IBTOUR1 ;ALB/AAS - CLAIMS TRACKING UR/ACTIVITY REPORT ; 27-OCT-93 ;;Version 2.0 ; INTEGRATED BILLING ;**56**; 21-MAR-94 ; % ; ; ibcnt(1) = total count of admissions ; ibcnt(1,1) = total count of admissions to nhcu ; ibcnt(1,2) = total count of admissions to domiciliary ; ibcnt(2) = total count of insured admissions ; ibcnt(3,0) = total count of billable admissions ; ibcnt(3,n) = count of non-billable admissions by reason (n) ; ibcnt(4) = count of admissions requiring reviews ; ibcnt(5) = admissions with pre-cert and follow-up ; ibcnt(6) = no pre-cert but active monitoring required ; ibcnt(7) = new closed cases = discharged, or no next rev. date, or ur not required ; ibcnt(7,0) = new cases closed, billable ; ibcnt(7,1) = new cases closed, not billable ; ibcnt(8) = new cases open (not closed) ; ; ibcnt(9) = previous case (find in REV), adm prior to begin date ; ibcnt(9,0) = cases closed billable ; ibcnt(9,1) = cases closed non-billable ; ibcnt(9,2) = previous cases still open ; ; ^tmp($j,"ibtour", $s(pt. name/specialty/review date) ,pt. name,sort3,ibtrc)=^ibt(ibtrc,0) ; ^tmp($j,"ibtour1",specialty)=days approved, days denied, $approved, $denied) ; BLD ; -- build data ;initialize summary array F I=1:1:11 S IBCNT(I)=0 I I=7!(I=9) F J=0:1:2 S IBCNT(I,J)=0 F I=40:1:52 S IBCNT(I)=0 I I=45 F J=1:1:3 S IBCNT(I,J)=0 ; D ADM D:IBSORT'="H" IREV^IBTOUR2,ISUB D:IBSORT'="I" HREV^IBTOUR2,HSUB^IBTOUR5 Q ; ADM ; -- count admission D CHK^IBTOSUM2 I $G(ZTSTOP) Q S IBDT=IBBDT-.000000001 F S IBDT=$O(^DGPM("AMV1",IBDT)) Q:'IBDT!(IBDT>(IBEDT+.24)) D .S DFN=0 F S DFN=$O(^DGPM("AMV1",IBDT,DFN)) Q:'DFN D ..S DGPM=0 F S DGPM=$O(^DGPM("AMV1",IBDT,DFN,DGPM)) Q:'DGPM D ...S IBCNT(1)=IBCNT(1)+1 ; count of admissions ...I $P($G(^DIC(42,+$P(^DGPM(DGPM,0),"^",6),0)),"^",3)="NH" S IBCNT(1,1)=$G(IBCNT(1,1))+1 ; count nhcu admissions ...I $P($G(^DIC(42,+$P(^DGPM(DGPM,0),"^",6),0)),"^",3)="D" S IBCNT(1,2)=$G(IBCNT(1,2))+1 ; count domiciliary admissions ...S IBTRN=$O(^IBT(356,"AD",DGPM,0)) ...Q:'IBTRN ...S IBTRND=$G(^IBT(356,+IBTRN,0)) ...Q:'$P(IBTRND,"^",20) ...S X=$P($G(^IBT(356,+IBTRN,1)),"^",7) I X>3 S IBCNT(4)=IBCNT(4)+1,^TMP($J,"IBTOUR0",IBTRN)=IBTRN ;reviews required ...I X="",$P(IBTRND,"^",24),'$P(IBTRND,"^",19) S IBCNT(4)=IBCNT(4)+1,^TMP($J,"IBTOUR0",IBTRN)=IBTRN ...; ...S IBINS=$$INSURED^IBCNS1(DFN,IBDT) I IBINS S IBCNT(2)=IBCNT(2)+1 ; count of insured admissions ...I IBINS S IBCNT(3,+$P(IBTRND,"^",19))=$G(IBCNT(3,+$P(IBTRND,"^",19)))+1 ;count of NOT Billable by reason billable Q ; ISUB ; -- count subtotals for cases reviewed N IBTRN,IBCLOS,DGPM,IBTPREV S IBTRN="" F S IBTRN=$O(^TMP($J,"IBTOUR0",IBTRN)) Q:'IBTRN D .S IBTRND=$G(^IBT(356,+IBTRN,0)) .Q:'$P(IBTRND,"^",20) ;inactive case .Q:$P(IBTRND,"^",8) ;rx fill, don't count .S DGPM=$P($G(^IBT(356,+IBTRN,0)),"^",5) .S IBCLOS=$$CLOSED(DGPM,IBTRN) .S IBTPREV=0 I $P($G(^IBT(356,+IBTRN,0)),"^",6)4 S IBCNT(5)=IBCNT(5)+1 I IBX=4 S IBCNT(6)=IBCNT(6)=1 ; I IBCLOS S IBCNT(7,$S($P(IBTRND,"^",19):1,1:0))=IBCNT(7,$S($P(IBTRND,"^",19):1,1:0))+1,IBCNT(7)=IBCNT(7)+1 ; I 'IBTPREV S IBX=$P($G(^IBT(356,+IBTRN,1)),"^",7) I IBX,IBX<4 S IBCNT(4)=IBCNT(4)+1 ; new case rev not required, but done. ; I 'IBCLOS,'IBTPREV S IBCNT(8)=IBCNT(8)+1 ;new cases still open I '$P(IBTRND,"^",5),$P(^IBE(356.6,+$P(IBTRND,"^",18),0),"^",8)=5 S IBCNT(11)=IBCNT(11)+1 CASEQ Q ; CLOSED(DGPM,IBTRN) ; -- is case closed N IBI,IBJ,IBCLOSE S IBCLOSE=0 I $P($G(^DGPM(+DGPM,0)),"^",17) S IBCLOSE=1 G CLOSEDQ ; - discharged I '$P($G(^IBT(356,+IBTRN,0)),"^",24) S IBCLOSE=1 G CLOSEDQ ; ur no longer required ; ; -- see if any reviews are still pending S IBCLOSE=1,IBI=0 F S IBI=$O(^IBT(356.2,"C",+IBTRN,IBI)) Q:'IBI I $P(^IBT(356.2,IBI,0),"^",24)>IBEDT S IBCLOSE=0 Q ; CLOSEDQ Q IBCLOSE ; PREV ; -- previous case Q:'$G(IBTPREV) I $P(IBTRND,"^",4)!($P(IBTRND,"^",8))!($P(IBTRND,"^",9)) Q ; only count previous admissions S IBCNT(9)=IBCNT(9)+1 ; number of previous cases I 'IBCLOS S IBCNT(9,2)=IBCNT(9,2)+1 ; still open I IBCLOS S IBCNT(9,$S($P(IBTRND,"^",19):1,1:0))=IBCNT(9,$S($P(IBTRND,"^",19):1,1:0))+1 ;closed and billable or not Q