| 1 | IBAECO ;ALB/BGA - LONG TERM CARE OUTPATIENT TRACKER ;16-OCT-01
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| 2 | ;;2.0;INTEGRATED BILLING;**164,171,176,188,312**;21-MAR-94
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| 3 | ;;Per VHA DIRECTIVE 10-93-142, this routine should not be modified.
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| 4 | ;
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| 5 | ; Comment- This routine is invoked via the appointment driver ^IBAMTS
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| 6 | ; This program checks for check outs and determines if
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| 7 | ; the person checking out is ELIGIBLE for Long Term Care
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| 8 | ; and determines if the encounter was related to LTC.
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| 9 | ; If the episode of care is related to LTC and the patient
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| 10 | ; is eligible to receive care and is compliant with all
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| 11 | ; the LTC business rules than the entry is added to
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| 12 | ; the LTC transaction file #351.8.
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| 13 | ;
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| 14 | ; Determine if this encounter has a status of checked out
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| 15 | EN N IBEVT,IBEV0,DFN,IBSDHDL,IBORG,IBOE,IBLTCST,IBCL,IBDT,IBST,IBM
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| 16 | N IBSWINFO S IBSWINFO=$$SWSTAT^IBBAPI() ;IB*2.0*312
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| 17 | S IBSDHDL=0
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| 18 | ;
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| 19 | ; === ON/OFF Switch by date if before 11/15/06 software will not run
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| 20 | ; === IBALTC=0 the Encounter is not LTC Billable pass to MT Module
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| 21 | ; === IBALTC=1 Encounter is LTC Billable do NOT Pass to MTC
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| 22 | ;
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| 23 | S IBALTC=0
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| 24 | ;I DT<$$STDATE^IBAECU1() Q ;quit if today<effective date
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| 25 | F S IBSDHDL=$O(^TMP("SDEVT",$J,IBSDHDL)) Q:'IBSDHDL D
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| 26 | . S IBORG=0 F S IBORG=$O(^TMP("SDEVT",$J,IBSDHDL,IBORG)) Q:'IBORG D
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| 27 | . . S IBOE=0 F S IBOE=$O(^TMP("SDEVT",$J,IBSDHDL,IBORG,"SDOE",IBOE)) Q:'IBOE S IBEVT=$G(^(IBOE,0,"AFTER")),IBEV0=$G(^("BEFORE")) D
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| 28 | . . . ;
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| 29 | . . . Q:$P(IBEVT,U,6) ; do not evaluate sibling encounters
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| 30 | . . . Q:$P(IBEVT,U,12)=8 ; do not evaluate inpatient encounters
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| 31 | . . . ;
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| 32 | . . . ; set variables
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| 33 | . . . S DFN=$P(IBEVT,U,2),IBDT=$S(+IBEVT:+IBEVT,1:+IBEV0),IBST=$P(IBEVT,U,3)
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| 34 | . . . Q:IBDT<$$STDATE^IBAECU1
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| 35 | . . . Q:'DFN!('IBDT)
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| 36 | . . . ;
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| 37 | . . . ; Do NOT PROCESS on VistA if IBDT>=Switch Eff Date ;CCR-930
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| 38 | . . . I +IBSWINFO,(IBDT+1)>$P(IBSWINFO,"^",2) Q ;IB*2.0*312
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| 39 | . . . ;
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| 40 | . . . ; stop code preset and LTC event?
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| 41 | . . . I 'IBST Q
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| 42 | . . . I '$$LTCSTOP^IBAECU(IBST) Q
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| 43 | . . . ;
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| 44 | . . . ; set flag to stop MT billing
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| 45 | . . . S IBALTC=1
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| 46 | . . . ;
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| 47 | . . . ; LTC patient check
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| 48 | . . . S IBLTCST=+$$LTCST^IBAECU(DFN,IBDT\1,1)
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| 49 | . . . ;
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| 50 | . . . ; no 1010EC on file
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| 51 | . . . I IBLTCST=0 D D XMNOEC^IBAECU(DFN,.IBDT,.IBM) Q
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| 52 | . . . . S IBM(1)="",IBM(2)=" Event Type: Outpatient Encounter"
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| 53 | . . . . S IBM(3)="",IBM(4)="Event Action: "_$S($P(IBEV0,"^",12)'=2&($P(IBEVT,"^",12)=2):"Checked Out",IBEVT&(IBEV0):"Edited",IBEV0:"Deleted",1:"Added")
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| 54 | . . . . S IBM(5)="",IBM(6)=" Location: "_$S($P(IBEVT,"^",4):$P($G(^SC(+$P(IBEVT,"^",4),0)),"^"),$P(IBEVO,"^",4):$P($G(^SC(+$P(IBEVO,"^",4),0)),"^"),1:"")
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| 55 | . . . ;
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| 56 | . . . ; is this a back billing issue, if so, send message and quit
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| 57 | . . . I $$LASTMJ^IBAECU()>0,$$LASTMJ^IBAECU()>IBDT D D XMBACK^IBAECU(DFN,.IBM) Q
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| 58 | . . . . S IBM(1)="An Outpatient Encounter was "_$S(IBEVT&(IBEV0):"Edited",IBEV0:"Deleted",1:"Added")_"."
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| 59 | . . . . S IBM(2)="This may result in a Back Billing issue for LTC. You should review the"
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| 60 | . . . . S IBM(3)="patient's records for "_$$FMTE^XLFDT(IBDT)_" to ensure correct billing."
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| 61 | . . . . S IBM(4)="LTC Billing Clock and LTC charges may have to be manually adjusted."
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| 62 | . . . ;
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| 63 | . . . ; add LTC clock/update last event date (if not LTC exempt)
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| 64 | . . . I IBLTCST=2 S IBCL=$$CLOCK^IBAECU(DFN,IBDT\1)
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| 65 | . . . ;
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| 66 | ;
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| 67 | Q
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| 68 | ;
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| 69 | CALC ; used to calculate the outpatient charge
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| 70 | ; variables needed DFN, IBLTCST, IBCHG, IBFR
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| 71 | ; this will adjust IBCHG so the patient is not above their calculated
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| 72 | ; copay cap for the month.
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| 73 | N IBTYP,IBT
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| 74 | ;
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| 75 | ; find all LTC charges and set flag to determine inpt or opt
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| 76 | ; cap to be used.
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| 77 | D TOT^IBAECU
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| 78 | ;
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| 79 | W !!," Calculated Monthly Copay Cap Type to be used: ",$S(IBTYP="I":"IN",1:"OUT"),"PATIENT"
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| 80 | W !," Calculated Monthly Copay Cap is: $ ",$FN($P(IBLTCST,"^",$S(IBTYP="I":3,1:5)),",",2)
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| 81 | W !," Total previously billed: $ ",$FN(IBT,",",2)
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| 82 | ;
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| 83 | I IBCHG+IBT>$P(IBLTCST,"^",$S(IBTYP="I":3,1:5)) S IBCHG=$P(IBLTCST,"^",$S(IBTYP="I":3,1:5))-IBT
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| 84 | ;
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| 85 | ; check for negative $ amount cap
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| 86 | I $P(IBLTCST,"^",$S(IBTYP="I":3,1:5))<0 S IBCHG=0
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| 87 | ;
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| 88 | Q
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