| [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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