[613] | 1 | FBDOC ;ALBISC\TET - ROUTINE DOCUMENTATION ;10/9/92 11:24
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| 2 | ;;3.5;FEE BASIS;**48**;JAN 30, 1995
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| 3 | ;;Per VHA Directive 10-93-142, this routine should not be modified.
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| 4 | ;Routine contains documentation of other routines. Name sets
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| 5 | ; of routines are indicated in line label.
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| 6 | FBPCR ;
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| 7 | ;POTENTIAL COST RECOVERY REPORT
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| 8 | ;user selects primary service areas and date range.
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| 9 | ;The user is able to filter data to include Copays or Insurance only
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| 10 | ;related information:
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| 11 | ; Include (P)atient Co-pays / (I)nsurance / (B)oth
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| 12 | ;If the user selects (P) or (B),the following prompt will allow
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| 13 | ;the user to include Mean Test or LTC copays only or Both:
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| 14 | ; Include (M)eans Test Co-pays /(L)TC Co-pays /(B)oth
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| 15 | ;output will sort by primary service area, patient, program, vendor, date.
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| 16 | ;only those that are means test category c/agree to pay deductible
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| 17 | ; or for non-service connected treatment are printed, as well as
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| 18 | ; insurance information.
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| 19 | ;Since 7/5/2002 all LTC related payments are flagged in the report with
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| 20 | ;appropriate messages. If the veteran doesn't have LTC test on file then
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| 21 | ;the LTC related payment is flagged with "1010EC missing" message.
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| 22 | ;
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| 23 | ;outpatient info - program 2 - fbpcr2 uses date finalized for date range sort
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| 24 | ; o for each service on a treatment date the value of the
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| 25 | ; 'service connected y/n' field is checked.
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| 26 | ; if no, flag to collect from insurance is set.
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| 27 | ; o for the INITIAL TREATMENT DATE, checks if patient was cat c
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| 28 | ; and agreed to pay deductible or was not exempt from LTC copay.
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| 29 | ; if true, then software uses IB call to determine if patient
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| 30 | ; is insured on treatment date
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| 31 | ; o if service is for C&P, or both of the above two flags are
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| 32 | ; negative, record is bypassed.
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| 33 | ;pharmacy info - program 3 - fbpcr3 uses date certified for payment for date range sort
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| 34 | ; o for each invoice number, RX number for a patient within the
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| 35 | ; specified date range, the value of the rx fill date field is
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| 36 | ; obtained and checked against the authorization in the fee
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| 37 | ; patient file. a check is made to see if the value of the
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| 38 | ; potential cost recovery field is yes for an authorization
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| 39 | ; which encompasses the fill date.
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| 40 | ; if yes, then software uses IB call to determine if patient
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| 41 | ; is insured on date certified for payment
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| 42 | ; o for date certified for payment, checks if patient was cat c
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| 43 | ; and agreed to pay deductible. if true, flag to collect from
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| 44 | ; patient is set.
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| 45 | ; o if both of the above two flags are negative, record is bypassed.
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| 46 | ;ch/cnh info - programs 6 and 7 - fbpcr67* uses date finalized for date range sort
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| 47 | ; o for each record, for a patient within the specified date
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| 48 | ; range, the value of the treatment from date is obtained
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| 49 | ; and checked against the authorization in the fee patient file.
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| 50 | ; a check is made to see if the value of the potential cost
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| 51 | ; recovery field is yes for an authorization which encompasses
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| 52 | ; the treatment from date.
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| 53 | ; if yes, then software uses IB call to determine if patient
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| 54 | ; is insured on date certified for payment.
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| 55 | ; o for TREATMENT FROM DATE and TREATMENT TO DATE, checks if
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| 56 | ; patient was cat c and agreed to pay deductible or was not
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| 57 | ; exempt from LTC copay. if true, flag to collect from patient
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| 58 | ; is set.
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| 59 | ; o if both of the above two flags are negative, record is bypassed.
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