IBCRBC ;ALB/ARH - RATES: BILL CALCULATION OF CHARGES ; 22-MAY-1996 ;;2.0;INTEGRATED BILLING;**52,80,106,51,137,245**;21-MAR-94 ;;Per VHA Directive 10-93-142, this routine should not be modified. ; ; Variable DGPTUPDT may be defined on entry/exit for inpt bills so the PTF will only be updated once per session ; Charges may be filed on the bill and if IBRSARR is passed but does not exist it may be updated ; otherwise there are no other outputs/results of this call. ; BILL(IBIFN,IBRSARR) ; given a bill number calculate and store all charges ; if IBRSARR is defined it will be used to create charges rather than the standard set for the bills Rate Type ; N IB0,IBU,IBBRT,IBBTYPE,IBCTYPE,DFN,PTF,IBDGPT,IBRS,IBCS,IBBEVNT Q:'$G(IBIFN) K ^TMP($J,"IBCRCC"),^TMP($J,"IBCRCS") ; S IB0=$G(^DGCR(399,+IBIFN,0)) Q:IB0="" S IBU=$G(^DGCR(399,+IBIFN,"U")) Q:'IBU S IBBRT=+$P(IB0,U,7),IBBTYPE=$S($$INPAT^IBCEF(IBIFN):1,1:3),IBCTYPE=+$P(IB0,U,27),DFN=$P(IB0,U,2) Q:'DFN ; ; if who's responsible is insurer, but bill has no insurer defined quit I $P(IB0,U,11)="i",'$G(^DGCR(399,+IBIFN,"MP")),'$$MCRWNR^IBEFUNC(+$$CURR^IBCEF2(IBIFN)) Q ; ; if inpt bill, PTF Status is Open, not a Fee Basis record and not previously done then Update the PTF record I IBBTYPE<3,'$D(DGPTUPDT) S PTF=$P(IB0,U,8) Q:'PTF S IBDGPT=$G(^DGPT(+PTF,0)) Q:IBDGPT="" D . I '$P(IBDGPT,U,6),'$P(IBDGPT,U,4) D UPDT^DGPTUTL S DGPTUPDT="" ; ; D DSPDL^IBCRBC3,DELALLRC^IBCRBF(IBIFN) ; delete all existing auto charges on the bill ; ; get standard set of all rate schedules and charge sets available for entire date range of the bill I '$D(IBRSARR) D RT^IBCRU3(IBBRT,IBBTYPE,$P(IBU,U,1,2),.IBRSARR,"",IBCTYPE) I 'IBRSARR G END ; ; process charge sets - set all charges for the bill into array S IBRS=0 F S IBRS=$O(IBRSARR(IBRS)) Q:'IBRS D . S IBCS=0 F S IBCS=$O(IBRSARR(IBRS,IBCS)) Q:'IBCS I +IBRSARR(IBRS,IBCS) D .. S IBBEVNT=+$P($G(^IBE(363.1,+IBCS,0)),U,3) Q:'IBBEVNT S IBBEVNT=$$EMUTL^IBCRU1(IBBEVNT) Q:IBBEVNT="" .. ; .. I IBBEVNT["INPATIENT BEDSECTION STAY" D INPTBS^IBCRBC1(IBIFN,IBRS,IBCS) .. I IBBEVNT["INPATIENT DRG" D INPTDRG^IBCRBC11(IBIFN,IBRS,IBCS) .. I IBBEVNT["OUTPATIENT VISIT DATE" D OPTVST^IBCRBC1(IBIFN,IBRS,IBCS) .. I IBBEVNT["PRESCRIPTION" D RX^IBCRBC1(IBIFN,IBRS,IBCS) .. I IBBEVNT["PROSTHETICS" D PI^IBCRBC1(IBIFN,IBRS,IBCS) .. I IBBEVNT["PROCEDURE" D CPT^IBCRBC1(IBIFN,IBRS,IBCS) ; I '$D(^TMP($J,"IBCRCC")) G END ; D MULTCPT^IBCRBCA1 ; adjust charges for Multiple Surgical Procedure Discount D PSB^IBCRBCA2 ; adjust charges for Primary/Secondary Bundling D MODADJ^IBCRBCA3 ; adjust charges for Modifier Adjustment ; D SORTCI^IBCRBC3 I '$D(^TMP($J,"IBCRCS")) G END ; D ADDBCHGS^IBCRBC3(IBIFN) ; D MAILADD(IBIFN,IBBTYPE) ; END I $D(^TMP("IBCRRX",$J)) D CLEANRX^IBCRBC3(IBIFN) K ^TMP($J,"IBCRCC"),^TMP($J,"IBCRCS") Q ; MAILADD(IBIFN,BTYPE) ; update the bill mailing address: it may be based on the types of charges ; an outpatient bill may go to either the opt or rx mailing addresses depending on the types of charges N DA,IB01,IB02 I $G(BTYPE)>2,+$G(IBIFN),$D(^IBA(362.4,"C",+IBIFN)),+$$CHGTYPE^IBCU(+IBIFN)=3 S DA=IBIFN D MAILA^IBCU5 D . I '$D(ZTQUEUED),'$G(IBAUTO) W !!,"Updating Bill Mailing Address" Q ; BILLITEM(IBIFN,IBITMARR) ; add selected unassociated item charges to the bill N IBRS,IBCS,IBBEVNT K ^TMP($J,"IBCRCC"),^TMP($J,"IBCRCS") ; S IBRS=0 F S IBRS=$O(IBITMARR(IBRS)) Q:'IBRS D . S IBCS=0 F S IBCS=$O(IBITMARR(IBRS,IBCS)) Q:'IBCS D .. S IBBEVNT=+$P($G(^IBE(363.1,+IBCS,0)),U,3) Q:'IBBEVNT S IBBEVNT=$$EMUTL^IBCRU1(IBBEVNT) Q:IBBEVNT="" .. ; .. I IBBEVNT["UNASSOCIATED" D UNASSOC^IBCRBC11(IBIFN,IBRS,IBCS,.IBITMARR) ; I $D(^TMP($J,"IBCRCC")) D SORTCI^IBCRBC3 ; I $D(^TMP($J,"IBCRCS")) D ADDBCHGS^IBCRBC3(IBIFN) ; K ^TMP($J,"IBCRCC"),^TMP($J,"IBCRCS") Q ; ; ; ; There are 3 types of charges/items: ; - ITEM: charge for an individual item: specific item has one or more charge entries in 363.2 ; for the charge to be applied to the bill the specific item must be found on the bill ; ; - EVENT: charge for an event, not an item: items are defined in 363.2 ; all charge items active on a date in the set define the charge for the event ; the item does not need to be defined on the bill for the charge to be applied to the bill ; the charge set on a date becomes the events charge, so effective date cuts across item and applies to event ; all charge items with the same effective date are used to calculate the event charge for that date ; each charge item effective date in the set overrides all previous entries in the set regardless of item ; ; - VA COST: charge for an individual item but no entries in 363.2 ; instead the charge is calculated/obtained when it is needed from an interface with the source package ; ; ; Auto calculation and filing of a bills charges ; ; IBCRBC (BILL) - determine if charges can be calculated and which rates (RS/CS) should be used ; then find billable items/events, calculate and store the charges ; called anytime a bills charges need to be updated ; ; IBCRBC1 (event) - gather billable items/events for each billable event type ; then accumulate all charges for the bill for each billable event/item ; ; IBCRCGx (event) - pull billable items/events from the bill ; IBCRBC2 (BITMCHRG) - calculate charges for billable item/event ; ; IBCRBC3 (SORTCI) - sort accumulated charges into order to store on bill, combine if possible ; IBCRBC3 (ADDBCHRGS) - store the sorted accumulated charges on the bill ; ; ; The Billable Event of the Charge Set is directly related to the Type of charge assigned ; to the charges calculated for that Charge Set. So, Billable Event (363.1,.03) <-> Type (399,42,.1) ; ; ; ^TMP($J,"IBCRCC") - array containing raw charges for a bill and related data, created in IBRCBC2 ; ^TMP($J,"IBCRCC",X) = 1 charge item ifn ; 2 charge set ifn ; 3 rate schedule ifn ; 4 item ptr (to source) ; 5 cpt modifier ptr ; 6 revenue code ptr ; 7 billable bedsection (bill) ; 8 event date (visit or st from or admission) ; 9 charge per unit/qty ; 10 units/qty (qty of item) ; 11 total charge per unit/qty ; 12 adjusted total charge per unit/qty ; 13 units (# item on bill) ; 14 CPT ptr ; 15 division ptr ; 16 item type (source) ; 17 item ptr (to source) ; 18 charge component ; 19 billable bedsection (for item) ; 20 procedure provider ; 21 procedures associated clinic ; 22 procedures Outpatient Encounter, pointer to #409.68 ; ; ^TMP($J,"IBCRCC",X,"CC",x) = comments explaining charge adjustements ; ; ^TMP($J,"IBCRCS") - array of charges from IBCRCC in sorted order and with only data needed to save on bill ; ^TMP($J,"IBCRCS", BS, RV, X) = 1 revenue code ptr ; 2 bedsection ptr ; 3 charge per units (adjusted total charge) ; 4 units (# item on bill) ; 5 CPT ptr ; 6 division ptr ; 7 item type ; 8 item ptr ; 9 charge component ; ; ; ; Inpatient Bill Dates use follow rules: ; - admission date is counted as billable ; - the discharge date is not billable and is not counted ; ; - if admission movement is found in the Patient Movement file then the dates of admission and discharge ; will be used as the outside limits of the LOS, even if date range of the bill is longer (LOS^IBCU64) ; ; - a day is counted as billable to the bedsection the patient was in at the end of the day (ie. counted ; in LOS of next movement after midnight) ; - if there is a movement on any given date that date is included in the LOS of the bedsection the patient ; moved into (same as admission date) ; - if there is a movement on any given date that date is NOT included in the LOS of the bedsection the ; patient moved out of (same as discharge date) ; ; - if the time frame of the bill is: ; - either interim-first or interim-continuous the last date on the bill should be billed ; - if the last date is counted it is added to the LOS of the bedsection the patient was in at the end ; of the day ; - either NOT interim-first or interim-continuous (final bills) the last date on the bill ; should NOT be billed (i.e. this is considered the discharge date) ; ; - start with first bedsection after begin date, day is counted in the bedsection the patient is in at midnight ; - continuous: last bedsection counted is the bedsection the patient is in at midnight of the end date ; - final:last bedsection counted is the bedsection the patient is in at midnight of the day before the end date ;