IBCRHBR6 ;ALB/ARH - RATES: UPLOAD (RC) SITE CALCULATIONS ; 10-OCT-1998 ;;2.0;INTEGRATED BILLING;**106,138,148,169,245**;21-MAR-94 ;;Per VHA Directive 10-93-142, this routine should not be modified. ; INPT(SITE) ; use Inpatient Facility National Rates to calculate Site Specific Rates N IBXTMPC,IBXTMPA,IBSITE,IBXRF1,IBXRF2,IBAA,IBI,IBDRG,IBEFF,IBINA,IBCHRG,IBSNS,IBDRMB,IBSRMB,IBDANC,IBSANC,IBRG,IBRATE,IBEVNT,IBBS,IBCSRB,IBCSAN ; S IBXTMPC="IBCR RC A",IBXTMPA="IBCR RC B",IBSITE=$$SITE(SITE,IBXTMPA,"Inpatient Facility") Q:'IBSITE S IBXRF1="IBCR UPLOAD RC "_$P(IBSITE,U,2)_" "_$P(IBSITE,U,3),IBXRF2="Inpt Fac" W !,$P(IBSITE,U,2)," ",$P(IBSITE,U,3)," - Inpatient Facility Charges" ; S IBAA=$G(^XTMP(IBXTMPA,+IBSITE)) Q:IBAA="" ; S IBRG=$$RG^IBCRHU2("RC "_$P(IBSITE,U,2)_" - "_$P(IBSITE,U,3),$P(IBSITE,U,2),$P(IBSITE,U,4)),IBRG=$P(IBRG,U,2) S IBRATE="RC INPATIENT FACILITY" S IBEVNT="INPATIENT DRG" S IBBS="GENERAL MEDICAL CARE" S IBCSRB=$$CS^IBCRHU2("RC-INPT R&B "_$P(IBSITE,U,2),IBRATE,IBEVNT,IBRG,"INST",101,IBBS) S IBCSAN=$$CS^IBCRHU2("RC-INPT ANC "_$P(IBSITE,U,2),IBRATE,IBEVNT,IBRG,"INST",240,IBBS) ; S IBI=0 F S IBI=$O(^XTMP(IBXTMPC,IBI)) Q:'IBI D I '(IBI#100) W "." . S IBDRG=$G(^XTMP(IBXTMPC,IBI)) Q:IBDRG="" . ; . S IBEFF=$P(IBDRG,U,5) I $P(IBAA,U,7)>IBEFF S IBEFF=$P(IBAA,U,7) . S IBINA=$P(IBDRG,U,6) I $P(IBAA,U,8)>IBINA S IBINA=$P(IBAA,U,8) . ; . S IBSNS=$P(IBDRG,U,2) . S IBDRMB=$P(IBDRG,U,3),IBSRMB=$S(IBSNS="S":$P(IBAA,U,2),IBSNS="N":$P(IBAA,U,4),1:0) . S IBCHRG=IBDRMB*IBSRMB,IBCHRG=$J(IBCHRG,0,$$RND) . D SET(IBXRF1,IBXRF2_" R&B","DRG"_+$P(IBDRG,U,1),IBEFF,IBINA,+IBCHRG,"",IBCSRB,4) . ; . S IBDANC=$P(IBDRG,U,4),IBSANC=$S(IBSNS="S":$P(IBAA,U,3),IBSNS="N":$P(IBAA,U,5),1:0) . S IBCHRG=IBDANC*IBSANC,IBCHRG=$J(IBCHRG,0,$$RND) . D SET(IBXRF1,IBXRF2_" Anc","DRG"_+$P(IBDRG,U,1),IBEFF,IBINA,+IBCHRG,"",IBCSAN,4) Q ; SNF(SITE) ; Skilled Nursing N IBXTMPC,IBXTMPA,IBSITE,IBXRF1,IBXRF2,IBAA,IBI,IBDRG,IBEFF,IBINA,IBCHRG,IBRG,IBRATE,IBEVNT,IBBS,IBCS ; ; S IBXTMPC="IBCR RC A",IBXTMPA="IBCR RC B",IBSITE=$$SITE(SITE,IBXTMPA,"Skilled Nursing") Q:'IBSITE S IBXRF1="IBCR UPLOAD RC "_$P(IBSITE,U,2)_" "_$P(IBSITE,U,3),IBXRF2="Inpt SNF" W !,$P(IBSITE,U,2)," ",$P(IBSITE,U,3)," - Inpatient Skilled Nursing Charges" ; S IBRG=$$RG^IBCRHU2("RC "_$P(IBSITE,U,2)_" - "_$P(IBSITE,U,3),$P(IBSITE,U,2),$P(IBSITE,U,4)),IBRG=$P(IBRG,U,2) S IBRATE="RC SKILLED NURSING/SUB-ACUTE" S IBEVNT="UNASSOCIATED" S IBBS="SKILLED NURSING/SUB-ACUTE CARE" S IBCS=$$CS^IBCRHU2("RC-SNF "_$P(IBSITE,U,2),IBRATE,IBEVNT,IBRG,"INST","100",IBBS) ; S IBAA=$G(^XTMP(IBXTMPA,+IBSITE)) Q:IBAA="" ; S IBI=0 F S IBI=$O(^XTMP(IBXTMPC,IBI)) Q:'IBI D . S IBDRG=$G(^XTMP(IBXTMPC,IBI)) I $P(IBDRG,U,1)'=999 Q . ; . S IBEFF=$P(IBDRG,U,5) I $P(IBAA,U,7)>IBEFF S IBEFF=$P(IBAA,U,7) . S IBINA=$P(IBDRG,U,6) I $P(IBAA,U,8)>IBINA S IBINA=$P(IBAA,U,8) . ; . S IBCHRG=$P(IBAA,U,6)*$P(IBDRG,U,3),IBCHRG=$J(IBCHRG,0,$$RND) . D SET(IBXRF1,IBXRF2,"SKILLED NURSING CARE",IBEFF,IBINA,+IBCHRG,"",IBCS,9) . S IBCHRG=$P(IBAA,U,6)*$P(IBDRG,U,3),IBCHRG=$J(IBCHRG,0,$$RND) . D SET(IBXRF1,IBXRF2,"SUB-ACUTE CARE",IBEFF,IBINA,+IBCHRG,"",IBCS,9) Q ; OPT(SITE) ; use Outpatient Facility National Rates to calculate Site Specific Rates N IBXTMPC,IBXTMPA,IBSITE,IBXRF1,IBXRF2,IBAA,IBI,IBCPT,IBEFF,IBINA,IBCHRG,IBRG,IBRATE,IBEVNT,IBBS,IBCS ; S IBXTMPC="IBCR RC C",IBXTMPA="IBCR RC D",IBSITE=$$SITE(SITE,IBXTMPA,"Outpatient Facility") Q:'IBSITE S IBXRF1="IBCR UPLOAD RC "_$P(IBSITE,U,2)_" "_$P(IBSITE,U,3),IBXRF2="Opt Fac" W !,$P(IBSITE,U,2)," ",$P(IBSITE,U,3)," - Outpatient Facility Charges" ; S IBRG=$$RG^IBCRHU2("RC "_$P(IBSITE,U,2)_" - "_$P(IBSITE,U,3),$P(IBSITE,U,2),$P(IBSITE,U,4)),IBRG=$P(IBRG,U,2) S IBRATE="RC FACILITY PR" S IBEVNT="PROCEDURE" S IBBS="OUTPATIENT VISIT" S IBCS=$$CS^IBCRHU2("RC-OPT FAC "_$P(IBSITE,U,2),IBRATE,IBEVNT,IBRG,"INST",510,IBBS) ; S IBAA=$G(^XTMP(IBXTMPA,+IBSITE)) Q:IBAA="" ; S IBI=0 F S IBI=$O(^XTMP(IBXTMPC,IBI)) Q:'IBI D I '(IBI#100) W "." . S IBCPT=$G(^XTMP(IBXTMPC,IBI)) Q:IBCPT="" . ; . I +$P(IBCPT,U,5),$P(IBCPT,U,5)'=$P(IBAA,U,5) Q ; site limited charge . ; . S IBEFF=$P(IBCPT,U,3) I $P(IBAA,U,3)>IBEFF S IBEFF=$P(IBAA,U,3) . S IBINA=$P(IBCPT,U,4) I $P(IBAA,U,4)>IBINA S IBINA=$P(IBAA,U,4) . ; . S IBCHRG=+$P(IBAA,U,2)*$P(IBCPT,U,2),IBCHRG=$J(IBCHRG,0,2) . D SET(IBXRF1,IBXRF2,$P(IBCPT,U,1),IBEFF,IBINA,+IBCHRG,"",IBCS,2) Q ; PCE(SITE) ; use Physician (General) National Rates to calculate Site Specific Rates N IBXTMPC,IBXTMPA,IBSITE,IBXRF1,IBXRF2,IBAA,IBI,IBCPT,IBEFF,IBINA,IBCHRG,IBAAM,IBCGP,IBC1,IBC2,IBC3,IBOK,IBRG,IBRATE,IBEVNT,IBBS,IBCS S IBOK=1 ; S IBXTMPC="IBCR RC E",IBXTMPA="IBCR RC H",IBSITE=$$SITE(SITE,IBXTMPA,"Physician E") Q:'IBSITE S IBXRF1="IBCR UPLOAD RC "_$P(IBSITE,U,2)_" "_$P(IBSITE,U,3),IBXRF2="Phys Fee E" W !,$P(IBSITE,U,2)," ",$P(IBSITE,U,3)," - Physician Charges E" ; S IBRG=$$RG^IBCRHU2("RC "_$P(IBSITE,U,2)_" - "_$P(IBSITE,U,3),$P(IBSITE,U,2),$P(IBSITE,U,4)),IBRG=$P(IBRG,U,2) S IBRATE="RC PHYSICIAN PR" S IBEVNT="PROCEDURE" S IBBS="OUTPATIENT VISIT" S IBCS=$$CS^IBCRHU2("RC-PHYSICIAN "_$P(IBSITE,U,2),IBRATE,IBEVNT,IBRG,"PROF",510,IBBS) ; S IBAA=$G(^XTMP(IBXTMPA,+IBSITE)) Q:IBAA="" S IBAAM=$G(^XTMP(IBXTMPA,+IBSITE,"BC")) Q:IBAAM="" ; S IBI=0 F S IBI=$O(^XTMP(IBXTMPC,IBI)) Q:'IBI D W:'(IBI#100) "." I 'IBOK Q . S IBCPT=$G(^XTMP(IBXTMPC,IBI)) Q:IBCPT="" . S IBCGP=$$CGP($P(IBCPT,U,5),IBXTMPC_"="_$P(IBCPT,U,1)) I 'IBCGP S IBOK=0 Q . ; . S IBEFF=$P(IBCPT,U,7) I $P(IBAA,U,5)>IBEFF S IBEFF=$P(IBAA,U,5) . S IBINA=$P(IBCPT,U,8) I $P(IBAA,U,6)>IBINA S IBINA=$P(IBAA,U,6) . ; . S IBC1=$P(IBCPT,U,3)*$P(IBAA,U,3)*$P(IBAA,U,2) . S IBC2=$P(IBCPT,U,4)*$P(IBAA,U,4) . S IBC3=$P(IBCPT,U,6)*$P(IBAAM,U,IBCGP) . S IBCHRG=(IBC1+IBC2)*IBC3,IBCHRG=$J(IBCHRG,0,2) . D SET(IBXRF1,IBXRF2,$P(IBCPT,U,1),IBEFF,IBINA,+IBCHRG,$P(IBCPT,U,2),IBCS,2) Q ; PCF(SITE) ; use Physician (Path & Anesthesia) National Rates to calculate Site Specific Rates N IBXTMPC,IBXTMPA,IBSITE,IBXRF1,IBXRF2,IBAA,IBI,IBCPT,IBEFF,IBINA,IBCHRG,IBAAM,IBCGP,IBOK,IBCS S IBOK=1 ; S IBXTMPC="IBCR RC F",IBXTMPA="IBCR RC H",IBSITE=$$SITE(SITE,IBXTMPA,"Physician F") Q:'IBSITE S IBXRF1="IBCR UPLOAD RC "_$P(IBSITE,U,2)_" "_$P(IBSITE,U,3),IBXRF2="Phys Fee F" W !,$P(IBSITE,U,2)," ",$P(IBSITE,U,3)," - Physician Charges F" ; S IBCS=$$USECS^IBCRHU2("RC-PHYSICIAN "_$P(IBSITE,U,2)) ; S IBAA=$G(^XTMP(IBXTMPA,+IBSITE)) Q:IBAA="" S IBAAM=$G(^XTMP(IBXTMPA,+IBSITE,"BC")) Q:IBAAM="" ; S IBI=0 F S IBI=$O(^XTMP(IBXTMPC,IBI)) Q:'IBI D W:'(IBI#100) "." I 'IBOK Q . S IBCPT=$G(^XTMP(IBXTMPC,IBI)) Q:IBCPT="" . S IBCGP=$$CGP($P(IBCPT,U,4),IBXTMPC_"="_$P(IBCPT,U,1)) I 'IBCGP S IBOK=0 Q . ; . S IBEFF=$P(IBCPT,U,5) I $P(IBAA,U,5)>IBEFF S IBEFF=$P(IBAA,U,5) . S IBINA=$P(IBCPT,U,6) I $P(IBAA,U,6)>IBINA S IBINA=$P(IBAA,U,6) . ; . S IBCHRG=+$P(IBAAM,U,IBCGP)*$P(IBCPT,U,3),IBCHRG=$J(IBCHRG,0,2) . D SET(IBXRF1,IBXRF2,$P(IBCPT,U,1),IBEFF,IBINA,+IBCHRG,$P(IBCPT,U,2),IBCS,2) Q ; PCG(SITE) ; use Physician (Total RVU) National Rates to calculate Site Specific Rates N IBXTMPC,IBXTMPA,IBXRF1,IBXRF2,IBSITE,IBAA,IBAAM,IBI,IBCPT,IBCGP,IBEFF,IBINA,IBCHRG,IBCS ; S IBXTMPC="IBCR RC G",IBXTMPA="IBCR RC I",IBSITE=$$SITE(SITE,IBXTMPA,"Physician G") Q:'IBSITE S IBXRF1="IBCR UPLOAD RC "_$P(IBSITE,U,2)_" "_$P(IBSITE,U,3),IBXRF2="Phys Fee G" W !,$P(IBSITE,U,2)," ",$P(IBSITE,U,3)," - Physician Charges G" ; S IBCS=$$USECS^IBCRHU2("RC-PHYSICIAN "_$P(IBSITE,U,2)) ; S IBAA=$G(^XTMP(IBXTMPA,+IBSITE)) Q:IBAA="" S IBAAM=$G(^XTMP("IBCR RC H",+IBSITE,"BC")) Q:IBAAM="" ; S IBI=0 F S IBI=$O(^XTMP(IBXTMPC,IBI)) Q:'IBI D I '(IBI#100) W "." . S IBCPT=$G(^XTMP(IBXTMPC,IBI)) Q:IBCPT="" . S IBCGP=$$CGP($P(IBCPT,U,4),IBXTMPC_"="_$P(IBCPT,U,1)) I 'IBCGP S IBOK=0 Q . ; . S IBEFF=$P(IBCPT,U,6) I $P(IBAA,U,3)>IBEFF S IBEFF=$P(IBAA,U,3) . S IBINA=$P(IBCPT,U,7) I $P(IBAA,U,4)>IBINA S IBINA=$P(IBAA,U,4) . ; . S IBCHRG=+$P(IBAAM,U,IBCGP)*$P(IBAA,U,2)*$P(IBCPT,U,3)*$P(IBCPT,U,5),IBCHRG=$J(IBCHRG,0,2) . D SET(IBXRF1,IBXRF2,$P(IBCPT,U,1),IBEFF,IBINA,+IBCHRG,$P(IBCPT,U,2),IBCS,2) Q ; SITE(IBSXIFN,IBXTMP,IBCHGTYP) ; return site data: XTMP file IFN ^ div num ^ name ^ 3-digit zip N IBSITE,IBSXTMP,IBSITEN S IBSITE="",IBSXTMP="IBCR RC SITE" S IBSITE=$G(^XTMP(IBSXTMP,IBSXIFN,IBXTMP)),IBSITEN=$G(^XTMP(IBSXTMP,IBSXIFN)) I +IBSITE S IBSITE=IBSITE_U_$P(IBSITEN,U,1,3) I 'IBSITE W !,"There are no ",$G(IBCHGTYP)," charges for ",$P(IBSITEN,U,1)," ",$P(IBSITEN,U,2),"!",! Q IBSITE ; SETHDR(IBXRF1) ; set up header for XTMP file N IBX K ^XTMP(IBXRF1) S IBX="IB Upload RC v"_$$VERSION^IBCRHBRV_" "_$P(IBXRF1,"UPLOAD RC ",2)_", "_$P($$HTE^XLFDT($H,2),":",1,2)_" by "_$P($G(^VA(200,+$G(DUZ),0)),U,1) S ^XTMP(IBXRF1,0)=$$FMADD^XLFDT(DT,2)_U_DT_U_IBX Q ; SET(IBXRF1,IBXRF2,ITEM,EFFDT,INACTDT,CHRG,MOD,CS,ITYPE) ; set calculated charges into XTMP ; N IBX,IBK,IBINACT S IBX=$G(^XTMP(IBXRF1,0)) I IBX="" D SETHDR(IBXRF1) S IBK=+$P(IBX,U,4)+1,$P(^XTMP(IBXRF1,0),U,4)=IBK S ^XTMP(IBXRF1,IBXRF2)=(+$G(^XTMP(IBXRF1,IBXRF2))+1)_U_$G(ITYPE)_U_$G(CS) ; S ^XTMP(IBXRF1,IBXRF2,IBK)=ITEM_U_$$DATE(EFFDT)_U_$$ENDDT(INACTDT)_U_+CHRG_U_$G(MOD) Q ; CGP(CG,TXT) ; if Code Group is defined return benefit category number in list N IBCGP I '$D(^TMP($J,"IBCR RC CGROUP")) D CGROUP^IBCRHBR S IBCGP=0 I $G(CG)'="" S IBCGP=+$G(^TMP($J,"IBCR RC CGROUP",CG)) I '$G(IBCGP) W !," *** Fatal Error: ",$G(TXT),!,?21,"could not find Code Group: ",CG Q IBCGP ; DATE(X) ; return yyyymmdd in FM format N Y S Y="" I $G(X)?8N S Y=$S($E(X,1,4)>1999:3,1:2)_$E(X,3,4)_$E(X,5,8) Q Y ; ENDDT(X) ; return yyyymmdd date in FM format, check version inactive date N Y,V S Y=$$DATE($G(X)) I 'Y S V=$G(^XTMP("IBCR RC SITE","VERSION INACTIVE")) I +V S Y=V Q Y ; RND() ; N Y S Y=$$VERSION^IBCRHBRV S Y=$S(Y=1:0,1:2) Q Y