[613] | 1 | IBCCCB0 ;ALB/ARH - COPY BILL FOR COB (OVERFLOW) ;06-19-97
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| 2 | ;;2.0;INTEGRATED BILLING;**51,137,155**;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 | DSPRB(IBIFN) ; display related bills
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| 6 | ;
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| 7 | N IBCOB,IBI,IBLABEL,IBJ,IBK,IBINS,IBAR,IBDS Q:'$G(IBIFN)
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| 8 | S IBDS="------------------------------------------------------------------"
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| 9 | D BCOB^IBCU3(IBIFN,.IBCOB) I $O(IBCOB(0)) D
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| 10 | . W !!!,?13,"Payer Responsible",?33,"Bill #",?41,"Status",?49,"Original",?59,"Collected",?72,"Balance",!,?13,IBDS
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| 11 | . S IBI=0 F S IBI=$O(IBCOB(IBI)) Q:'IBI D
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| 12 | .. S IBLABEL=$S(IBI=1:"Primary",IBI=2:"Secondary",IBI=3:"Tertiary",1:"Other")_":",IBLABEL=$J(IBLABEL,10)
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| 13 | .. S IBJ=0 F S IBJ=$O(IBCOB(IBI,IBJ)) Q:'IBJ D
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| 14 | ... S IBK="" F S IBK=$O(IBCOB(IBI,IBJ,IBK)) Q:IBK="" D
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| 15 | .... S IBINS=$G(^DIC(36,+IBJ,0))
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| 16 | .... W !," ",IBLABEL,?13,$E($P(IBINS,U),1,18) S IBLABEL="" Q:'IBK
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| 17 | .... S IBAR=$$BILL^RCJIBFN2(IBK)
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| 18 | .... W ?33,$P($G(^DGCR(399,+IBK,0)),U)
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| 19 | .... W ?43,$P($$STNO^RCJIBFN2(+$P(IBAR,U,2)),U,2)
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| 20 | .... W ?47,$J($P(IBAR,U),10,2)
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| 21 | .... W ?58,$J($P(IBAR,U,4),10,2)
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| 22 | .... W ?69,$J($P(IBAR,U,3),10,2)
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| 23 | I +$$IB^IBRUTL(IBIFN,0) W !!,?8,"* There are patient bills on Hold for the date range of this bill."
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| 24 | W !!
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| 25 | Q
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| 26 | ;
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| 27 | CTCOPY(IBIFN,IBMRA) ; based on the type of bill, copy it without cancelling
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| 28 | ; IBMRA = 1 if an MRA bill and copy for prof components is desired
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| 29 | ;
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| 30 | N IB0,IBCTYPE I +$G(IBCBCOPY) Q
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| 31 | S IB0=$G(^DGCR(399,+$G(IBIFN),0)),IBCTYPE=+$P(IB0,U,27) Q:'IBCTYPE
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| 32 | I $S('$G(IBMRA):$P(IB0,U,21)'=$E($$BINS^IBCU3(+$G(IBIFN))),1:0) Q ; don't copy if not first in series, current payer=first payer and not an MRA
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| 33 | I IBCTYPE=1 D CTCOPY1(IBIFN) Q
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| 34 | I IBCTYPE=2 D CTCOPY2(IBIFN) Q
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| 35 | Q
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| 36 | ;
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| 37 | CTCOPY1(IBIFN) ; Copy a Reasonable Charges inst bill to create a prof bill:
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| 38 | ; - Billing Rate must be Reasonable Charges
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| 39 | ; - Bill being copied must be an inst bill
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| 40 | ; - Prof bill must not already exist for the event date
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| 41 | ; - If the bill is outpt at least one CPT must have prof charges
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| 42 | ; - Procedure codes are copied only if the care is outpt
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| 43 | ;
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| 44 | N IB0,IBU,IBBTYPE,IBBCTO,IBBCTN,IBBCTOD,IBBCTND,IBNOCPT,IBCTCOPY,IBX,IBHV,IBNOTC
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| 45 | ;
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| 46 | S IBCTCOPY=1 ; flag - the copy function entered to auto copy Inst->Prof
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| 47 | ;
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| 48 | S IB0=$G(^DGCR(399,+$G(IBIFN),0)) Q:IB0="" S IBU=$G(^("U")) Q:'IBU
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| 49 | S IBBTYPE=$S($P(IB0,U,5)<3:"Inpatient",1:"Outpatient")
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| 50 | ;
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| 51 | S IBBCTO=$P(IB0,U,27),IBBCTN=0 I 'IBBCTO Q
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| 52 | I IBBCTO=1 S IBBCTN=2 ; inst defined, create prof
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| 53 | I 'IBBCTN Q
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| 54 | ;
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| 55 | I '$$BILLRATE^IBCRU3($P(IB0,U,7),$P(IB0,U,5),$P(IBU,U,1,2),"RC") Q ; copy only reasonable charges bills
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| 56 | ;
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| 57 | S IBBCTOD=$S(IBBCTO=1:"INSTITUTIONAL",2:"PROFESSIONAL"),IBBCTND=$S(IBBCTN=1:"INSTITUTIONAL",2:"PROFESSIONAL")
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| 58 | ;
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| 59 | I $P(IB0,U,5)>2,'$$CPTCHG^IBCRCU1(IBIFN,"PROF") W !!!,"There are no Reasonable Charges Outpatient Professional charges for this bill,",!,"second bill not created.",!! Q
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| 60 | ;
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| 61 | W !!!,"This ",IBBTYPE," ",IBBCTOD," bill may have corresponding ",IBBCTND," charges."
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| 62 | ;
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| 63 | I '$G(^DGCR(399,IBIFN,"U1")) W !!,"The current bill has no charges defined, no second bill created." Q
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| 64 | ;
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| 65 | S IBX=$$CTCHK^IBCU41(IBIFN) I +IBX W !!,"There is an existing ",IBBTYPE," ",IBBCTND," bill (",$P($G(^DGCR(399,+IBX,0)),U,1),") that appears",!,"to correspond to this ",IBBCTOD," bill, second bill not created.",!! Q
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| 66 | ;
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| 67 | W !,"Creating an ",IBBTYPE," ",IBBCTND," bill.",!!
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| 68 | ;
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| 69 | S IBCOB(0,27)=IBBCTN
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| 70 | S IBIDS(.15)=IBIFN D KVAR^IBCCCB
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| 71 | ;
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| 72 | I $P(IB0,U,5)<3 S IBNOCPT=1 ; do not copy inpt facility procedures (ICD) to inpt prof bill
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| 73 | S IBNOTC=1 ; don't copy TC modifier from inst to prof bill
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| 74 | D STEP2^IBCCC ; copy/create second bill
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| 75 | ;
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| 76 | I $G(IBHV("IBIFN1"))!(IBCTCOPY=1) D FTPRV^IBCEU5(+$G(IBHV("IBIFN1")),1) ; Change att to rend prov if new prof bill added
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| 77 | S IBV=0,IBAC=1
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| 78 | ;
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| 79 | ; DSS QuadraMed Interface: CPT Sequence and Diagnosis Linkage
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| 80 | I +$G(IBHV("IBIFN1")),$$QMED^IBCU1("CTCOPY^VEJDIBE1",IBHV("IBIFN1")) D CTCOPY^VEJDIBE1(IBHV("IBIFN1"))
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| 81 | Q
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| 82 | ;
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| 83 | CTCOPY2(IBIFN) ; Copy a Reasonable Charges prof bill to create another prof bill if user wants another:
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| 84 | ; - Billing Rate must be Reasonable Charges
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| 85 | ; - Bill being copied must be a prof bill
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| 86 | ; - Procedures are not copied
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| 87 | ;
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| 88 | N IB0,IBU,IBBTYPE,IBBCTO,IBNOCPT,IBCTCOPY,IBX,DIR,DIRUT,DUOUT,DTOUT,X,Y
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| 89 | ;
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| 90 | S IBCTCOPY=2 ; flag indicating the copy function is entered to auto Copy prof->prof
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| 91 | ;
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| 92 | S IB0=$G(^DGCR(399,+$G(IBIFN),0)) Q:IB0="" S IBU=$G(^("U")) Q:'IBU
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| 93 | S IBBTYPE=$S($P(IB0,U,5)<3:"Inpatient",1:"Outpatient")
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| 94 | S IBBCTO=$P(IB0,U,27) I IBBCTO'=2 Q ; prof bills only
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| 95 | ;
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| 96 | I '$$BILLRATE^IBCRU3($P(IB0,U,7),$P(IB0,U,5),$P(IBU,U,1,2),"RC") Q ; copy only reasonable charges bills
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| 97 | ;
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| 98 | I '$G(^DGCR(399,IBIFN,"U1")) Q ; if the current bill has no charges do not allow creation of another one
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| 99 | ;
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| 100 | ; ask if they want a second prof bill
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| 101 | S DIR("?",1)="If answered Yes, the current bill will be copied, without being cancelled,"
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| 102 | S DIR("?",2)="to create another Professional bill for the same dates of care.",DIR("?",3)=" "
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| 103 | S DIR("?")="Enter Yes if multiple professional bills are needed for the care provided on this date."
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| 104 | S DIR("A")="Copy this bill to create another Professional bill for this date now"
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| 105 | W !! S DIR(0)="Y",DIR("B")="No" D ^DIR I $D(DIRUT)!('Y) Q
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| 106 | ;
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| 107 | W !,"Creating an ",IBBTYPE," Professional bill.",!!
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| 108 | ;
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| 109 | S IBIDS(.15)=IBIFN D KVAR^IBCCCB
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| 110 | ;
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| 111 | S IBNOCPT=1
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| 112 | D STEP2^IBCCC ; copy/create second prof bill
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| 113 | S IBV=0,IBAC=1
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| 114 | Q
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| 115 | ;
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| 116 | ;
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| 117 | FINALEOB(IBIFN) ; Returns 1 if user indicates final EOB has been received
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| 118 | ; from prior payer
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| 119 | N DIR,X,Y,IBOK
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| 120 | S IBOK=0
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| 121 | I '$$MCRONBIL^IBEFUNC(IBIFN) D G FEOBQ
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| 122 | . S DIR(0)="YA",DIR("B")="NO",DIR("A")="Has the final EOB been received for this claim?: "
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| 123 | . S DIR("?",1)="COB should not normally be performed until the claim is fully processed by the",DIR("?",2)="prior payer. Enter Y (yes) if the prior payer's final EOB has",DIR("?")="been received"
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| 124 | . D ^DIR K DIR
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| 125 | . I Y'=0 S IBOK=$S(Y>0:1,1:0)
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| 126 | I $$SPLTMRA^IBCEMU1(IBIFN)=1 D G FEOBQ
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| 127 | . W !!," Only one MRA has been received for this claim. The MRA on file indicates"
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| 128 | . W !," that it is a 'split MRA' meaning that additional MRA's are needed."
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| 129 | . W !," Processing cannot continue until all MRA's have been received for this claim."
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| 130 | . W ! S DIR(0)="E" D ^DIR K DIR
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| 131 | . Q
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| 132 | ;
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| 133 | I $$SPLTMRA^IBCEMU1(IBIFN)>1 D
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| 134 | . W !!," At least 2 MRA's have been received for this claim."
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| 135 | . W !,"Please verify that all possible MRA's have been received for",!,"this claim before processing.",!
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| 136 | S DIR(0)="YA",DIR("B")="NO",DIR("A")="Are you sure you want to continue to process this COB?: "
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| 137 | D ^DIR K DIR
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| 138 | W !
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| 139 | S IBOK=$S(Y'=1:0,1:1)
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| 140 | FEOBQ Q IBOK
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| 141 | ;
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| 142 | ;
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| 143 | COBOK(IBIFN) ; Returns 1 if user indicates the COB process should proceed
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| 144 | ; even though the prior payer's bill is still in ENTERED/NOT REVIEWED
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| 145 | ; or REQUEST MRA status (1,2)
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| 146 | N DIR,X,Y,IBOK,IBSTAT
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| 147 | S IBOK=0,IBSTAT=$P($G(^DGCR(399,IBIFN,0)),U,13)
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| 148 | I "^1^2"'[(U_IBSTAT_U) S IBOK=1 G COBOKQ
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| 149 | S DIR(0)="YA",DIR("B")="NO"
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| 150 | S DIR("A",1)="The bill for the prior ("_$P("primary^secondary",U,+$$COBN^IBCEF(IBIFN))_") payer is still in "_$$EXTERNAL^DILFD(399,.13,,IBSTAT)_" status"
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| 151 | S DIR("A")="Are you sure you want to continue to process this COB?: "
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| 152 | D ^DIR K DIR
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| 153 | W !
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| 154 | S IBOK=$S(Y'=1:0,1:1)
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| 155 | COBOKQ Q IBOK
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| 156 | ;
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