[613] | 1 | IBCEMRAX ;ALB/DSM - MEDICARE REMITTANCE ADVICE DETAIL-PART A Cont'd ;25-APR-2003
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| 2 | ;;2.0;INTEGRATED BILLING;**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 | Q
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| 6 | ;
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| 7 | DEV(IBIFN) ; Prompt the user for a device
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| 8 | ; Input: IBIFN= ien# of Claim file
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| 9 | ;
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| 10 | N %ZIS,ZTRTN,ZTSAVE,ZTDESC,POP,MRACNT
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| 11 | I '$G(IBIFN) Q ;DEV
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| 12 | W !!,"This report displays Medicare-equivalent Remittance Advice Detail."
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| 13 | S MRACNT=$$MRACNT^IBCEMU1(IBIFN)
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| 14 | I MRACNT>1 W !,"*** Multiple MRAs on File for this claim. ",MRACNT," MRAs will be printed. ***"
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| 15 | W !,"You will need a 132 column printer for this report",!
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| 16 | ;
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| 17 | S %ZIS="QM" D ^%ZIS I POP S IBQUIT=1 Q
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| 18 | ; handle queuing report next
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| 19 | I $D(IO("Q")) D S IBQUIT=1 Q
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| 20 | . S ZTRTN="PROC^IBCEMRAA" ; background re-entry point
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| 21 | . S ZTDESC="Medicare-equivalent Remittance Advice Detail Print"
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| 22 | . S ZTSAVE("IB*")=""
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| 23 | . D ^%ZTLOAD
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| 24 | . W !!,$S($D(ZTSK):"Your task number "_ZTSK_" has been queued.",1:"Unable to queue this job.")
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| 25 | . K ZTSK,IO("Q") D HOME^%ZIS
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| 26 | U IO ; Output device
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| 27 | Q ;DEV
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| 28 | ;
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| 29 | SRVHDR ; Print Srvice Level Header
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| 30 | ; ROW 23 -
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| 31 | ; Service (Line) Level Adjustments Data
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| 32 | W !!! I '$G(INPAT) W "SERV DATE" ;print only on outpatient claims
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| 33 | W ?12,"PT",?15,"PROC",?21,"MODS",?30,"REV",?35,"APC",?43,"UNITS",?50,"TOT CHARGES"
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| 34 | W ?67,"DEDUCT",?80,"COINS",?90,"ALLOWED",?102,"PAYMENT",?111,"GRP-RC",?123,"ADJ AMT"
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| 35 | Q ;SRVHDR
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| 36 | ;
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| 37 | SRVDATA ; Get Service Level Data of EOB file (#361.1 Level 15)
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| 38 | ;
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| 39 | N LNLVL,RLVL,GLVL,RLVLD,GLVLD,SRVDED,GRPCD,RSNCD,SRVCOIN,I,MOD,SRMKS,LNLVLD
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| 40 | N PRCD,REVCD,UNIT,SRVDT,PRCTYP,ALWD,PAID,SRVDED,GLVL,RCNT,OPRCD,TOTL,LNORD,LNCNT
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| 41 | ; Use array LNORD to sort Service Lines in order of Referenced Line #
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| 42 | S LNLVL=0,LNCNT=1000
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| 43 | F S LNLVL=$O(^IBM(361.1,IEN,15,LNLVL)) Q:'LNLVL S LNORD=$P(^(LNLVL,0),U,12) D ;
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| 44 | . I LNORD S LNORD(LNORD)=LNLVL Q
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| 45 | . S LNORD(LNCNT)=LNLVL,LNCNT=LNCNT+1
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| 46 | ;
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| 47 | S LNORD=0
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| 48 | F S LNORD=$O(LNORD(LNORD)) Q:'LNORD S LNLVL=LNORD(LNORD) D I IBQUIT Q
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| 49 | . S LNLVLD=$G(^IBM(361.1,IEN,15,LNLVL,0)) I LNLVLD="" Q
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| 50 | . I ($Y+4)>IOSL D I IBQUIT Q
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| 51 | . . D PAUSE I IBQUIT Q
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| 52 | . . W @IOF D CLMHDR^IBCEMRAA
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| 53 | . . D SRVHDR
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| 54 | . ;
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| 55 | . K MOD,RCNT,TOTL S RCNT=0
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| 56 | . ; Procedure Code, Revenue Code, Units, From Service Date, Procedure Type
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| 57 | . S PRCD=$P(LNLVLD,U,4),REVCD=$P(LNLVLD,U,10),UNIT=$P(LNLVLD,U,11),SRVDT=$P(LNLVLD,U,16)
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| 58 | . S PRCTYP=$P(LNLVLD,U,18) I PRCTYP="NU" S PRCTYP="" ;don't display NU for Proc Type
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| 59 | . ; Resolve Revenue Code Pointer
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| 60 | . I REVCD'="" S REVCD=$P($G(^DGCR(399.2,REVCD,0)),U)
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| 61 | . ; Allowed, Payment, Original Procedure Code
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| 62 | . S ALWD=$P(LNLVLD,U,13),PAID=$P(LNLVLD,U,3),OPRCD=$P(LNLVLD,U,15)
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| 63 | . ; Handle Multiple Paid Modifiers from the Service Line Level (may have 4 mod's, could only fit 3)
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| 64 | . M MOD=^IBM(361.1,IEN,15,LNLVL,2) S MOD="" F I=1:1:3 Q:'$D(MOD(I)) S MOD=MOD_$S(MOD="":"",1:",")_MOD(I,0)
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| 65 | . ; Get Total Charge by matching 837 Extract Records with Bill's Original Line# on the current Service Line (LNLVLD)
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| 66 | . S TOTL=$P($G(IBZDATA($P(LNLVLD,U,12))),U,5)
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| 67 | . ; Service Line Level Remarks Codes
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| 68 | . S SRMKS=$G(^IBM(361.1,IEN,15,LNLVL,3))
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| 69 | . ; Row 24 - print Service date only on Outpatient claims (skip on Inpatients)
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| 70 | . W ! I '$G(INPAT) W $$FMTE^XLFDT(SRVDT,5)
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| 71 | . W ?12,PRCTYP,?15,PRCD,?21,MOD,?30,REVCD,?41,$J(UNIT,7),?49,$J($G(TOTL),12,2)
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| 72 | . ;
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| 73 | . ; Get Service Level Group Code/Reason Code Data
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| 74 | . ; RLVLD=reason_code^amount^quantity^reason text
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| 75 | . S (SRVDED,GLVL,RCNT,SRVCOIN)=0 K RSNCD
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| 76 | . F S GLVL=$O(^IBM(361.1,IEN,15,LNLVL,1,GLVL)) Q:'GLVL S GLVLD=^(GLVL,0) D ;
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| 77 | . . S GRPCD=$P(GLVLD,U),RLVL=0
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| 78 | . . F S RLVL=$O(^IBM(361.1,IEN,15,LNLVL,1,GLVL,1,RLVL)) Q:'RLVL S RLVLD=^(RLVL,0),RSNCD=$P(RLVLD,U) D ;
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| 79 | . . . I GRPCD="PR",RSNCD="AAA" Q ;exception
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| 80 | . . . I GRPCD="OA",RSNCD="AB3" Q ;exception
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| 81 | . . . I GRPCD="LQ" Q ;exception
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| 82 | . . . I GRPCD="PR",RSNCD=1!(RSNCD=66) S SRVDED=SRVDED+$P(RLVLD,U,2) Q ;deductible
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| 83 | . . . I GRPCD="PR",RSNCD=2 S SRVCOIN=$P(RLVLD,U,2) Q ;coinsurance
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| 84 | . . . S RCNT=RCNT+1,RSNCD(RCNT)=GRPCD_"-"_RSNCD_U_$P(RLVLD,U,2)
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| 85 | . ; Print Service Level Group Code/Reason Code Data
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| 86 | . ; Service Level deductible, Coinsurance, Allowed, Paid Amount
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| 87 | . W ?62,$J(SRVDED,11,2),?74,$J(SRVCOIN,11,2),?86,$J(ALWD,11,2),?98,$J(PAID,11,2)
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| 88 | . ; Print Group Code-Reason Code, Adjustment Amount
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| 89 | . F I=1:1:RCNT W:I>1 ! W ?111,$P(RSNCD(I),U),?118,$J($P(RSNCD(I),U,2),12,2)
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| 90 | . ; Row 25
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| 91 | . I OPRCD="",(SRMKS="") Q
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| 92 | . W ! I OPRCD'="" W ?15,"(",$E(OPRCD,1,4),")"
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| 93 | . I SRMKS'="" W ?26,"REM:",?30,$P(SRMKS,U)
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| 94 | ;
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| 95 | Q ;SRVDATA
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| 96 | ;
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| 97 | PAUSE ; Pause at the bottom of screen. This section is called
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| 98 | ; from different points of the MRA report.
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| 99 | ;
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| 100 | I $E(IOST,1,2)'["C-" Q ;if not terminal, don't pause
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| 101 | N DIR,DIROUT,DIRUT,DTOUT,DUOUT
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| 102 | S DIR(0)="E" D ^DIR
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| 103 | I $D(DIRUT)!($D(DUOUT)) S IBQUIT=1 Q
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| 104 | Q ;PAUSE
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| 105 | ;
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| 106 | DSCLMR ;
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| 107 | N LINE
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| 108 | S $P(LINE,"-",122)=""
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| 109 | W !!,LINE
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| 110 | W !,"This is a printed representation of a remittance advice, developed through a joint effort between the Centers for Medicare and"
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| 111 | W !,"Medicaid Services and the Department of Veterans Affairs, for a claim for services or supplies furnished to a Medicare-eligible"
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| 112 | W !,"veteran through a facility of the Department of Veterans Affairs. The remittance advice shows the amount that Medicare would have"
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| 113 | W !,"paid had the claim been payable by Medicare, as well as the coinsurance and deductible amounts that would have applied."
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| 114 | W !,"The claim is not payable under the Medicare program, and no Medicare payment was issued."
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| 115 | W !
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| 116 | Q ;DSCLMR
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| 117 | ;
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| 118 | LINELVL ; This section is called when printing Institutional Reports
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| 119 | ; The values of Coinsurance, Contractual Adjustment, Noncovered Charges
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| 120 | ; and Deductible are calculated from the Service Line level and not
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| 121 | ; from the Claim level.
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| 122 | ;
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| 123 | ; RLVLD=reason_code^amount^quantity^reason text
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| 124 | ; IBCOINS,IBCTADJ,NCVRCHRG,CLMADJ are set to zero in the calling section CLMDATA
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| 125 | ;
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| 126 | N LNLVL,LNLVLD,GLVL,GLVLD,RLVL,RLVLD,GRPCD,RSNCD
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| 127 | S LNLVL=0
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| 128 | F S LNLVL=$O(^IBM(361.1,IEN,15,LNLVL)) Q:'LNLVL S LNLVLD=^(LNLVL,0) D ;
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| 129 | . S GLVL=0 F S GLVL=$O(^IBM(361.1,IEN,15,LNLVL,1,GLVL)) Q:'GLVL S GLVLD=^(GLVL,0) D ;
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| 130 | . . S GRPCD=$P(GLVLD,U),RLVL=0
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| 131 | . . F S RLVL=$O(^IBM(361.1,IEN,15,LNLVL,1,GLVL,1,RLVL)) Q:'RLVL S RLVLD=^(RLVL,0),RSNCD=$P(RLVLD,U) D ;
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| 132 | . . . I GRPCD="PR",RSNCD="AAA" Q ;exception
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| 133 | . . . I GRPCD="OA",RSNCD="AB3" Q ;exception
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| 134 | . . . I GRPCD="LQ" Q ;exception
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| 135 | . . . ; set Claim Adjustment only if none were found at the claim level (don't check for group code)
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| 136 | . . . I RCLMADJ[(","_RSNCD_",") S CLMADJ=CLMADJ+$P(RLVLD,U,2)
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| 137 | . . . ; Coinsurance
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| 138 | . . . I GRPCD="PR",RCOINS[(","_RSNCD_",") S IBCOINS=IBCOINS+$P(RLVLD,U,2) Q
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| 139 | . . . ; Deductible
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| 140 | . . . I GRPCD="PR" I RCDED[(","_RSNCD_",") S IBDED=IBDED+$P(RLVLD,U,2) Q
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| 141 | . . . I GRPCD="CO" D ;
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| 142 | . . . . ; Contractual Adjustment
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| 143 | . . . . I RCTADJ[(","_RSNCD_",") S IBCTADJ=IBCTADJ+$P(RLVLD,U,2)
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| 144 | . . . . ; Noncovered Charges
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| 145 | . . . . I RCNCVR'[(","_RSNCD_",") S NCVRCHRG=NCVRCHRG+$P(RLVLD,U,2)
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| 146 | Q ;LINELVL
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| 147 | ;
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