IBCRBC2 ;ALB/ARH - RATES: BILL CALCULATION OF ITEM CHARGE ; 22-MAY-1996 ;;2.0;INTEGRATED BILLING;**52,106,138,148,245**;21-MAR-94 ;;Per VHA Directive 10-93-142, this routine should not be modified. ; ; Input: RS - rate schedule necessary to calculated modified charges ; CS - required, charge set which defines the charges to calculate ; ITEM - required, ptr to source item to be billed, type defined by billable item of the rate ; EVDT - date of event, to be used when searching for a charge effective date, default=DT ; UNITS - required, used only for Quantity: # of units of Charge Item Charge for each Item ; MOD - CPT Modifier if any ; INSRC - special revenue code to use (from ins comp), if any (overrides set and item rv cd) ; IDFRC - different revenue codes to use, these replace the standard set in CM (DRC:SRC,DRC:SRC) ; SAVE - serveral data items not needed here but passed on to next step (store) in TMP array: ; TUNITS - required to add charge to bill, total # of the Item on the bill ; CPT - default CPT to be added to the bill for the charge ; DIV - division charges apply to ; TYPE - type of item being billed - defines the source of the item on the bill ; ITMPTR - soft pointer to the item on the bill: may be a multiple or file IFN ; CMPNT - what component of the total charge: institutional or professional ; BEDS - billable bedsection to use if not a bedsection item, if null uses set default ; PROV - procedure provider ; CLINIC - procedures associated clinic ; IBOE - Outpatient Encounter, pointer to #408.69 ; ; Total charge is calculated: X = UNITS * UNIT CHARGE of the item (per unit charge (un-adjusted)) ; Y = X modified by Rate Schedule Adjustment (per unit charge (adjusted)) ; the Units are used to calculate the per item charge: 30 pills for an rx, 1 bs per bs ; and the Tunits are the number of that Item on the bill: 1 rx of 30 pills, 11 days of bs stay ; ; Output: TMP($J,"IBCRCC", containing all chargable items and all related info needed to file them on the bill ; each charge will have it's own entry, nothing combined (12 = per unit charge (adjusted), p13 = Tunits) ; TMP is not killed on entry so each items charges are compiled and added to existing charges ; BITMCHG(RS,CS,ITEM,EVDT,UNITS,MOD,INSRC,IDFRC,SAVE) ; get bill charges for a specific item, rate schedule and charge set and date set into temp array ; N IBCS0,IBDRVCD,IBBS,IBCHGARR,IBI,IBCNT,IBLN,IBCI,IBRVCD,IBPPRV,IBCHRG,IBTCHRG,IBRCHRG,IBPCHRG,IBACHRG,IBBASE,IBCOM I '$G(ITEM)!'$G(CS)!'$G(UNITS) Q ; S RS=$G(RS),EVDT=$S(+$G(EVDT):+EVDT\1,1:DT),MOD=$G(MOD),INSRC=$G(INSRC),IDFRC=$G(IDFRC),SAVE=$G(SAVE) S IBCS0=$G(^IBE(363.1,+CS,0)),IBDRVCD=$P(IBCS0,U,5),IBPPRV=$P(SAVE,U,8) S IBBS=+ITEM I $P($G(^IBE(363.3,+$P(IBCS0,U,2),0)),U,4)'=1 S IBBS=$P(SAVE,U,7) I 'IBBS S IBBS=$P(IBCS0,U,6) I 'IBBS Q ; D ITMCHG^IBCRCC(CS,ITEM,EVDT,MOD,.IBCHGARR) ; S IBCNT=+$G(^TMP($J,"IBCRCC")) S IBI=0 F S IBI=$O(IBCHGARR(IBI)) Q:'IBI D . S IBLN=IBCHGARR(IBI),IBCI=+IBLN,IBCHRG=$P(IBLN,U,3),(IBPCHRG,IBRCHRG)="" Q:'IBCHRG S IBBASE=$P(IBLN,U,4) . S IBRVCD=INSRC I 'IBRVCD S IBRVCD=$P(IBLN,U,2) . I 'IBRVCD S IBRVCD=$P($$RVLNK^IBCRU6(+ITEM,"",+CS),U,2) I 'IBRVCD S IBRVCD=IBDRVCD Q:'IBRVCD . I +IDFRC,+$P(IDFRC,IBRVCD_":",2) S IBRVCD=+$P(IDFRC,IBRVCD_":",2) Q:IBRVCD'?3N . ; . S IBCHRG=IBCHRG*UNITS . S IBCHRG=IBCHRG+IBBASE . S IBPCHRG=IBCHRG I +IBPPRV S IBPCHRG=$$PRVCHG^IBCRCC(CS,IBCHRG,IBPPRV,EVDT,ITEM) . S (IBCHRG,IBTCHRG)=+IBPCHRG . S IBACHRG=IBTCHRG I +RS,+IBTCHRG S IBRCHRG=$$RATECHG^IBCRCC(RS,IBTCHRG,EVDT),IBACHRG=+IBRCHRG . ; . S IBCNT=IBCNT+1,^TMP($J,"IBCRCC")=IBCNT . S ^TMP($J,"IBCRCC",IBCNT)=IBCI_U_CS_U_RS_U_ITEM_U_MOD_U_IBRVCD_U_IBBS_U_EVDT_U_IBCHRG_U_UNITS_U_IBTCHRG_U_IBACHRG_U_$G(SAVE) . ; . I (UNITS>1)!(+IBBASE) S IBCOM=$$COMMUB(CS,UNITS,IBBASE) I IBCOM'="" D COMMENT(IBCNT,IBCOM) . I $P(IBPCHRG,U,2)'="" S IBCOM=$P(IBPCHRG,U,2) I IBCOM'="" D COMMENT(IBCNT,IBCOM) . I $P(IBRCHRG,U,2)'="" S IBCOM=$P(IBRCHRG,U,2) I IBCOM'="" D COMMENT(IBCNT,IBCOM) Q ; COMMENT(LINE,COMM) ; set comment into charge array for a particular line item I +$D(^TMP($J,"IBCRCC",+$G(LINE))) N IBX D . S IBX=$O(^TMP($J,"IBCRCC",+LINE,"CC",9999),-1) S IBX=IBX+1 . S ^TMP($J,"IBCRCC",+LINE,"CC",IBX)=$G(COMM) Q ; COMMUB(CS,UNITS,BASE) ; return comment for special units and base N IBX,IBY,IBCM S IBX="",IBY="Charge calculated" S IBCM=$P($G(^IBE(363.1,+CS,0)),U,2),IBCM=$P($G(^IBE(363.3,+IBCM,0)),U,5) S IBCM=$S(IBCM=4:"Miles",IBCM=5:"SubUnits",IBCM=6:"Hours",1:"") I +$G(UNITS) S IBX=IBY_" for "_UNITS_" "_IBCM,IBY="" I +$G(BASE) S IBX=IBY_IBX_" with a Base Charge="_$J(BASE,0,2) Q IBX ; ALLBEDS(RS,CS,EVDT,RC,DFRC,SAVE) ; get charges for all bedsections active on date of visit ; each effective date supercedes all previous effective date, regardless of the item ; used for per diem rates where the charges are associated with a bedsection, but the item being billed is not ; a bedsection, so the count of the item on the bill is found and applied as the units to all bedsections active ; on the event date (the 3 opt visit dates on a bill are the units for the Outpatient Visit bedsection charge) ; N IBITM,IBITEMS I '$G(CS)!'$G(EVDT) Q ; D CSALL^IBCRCU1(CS,EVDT,.IBITEMS) ; I +IBITEMS S IBITM="" F S IBITM=$O(IBITEMS(IBITM)) Q:'IBITM D . D BITMCHG($G(RS),CS,IBITM,EVDT,1,"",$G(RC),$G(DFRC),$G(SAVE)) Q ; ; CPTUNITS(CS,CHGMTH,ITLINE) ; return CPT units based on Charge Method and CPT data ; Input: CS is the related Charge Set ; CHGMTH is the Rate Schedule Charge Method (363.3, .05) ; ITLINE is item data from CPT^IBCRBG1 ; Output: calculated units for CPT, 1 or calculated for miles/minutes/hours N IBUNIT S IBUNIT=1,CHGMTH=$G(CHGMTH),ITLINE=$G(ITLINE),CS=$G(CS) I CHGMTH=4 S IBUNIT=+$P(ITLINE,U,8) ; miles I CHGMTH=5 S IBUNIT=+$P(ITLINE,U,7) ; minutes I CHGMTH=6 S IBUNIT=+$P(ITLINE,U,9) ; hours S IBUNIT=$$CPTUNITS^IBCRCU1(CS,IBUNIT) Q IBUNIT ; CHGOTH(IBIFN,RS,EVDT) ; check if the Rate Schedule charges are applicable to the event date for the bill ; this is relevent to RC v2.0 and type of care of Other ; both Rate Schedule is SNF and event date is SNF care or neither can be otherwise no charge ; SNF charges can't be used for non-SNF care and non-SNF charges can't be used for SNF care ; Output: returns true if charges and bill date are of same type, SNF or non-SNF N IBOK,IBRSTY,IBDTTY S (IBRSTY,IBDTTY)=0,IBOK=1 I $G(EVDT)<$$VERSDT^IBCRU8(2) G CHGOTHQ I '$G(IBIFN)!'$G(RS) G CHGOTHQ ; S IBRSTY=$$RSOTHER^IBCRU8(RS) ; are charges for other type of care S IBDTTY=$$BOTHER^IBCU3(IBIFN,EVDT) ; is date other type of care ; I +IBRSTY,'IBDTTY S IBOK=0 I 'IBRSTY,+IBDTTY S IBOK=0 ; CHGOTHQ Q IBOK ; CHGICU(CS,BS) ; check if charge and bedsection match relative to ICU RC 2.0+, compares Charge Set Name and Bedsection ; both the charge set and the bedsection have to be ICU or neither of them can be ICU otherwise no charge ; ICU charges can't be used with non-ICU bedsections and non-ICU charges can't be used with ICU bedsection ; Output: returns true if charges and bedsection are of same type, ICU or non-ICU N IBCSICU,IBCSN,IBICU,IBOK S (IBOK,IBCSICU)=0,BS=+$G(BS) S IBICU=$$MCCRUTL^IBCRU1("ICU",5) S IBCSN=$G(^IBE(363.1,+$G(CS),0)) I $E(IBCSN,1,2)'="RC" S IBOK=1 I $P(IBCSN,U,1)["ICU" S IBCSICU=1 ; charge set is icu ; I BS=IBICU,+IBCSICU S IBOK=1 ; both bedsection and charge set are icu I BS'=IBICU,'IBCSICU S IBOK=1 ; niether bedsection nor charge set are icu Q IBOK