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

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

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1IBCRBC ;ALB/ARH - RATES: BILL CALCULATION OF CHARGES ; 22-MAY-1996
2 ;;2.0;INTEGRATED BILLING;**52,80,106,51,137,245**;21-MAR-94
3 ;;Per VHA Directive 10-93-142, this routine should not be modified.
4 ;
5 ; Variable DGPTUPDT may be defined on entry/exit for inpt bills so the PTF will only be updated once per session
6 ; Charges may be filed on the bill and if IBRSARR is passed but does not exist it may be updated
7 ; otherwise there are no other outputs/results of this call.
8 ;
9BILL(IBIFN,IBRSARR) ; given a bill number calculate and store all charges
10 ; if IBRSARR is defined it will be used to create charges rather than the standard set for the bills Rate Type
11 ;
12 N IB0,IBU,IBBRT,IBBTYPE,IBCTYPE,DFN,PTF,IBDGPT,IBRS,IBCS,IBBEVNT Q:'$G(IBIFN)
13 K ^TMP($J,"IBCRCC"),^TMP($J,"IBCRCS")
14 ;
15 S IB0=$G(^DGCR(399,+IBIFN,0)) Q:IB0="" S IBU=$G(^DGCR(399,+IBIFN,"U")) Q:'IBU
16 S IBBRT=+$P(IB0,U,7),IBBTYPE=$S($$INPAT^IBCEF(IBIFN):1,1:3),IBCTYPE=+$P(IB0,U,27),DFN=$P(IB0,U,2) Q:'DFN
17 ;
18 ; if who's responsible is insurer, but bill has no insurer defined quit
19 I $P(IB0,U,11)="i",'$G(^DGCR(399,+IBIFN,"MP")),'$$MCRWNR^IBEFUNC(+$$CURR^IBCEF2(IBIFN)) Q
20 ;
21 ; if inpt bill, PTF Status is Open, not a Fee Basis record and not previously done then Update the PTF record
22 I IBBTYPE<3,'$D(DGPTUPDT) S PTF=$P(IB0,U,8) Q:'PTF S IBDGPT=$G(^DGPT(+PTF,0)) Q:IBDGPT="" D
23 . I '$P(IBDGPT,U,6),'$P(IBDGPT,U,4) D UPDT^DGPTUTL S DGPTUPDT=""
24 ;
25 ;
26 D DSPDL^IBCRBC3,DELALLRC^IBCRBF(IBIFN) ; delete all existing auto charges on the bill
27 ;
28 ; get standard set of all rate schedules and charge sets available for entire date range of the bill
29 I '$D(IBRSARR) D RT^IBCRU3(IBBRT,IBBTYPE,$P(IBU,U,1,2),.IBRSARR,"",IBCTYPE) I 'IBRSARR G END
30 ;
31 ; process charge sets - set all charges for the bill into array
32 S IBRS=0 F S IBRS=$O(IBRSARR(IBRS)) Q:'IBRS D
33 . S IBCS=0 F S IBCS=$O(IBRSARR(IBRS,IBCS)) Q:'IBCS I +IBRSARR(IBRS,IBCS) D
34 .. S IBBEVNT=+$P($G(^IBE(363.1,+IBCS,0)),U,3) Q:'IBBEVNT S IBBEVNT=$$EMUTL^IBCRU1(IBBEVNT) Q:IBBEVNT=""
35 .. ;
36 .. I IBBEVNT["INPATIENT BEDSECTION STAY" D INPTBS^IBCRBC1(IBIFN,IBRS,IBCS)
37 .. I IBBEVNT["INPATIENT DRG" D INPTDRG^IBCRBC11(IBIFN,IBRS,IBCS)
38 .. I IBBEVNT["OUTPATIENT VISIT DATE" D OPTVST^IBCRBC1(IBIFN,IBRS,IBCS)
39 .. I IBBEVNT["PRESCRIPTION" D RX^IBCRBC1(IBIFN,IBRS,IBCS)
40 .. I IBBEVNT["PROSTHETICS" D PI^IBCRBC1(IBIFN,IBRS,IBCS)
41 .. I IBBEVNT["PROCEDURE" D CPT^IBCRBC1(IBIFN,IBRS,IBCS)
42 ;
43 I '$D(^TMP($J,"IBCRCC")) G END
44 ;
45 D MULTCPT^IBCRBCA1 ; adjust charges for Multiple Surgical Procedure Discount
46 D PSB^IBCRBCA2 ; adjust charges for Primary/Secondary Bundling
47 D MODADJ^IBCRBCA3 ; adjust charges for Modifier Adjustment
48 ;
49 D SORTCI^IBCRBC3 I '$D(^TMP($J,"IBCRCS")) G END
50 ;
51 D ADDBCHGS^IBCRBC3(IBIFN)
52 ;
53 D MAILADD(IBIFN,IBBTYPE)
54 ;
55END I $D(^TMP("IBCRRX",$J)) D CLEANRX^IBCRBC3(IBIFN)
56 K ^TMP($J,"IBCRCC"),^TMP($J,"IBCRCS")
57 Q
58 ;
59MAILADD(IBIFN,BTYPE) ; update the bill mailing address: it may be based on the types of charges
60 ; an outpatient bill may go to either the opt or rx mailing addresses depending on the types of charges
61 N DA,IB01,IB02
62 I $G(BTYPE)>2,+$G(IBIFN),$D(^IBA(362.4,"C",+IBIFN)),+$$CHGTYPE^IBCU(+IBIFN)=3 S DA=IBIFN D MAILA^IBCU5 D
63 . I '$D(ZTQUEUED),'$G(IBAUTO) W !!,"Updating Bill Mailing Address"
64 Q
65 ;
66BILLITEM(IBIFN,IBITMARR) ; add selected unassociated item charges to the bill
67 N IBRS,IBCS,IBBEVNT K ^TMP($J,"IBCRCC"),^TMP($J,"IBCRCS")
68 ;
69 S IBRS=0 F S IBRS=$O(IBITMARR(IBRS)) Q:'IBRS D
70 . S IBCS=0 F S IBCS=$O(IBITMARR(IBRS,IBCS)) Q:'IBCS D
71 .. S IBBEVNT=+$P($G(^IBE(363.1,+IBCS,0)),U,3) Q:'IBBEVNT S IBBEVNT=$$EMUTL^IBCRU1(IBBEVNT) Q:IBBEVNT=""
72 .. ;
73 .. I IBBEVNT["UNASSOCIATED" D UNASSOC^IBCRBC11(IBIFN,IBRS,IBCS,.IBITMARR)
74 ;
75 I $D(^TMP($J,"IBCRCC")) D SORTCI^IBCRBC3
76 ;
77 I $D(^TMP($J,"IBCRCS")) D ADDBCHGS^IBCRBC3(IBIFN)
78 ;
79 K ^TMP($J,"IBCRCC"),^TMP($J,"IBCRCS")
80 Q
81 ;
82 ;
83 ;
84 ; There are 3 types of charges/items:
85 ; - ITEM: charge for an individual item: specific item has one or more charge entries in 363.2
86 ; for the charge to be applied to the bill the specific item must be found on the bill
87 ;
88 ; - EVENT: charge for an event, not an item: items are defined in 363.2
89 ; all charge items active on a date in the set define the charge for the event
90 ; the item does not need to be defined on the bill for the charge to be applied to the bill
91 ; the charge set on a date becomes the events charge, so effective date cuts across item and applies to event
92 ; all charge items with the same effective date are used to calculate the event charge for that date
93 ; each charge item effective date in the set overrides all previous entries in the set regardless of item
94 ;
95 ; - VA COST: charge for an individual item but no entries in 363.2
96 ; instead the charge is calculated/obtained when it is needed from an interface with the source package
97 ;
98 ;
99 ; Auto calculation and filing of a bills charges
100 ;
101 ; IBCRBC (BILL) - determine if charges can be calculated and which rates (RS/CS) should be used
102 ; then find billable items/events, calculate and store the charges
103 ; called anytime a bills charges need to be updated
104 ;
105 ; IBCRBC1 (event) - gather billable items/events for each billable event type
106 ; then accumulate all charges for the bill for each billable event/item
107 ;
108 ; IBCRCGx (event) - pull billable items/events from the bill
109 ; IBCRBC2 (BITMCHRG) - calculate charges for billable item/event
110 ;
111 ; IBCRBC3 (SORTCI) - sort accumulated charges into order to store on bill, combine if possible
112 ; IBCRBC3 (ADDBCHRGS) - store the sorted accumulated charges on the bill
113 ;
114 ;
115 ; The Billable Event of the Charge Set is directly related to the Type of charge assigned
116 ; to the charges calculated for that Charge Set. So, Billable Event (363.1,.03) <-> Type (399,42,.1)
117 ;
118 ;
119 ; ^TMP($J,"IBCRCC") - array containing raw charges for a bill and related data, created in IBRCBC2
120 ; ^TMP($J,"IBCRCC",X) = 1 charge item ifn
121 ; 2 charge set ifn
122 ; 3 rate schedule ifn
123 ; 4 item ptr (to source)
124 ; 5 cpt modifier ptr
125 ; 6 revenue code ptr
126 ; 7 billable bedsection (bill)
127 ; 8 event date (visit or st from or admission)
128 ; 9 charge per unit/qty
129 ; 10 units/qty (qty of item)
130 ; 11 total charge per unit/qty
131 ; 12 adjusted total charge per unit/qty
132 ; 13 units (# item on bill)
133 ; 14 CPT ptr
134 ; 15 division ptr
135 ; 16 item type (source)
136 ; 17 item ptr (to source)
137 ; 18 charge component
138 ; 19 billable bedsection (for item)
139 ; 20 procedure provider
140 ; 21 procedures associated clinic
141 ; 22 procedures Outpatient Encounter, pointer to #409.68
142 ;
143 ; ^TMP($J,"IBCRCC",X,"CC",x) = comments explaining charge adjustements
144 ;
145 ; ^TMP($J,"IBCRCS") - array of charges from IBCRCC in sorted order and with only data needed to save on bill
146 ; ^TMP($J,"IBCRCS", BS, RV, X) = 1 revenue code ptr
147 ; 2 bedsection ptr
148 ; 3 charge per units (adjusted total charge)
149 ; 4 units (# item on bill)
150 ; 5 CPT ptr
151 ; 6 division ptr
152 ; 7 item type
153 ; 8 item ptr
154 ; 9 charge component
155 ;
156 ;
157 ;
158 ; Inpatient Bill Dates use follow rules:
159 ; - admission date is counted as billable
160 ; - the discharge date is not billable and is not counted
161 ;
162 ; - if admission movement is found in the Patient Movement file then the dates of admission and discharge
163 ; will be used as the outside limits of the LOS, even if date range of the bill is longer (LOS^IBCU64)
164 ;
165 ; - a day is counted as billable to the bedsection the patient was in at the end of the day (ie. counted
166 ; in LOS of next movement after midnight)
167 ; - if there is a movement on any given date that date is included in the LOS of the bedsection the patient
168 ; moved into (same as admission date)
169 ; - if there is a movement on any given date that date is NOT included in the LOS of the bedsection the
170 ; patient moved out of (same as discharge date)
171 ;
172 ; - if the time frame of the bill is:
173 ; - either interim-first or interim-continuous the last date on the bill should be billed
174 ; - if the last date is counted it is added to the LOS of the bedsection the patient was in at the end
175 ; of the day
176 ; - either NOT interim-first or interim-continuous (final bills) the last date on the bill
177 ; should NOT be billed (i.e. this is considered the discharge date)
178 ;
179 ; - start with first bedsection after begin date, day is counted in the bedsection the patient is in at midnight
180 ; - continuous: last bedsection counted is the bedsection the patient is in at midnight of the end date
181 ; - final:last bedsection counted is the bedsection the patient is in at midnight of the day before the end date
182 ;
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