBER,231) Q
24 . I $$INPAT^IBCEF(IBIFN,1) S Z="Admitting Diagnosis may be required by payer, please verify" D WARN^IBCBB11(Z)
25 ;
26 D GETPRV^IBCEU(IBIFN,"2,3,4",.Z)
27 S IBOK=1,Z=0,IBZP=U F S Z=$O(Z(Z)) Q:'Z S:$S($P($G(Z(Z,1)),U,3)["VA(200":1,1:0) IBZP=IBZP_+$P(Z(Z,1),U,3)_U
28 D ALLPROC^IBCVA1(IBIFN,.IBZP1)
29 S Z=0 F S Z=$O(IBZP1(Z)) Q:'Z I $P(IBZP1(Z),U,18),(U_$P(IBZP1(Z),U,18)_U)'[IBZP S IBOK=0 Q
30 I 'IBOK D WARN^IBCBB11("At least one provider on a procedure does not match your "_$S(IBFT=2:"render",1:"attend")_"ing or operating provider")
31 I IBFT=2 D EN^IBCBB2
32 ; edit checks for UB-04 (institutional) forms
33 I IBFT=3 D EN^IBCBB21(.IBZPRC92)
34 ;
35 Q
36 ;
37PARTA ; MEDICARE specific edit checks for PART A claims (UB-04 formats)
38 ;
39 N IBI,IBJ,IBX,IBCTYP,VADM,VAPA,IBSTOP,IBDXC,IBDXARY,IBPR,IBLABS
40 N IBS,IBTUNIT,IBCAGE,IBREV1,IBOCCS,IBOCSDT,IBVALCD,IBOCCD,IBNOPR
41 N IBCCARY1,IBPATST,IBZADMIT,IBZDISCH,IBXIEN,IBXERR,IBXDATA,IBOCSP
42 N IBCOV,IBNCOV,IBREVC,IBREVDUP,IBBCPT,IBREVC12,IBREVTOT,IBECAT,IBINC
43 ;
44 ; Medicare is the current payer, but no diagnosis codes
45 I $$WNRBILL^IBEFUNC(IBIFN) D SET^IBCSC4D(IBIFN,.IBDX,.IBDXO) I '$P(IBDX,U,2) S IBQUIT=$$IBER(.IBER,120) Q:IBQUIT
46 ;
47 ; Type of Bill must be three digits
48 I IBTOB'?3N S X=$$IBER(.IBER,103) Q
49 ;
50 ; Covered Days
51 S IBCTYP=0
52 S IBCOV=$P(IBNDU2,U,2),IBNCOV=$P(IBNDU2,U,3)
53 ;
54 ; If interim bill, covered days must not be greater than 60
55 I "23"[$E(IBTOB,3),IBCOV>60 S IBQUIT=$$IBER(.IBER,"096") Q:IBQUIT
56 ;
57 ; I bill type is 11x or 18x or 21x then we need covered days
58 I "^11^18^21^"[(U_IBTOB12_U) S IBCTYP=1 I IBCOV="" S IBQUIT=$$IBER(.IBER,106) Q:IBQUIT
59 ;
60 S (IBI,IBJ)=0
61 K IBXDATA D F^IBCEF("N-CONDITION CODES",,,IBIFN)
62 ; Re-sort the condition codes by code
63 S IBI=0 F S IBI=$O(IBXDATA(IBI)) Q:'IBI S IBCCARY1($P(IBXDATA(IBI),U))=""
64 ;
65 ; for condition code 40, covered days must be 0
66 I $D(IBCCARY1(40)),IBCOV'=0 S IBQUIT=$$IBER(.IBER,107) Q:IBQUIT
67 ;
68 ; cov days+non=to date -from date unless the patient status = 30 (still
69 ; pt) or outpatient or if the to date and from date are same then add 1
70 S IBPATST="",IBX=$P(IBNDU,U,12),IBPATST=$P($G(^DGCR(399.1,+IBX,0)),U,2)
71 S IBINC=$S(IBPATST=30!(IBFDT=IBTDT):1,1:0)
72 I $$INPAT^IBCEF(IBIFN,1),(IBCOV+IBNCOV)'=($$FMDIFF^XLFDT(IBTDT,IBFDT)+IBINC) S IBQUIT=$$IBER(.IBER,108) Q:IBQUIT
73 ;
74 ; if covered days >100 and type of bill is 21x or 18x error
75 I IBCOV>100,(IBTOB12=18!(IBTOB12=21)) S IBQUIT=$$IBER(.IBER,109) Q:IBQUIT
76 ;
77 S (IBJ,IBTUNIT,IBS,IBREVTOT("AC"),IBREVTOT("AI"),IBREVTOT("AO"),IBREVTOT)=0
78 ;
79 K IBXDATA D F^IBCEF("N-UB-04 SERVICE LINE (EDI)",,,IBIFN) ;Get rev codes
80 ;
81 ; Re-sort the revenue codes by code
82 ;>> IBREV1(rev code,x)=Rev code^ptr cpt^unit chg^units^total^tot unc
83 ; IBREV1(rev code) = revenue code edit category
84 ;
85 ; IBNOPR = flag that determines if there are revenue codes with
86 ; charges that do not have a procedure - no need to check
87 ; for billable MCR procedures if at least one RC is billable
88 ; 1 = there is at least one billable revenue code without a
89 ; procedure
90 ;
91 S (IBNOPR,IBI)=0
92 F S IBI=$O(IBXDATA(IBI)) Q:'IBI D
93 . S IBJ=$P(IBXDATA(IBI),U),IBECAT=""
94 . I 'IBNOPR D
95 .. I $P(IBXDATA(IBI),U,2)'="" S IBPR($P(IBXDATA(IBI),U,2))=IBI Q
96 .. S IBNOPR=1 K IBPR
97 . S:$D(IBREV1(IBJ)) IBECAT=$G(IBREV1(IBJ))
98 . I '$D(IBREV1(IBJ))!(IBECAT="") D S IBREV1(IBJ)=IBECAT
99 . . ;
100 . . ; Accomodations (AC)
101 . . I (IBJ'<100&(IBJ'>219))!(IBJ=224) S IBECAT="AC" Q
102 . . ;
103 . . ; Ancillary Outpatient (AO)
104 . . I '$$INPAT^IBCEF(IBIFN,1) S IBECAT="AO" Q
105 . . ;
106 . . ; Ancillary Inpatient (AI)
107 . . S IBECAT="AI"
108 . ;
109 . S IBREV1(IBJ,+$O(IBREV1(IBJ,""),-1)+1)=IBXDATA(IBI)
110 . S IBREVTOT(IBECAT)=IBREVTOT(IBECAT)+$P(IBXDATA(IBI),U,6)
111 . I IBECAT="AC" S IBTUNIT=IBTUNIT+$P(IBXDATA(IBI),U,4)
112 ;
113 I $$NEEDMRA^IBEFUNC(IBIFN),$O(IBPR(""))'="" D Q:IBQUIT
114 . ; Don't allow a bill containing only billable procedures for:
115 . ; Oxygen, labs, or influenza shots
116 . ; OR a bill with prosthetics on it
117 . ; to be sent to MEDICARE for an MRA
118 . D NONMCR(.IBPR,.IBLABS) ; Remove Oxygen, labs, influenza shots
119 . ;I $O(IBPR(""))="" D
120 . I $G(IBLABS) D WARN^IBCBB11("The only possible billable procedures on this bill are labs -"),WARN^IBCBB11(" Please verify that MEDICARE does not reimburse these labs at 100%") Q
121 . I $O(IBPR(""))="" D
122 .. S IBQUIT=$$IBER(.IBER,"098")
123 ;
124 ; covered days+non covered = units of accom rev codes
125 ; Check room and board
126 I IBTUNIT,IBTUNIT'=(IBCOV+IBNCOV) S IBQUIT=$$IBER(.IBER,114) Q:IBQUIT
127 ;
128 ; Non Covered Days
129 ; required when the type of bill is 11x,18x,21x or covered days=0
130 I IBNCOV="",(IBCTYP!(IBCOV=0)) S IBQUIT=$$IBER(.IBER,115) Q:IBQUIT
131 ;
132 ; if cc code=40 then non-covered days must be 1
133 I $D(IBCCARY1(40)),IBNCOV'=1 S IBQUIT=$$IBER(.IBER,116) Q:IBQUIT
134 ;
135 ; Patient Sex
136 ; must be "M" or "F"
137 D DEM^VADPT
138 I $P(VADM(5),U)'="M",$P(VADM(5),U)'="F" S IBQUIT=$$IBER(.IBER,124) Q:IBQUIT
139 ;
140 D ^IBCBB4
141 Q
142 ;
143IBER(IBER,ERRNO) ; Sets error list
144 ; NOTE: add code to check error list > 20 ... If so, display message and
145 ; quit so we don't get too many errors at once to handle
146 ; Print all if printing list
147 ;
148 I '$G(IBQUIT) D
149 . I ERRNO?1N.N S:$L(ERRNO)<3 ERRNO=$E("00",1,3-$L(ERRNO))_ERRNO
150 . I $L(IBER,";")>19,'$G(IBPRT("PRT")) S IBER=IBER_"IB999;",IBQUIT=1
151 . I $G(IBER)'[("IB"_ERRNO_";") S IBER=IBER_"IB"_ERRNO_";"
152 Q IBQUIT
153 ;
154NONMCR(IBPR,IBLABS) ; Delete all oxygen and lab, flu shot CPT entries from IBPR
155 ; IBPR = array subscripted by CPT codes from bill
156 ; IBLABS = flag returned =1 if labs found on bill
157 N Z S IBLABS=0
158 ; Oxygen
159 F Z="A0422","A4575","A4616","A4619","A4620","A4621","E0455","E1353","E1355" K IBPR(Z)
160 F Z=77:1:85 S Z0="E13"_Z K IBPR(Z0)
161 ; Labs
162 ;S Z="80000" F S Z=$O(IBPR(Z)) Q:Z'?1"8"4N K IBPR(Z) S IBLABS=1
163 S Z="80000" F S Z=$O(IBPR(Z)) Q:Z'?1"8"4N S IBLABS=1
164 ; Flu shots
165 F Z="90724","G0008","90732","G0009","90657","90658","90659","90660" K IBPR(Z)
166 Q
167 ;
168MCRANUM(IBIFN) ; Determine MEDICARE A provider ID # from bedsection for
169 ; bill ien IBIFN
170 N IBX
171 ; PART A MRA (only) needed - determine if psych/non-psych claim
172 N IBX,IBI
173 S IBI=$P($G(^DGCR(399,IBIFN,"U")),U,11)
174 S IBX=$S($TR($P($G(^DGCR(399.1,+IBI,0)),U),"psych","PSYCH")'["PSYCH":670899,1:674499)
175 Q IBX
176 ;
177MCRACK(IBIFN,X,IBFLD) ; Check for MEDICARE A for bill IBIFN
178 ; Called from CLAIM STATUS MRA field (#24) xrefs in file 399
179 ; X = current value of field 399;24
180 ; IBFLD = 1 for primary ins co, 2 for secondary, 3 for tertiary
181 N IB
182 S IB=0
183 I +X,$$COBN^IBCEF(IBIFN)=IBFLD,$$WNRBILL^IBEFUNC(IBIFN,IBFLD),$$MRATYPE^IBEFUNC(IBIFN,"C")="A" S IB=1
184 Q IB
185 ;
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