source: WorldVistAEHR/trunk/r/INTEGRATED_BILLING-IB-PRQ--IBD--IBQ--PRQS/IBCEMRAX.m@ 724

Last change on this file since 724 was 613, checked in by George Lilly, 15 years ago

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1IBCEMRAX ;ALB/DSM - MEDICARE REMITTANCE ADVICE DETAIL-PART A Cont'd ;25-APR-2003
2 ;;2.0;INTEGRATED BILLING;**155**;21-MAR-94
3 ;;Per VHA Directive 10-93-142, this routine should not be modified.
4 ;
5 Q
6 ;
7DEV(IBIFN) ; Prompt the user for a device
8 ; Input: IBIFN= ien# of Claim file
9 ;
10 N %ZIS,ZTRTN,ZTSAVE,ZTDESC,POP,MRACNT
11 I '$G(IBIFN) Q ;DEV
12 W !!,"This report displays Medicare-equivalent Remittance Advice Detail."
13 S MRACNT=$$MRACNT^IBCEMU1(IBIFN)
14 I MRACNT>1 W !,"*** Multiple MRAs on File for this claim. ",MRACNT," MRAs will be printed. ***"
15 W !,"You will need a 132 column printer for this report",!
16 ;
17 S %ZIS="QM" D ^%ZIS I POP S IBQUIT=1 Q
18 ; handle queuing report next
19 I $D(IO("Q")) D S IBQUIT=1 Q
20 . S ZTRTN="PROC^IBCEMRAA" ; background re-entry point
21 . S ZTDESC="Medicare-equivalent Remittance Advice Detail Print"
22 . S ZTSAVE("IB*")=""
23 . D ^%ZTLOAD
24 . W !!,$S($D(ZTSK):"Your task number "_ZTSK_" has been queued.",1:"Unable to queue this job.")
25 . K ZTSK,IO("Q") D HOME^%ZIS
26 U IO ; Output device
27 Q ;DEV
28 ;
29SRVHDR ; Print Srvice Level Header
30 ; ROW 23 -
31 ; Service (Line) Level Adjustments Data
32 W !!! I '$G(INPAT) W "SERV DATE" ;print only on outpatient claims
33 W ?12,"PT",?15,"PROC",?21,"MODS",?30,"REV",?35,"APC",?43,"UNITS",?50,"TOT CHARGES"
34 W ?67,"DEDUCT",?80,"COINS",?90,"ALLOWED",?102,"PAYMENT",?111,"GRP-RC",?123,"ADJ AMT"
35 Q ;SRVHDR
36 ;
37SRVDATA ; Get Service Level Data of EOB file (#361.1 Level 15)
38 ;
39 N LNLVL,RLVL,GLVL,RLVLD,GLVLD,SRVDED,GRPCD,RSNCD,SRVCOIN,I,MOD,SRMKS,LNLVLD
40 N PRCD,REVCD,UNIT,SRVDT,PRCTYP,ALWD,PAID,SRVDED,GLVL,RCNT,OPRCD,TOTL,LNORD,LNCNT
41 ; Use array LNORD to sort Service Lines in order of Referenced Line #
42 S LNLVL=0,LNCNT=1000
43 F S LNLVL=$O(^IBM(361.1,IEN,15,LNLVL)) Q:'LNLVL S LNORD=$P(^(LNLVL,0),U,12) D ;
44 . I LNORD S LNORD(LNORD)=LNLVL Q
45 . S LNORD(LNCNT)=LNLVL,LNCNT=LNCNT+1
46 ;
47 S LNORD=0
48 F S LNORD=$O(LNORD(LNORD)) Q:'LNORD S LNLVL=LNORD(LNORD) D I IBQUIT Q
49 . S LNLVLD=$G(^IBM(361.1,IEN,15,LNLVL,0)) I LNLVLD="" Q
50 . I ($Y+4)>IOSL D I IBQUIT Q
51 . . D PAUSE I IBQUIT Q
52 . . W @IOF D CLMHDR^IBCEMRAA
53 . . D SRVHDR
54 . ;
55 . K MOD,RCNT,TOTL S RCNT=0
56 . ; Procedure Code, Revenue Code, Units, From Service Date, Procedure Type
57 . S PRCD=$P(LNLVLD,U,4),REVCD=$P(LNLVLD,U,10),UNIT=$P(LNLVLD,U,11),SRVDT=$P(LNLVLD,U,16)
58 . S PRCTYP=$P(LNLVLD,U,18) I PRCTYP="NU" S PRCTYP="" ;don't display NU for Proc Type
59 . ; Resolve Revenue Code Pointer
60 . I REVCD'="" S REVCD=$P($G(^DGCR(399.2,REVCD,0)),U)
61 . ; Allowed, Payment, Original Procedure Code
62 . S ALWD=$P(LNLVLD,U,13),PAID=$P(LNLVLD,U,3),OPRCD=$P(LNLVLD,U,15)
63 . ; Handle Multiple Paid Modifiers from the Service Line Level (may have 4 mod's, could only fit 3)
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)
65 . ; Get Total Charge by matching 837 Extract Records with Bill's Original Line# on the current Service Line (LNLVLD)
66 . S TOTL=$P($G(IBZDATA($P(LNLVLD,U,12))),U,5)
67 . ; Service Line Level Remarks Codes
68 . S SRMKS=$G(^IBM(361.1,IEN,15,LNLVL,3))
69 . ; Row 24 - print Service date only on Outpatient claims (skip on Inpatients)
70 . W ! I '$G(INPAT) W $$FMTE^XLFDT(SRVDT,5)
71 . W ?12,PRCTYP,?15,PRCD,?21,MOD,?30,REVCD,?41,$J(UNIT,7),?49,$J($G(TOTL),12,2)
72 . ;
73 . ; Get Service Level Group Code/Reason Code Data
74 . ; RLVLD=reason_code^amount^quantity^reason text
75 . S (SRVDED,GLVL,RCNT,SRVCOIN)=0 K RSNCD
76 . F S GLVL=$O(^IBM(361.1,IEN,15,LNLVL,1,GLVL)) Q:'GLVL S GLVLD=^(GLVL,0) D ;
77 . . S GRPCD=$P(GLVLD,U),RLVL=0
78 . . F S RLVL=$O(^IBM(361.1,IEN,15,LNLVL,1,GLVL,1,RLVL)) Q:'RLVL S RLVLD=^(RLVL,0),RSNCD=$P(RLVLD,U) D ;
79 . . . I GRPCD="PR",RSNCD="AAA" Q ;exception
80 . . . I GRPCD="OA",RSNCD="AB3" Q ;exception
81 . . . I GRPCD="LQ" Q ;exception
82 . . . I GRPCD="PR",RSNCD=1!(RSNCD=66) S SRVDED=SRVDED+$P(RLVLD,U,2) Q ;deductible
83 . . . I GRPCD="PR",RSNCD=2 S SRVCOIN=$P(RLVLD,U,2) Q ;coinsurance
84 . . . S RCNT=RCNT+1,RSNCD(RCNT)=GRPCD_"-"_RSNCD_U_$P(RLVLD,U,2)
85 . ; Print Service Level Group Code/Reason Code Data
86 . ; Service Level deductible, Coinsurance, Allowed, Paid Amount
87 . W ?62,$J(SRVDED,11,2),?74,$J(SRVCOIN,11,2),?86,$J(ALWD,11,2),?98,$J(PAID,11,2)
88 . ; Print Group Code-Reason Code, Adjustment Amount
89 . F I=1:1:RCNT W:I>1 ! W ?111,$P(RSNCD(I),U),?118,$J($P(RSNCD(I),U,2),12,2)
90 . ; Row 25
91 . I OPRCD="",(SRMKS="") Q
92 . W ! I OPRCD'="" W ?15,"(",$E(OPRCD,1,4),")"
93 . I SRMKS'="" W ?26,"REM:",?30,$P(SRMKS,U)
94 ;
95 Q ;SRVDATA
96 ;
97PAUSE ; Pause at the bottom of screen. This section is called
98 ; from different points of the MRA report.
99 ;
100 I $E(IOST,1,2)'["C-" Q ;if not terminal, don't pause
101 N DIR,DIROUT,DIRUT,DTOUT,DUOUT
102 S DIR(0)="E" D ^DIR
103 I $D(DIRUT)!($D(DUOUT)) S IBQUIT=1 Q
104 Q ;PAUSE
105 ;
106DSCLMR ;
107 N LINE
108 S $P(LINE,"-",122)=""
109 W !!,LINE
110 W !,"This is a printed representation of a remittance advice, developed through a joint effort between the Centers for Medicare and"
111 W !,"Medicaid Services and the Department of Veterans Affairs, for a claim for services or supplies furnished to a Medicare-eligible"
112 W !,"veteran through a facility of the Department of Veterans Affairs. The remittance advice shows the amount that Medicare would have"
113 W !,"paid had the claim been payable by Medicare, as well as the coinsurance and deductible amounts that would have applied."
114 W !,"The claim is not payable under the Medicare program, and no Medicare payment was issued."
115 W !
116 Q ;DSCLMR
117 ;
118LINELVL ; This section is called when printing Institutional Reports
119 ; The values of Coinsurance, Contractual Adjustment, Noncovered Charges
120 ; and Deductible are calculated from the Service Line level and not
121 ; from the Claim level.
122 ;
123 ; RLVLD=reason_code^amount^quantity^reason text
124 ; IBCOINS,IBCTADJ,NCVRCHRG,CLMADJ are set to zero in the calling section CLMDATA
125 ;
126 N LNLVL,LNLVLD,GLVL,GLVLD,RLVL,RLVLD,GRPCD,RSNCD
127 S LNLVL=0
128 F S LNLVL=$O(^IBM(361.1,IEN,15,LNLVL)) Q:'LNLVL S LNLVLD=^(LNLVL,0) D ;
129 . S GLVL=0 F S GLVL=$O(^IBM(361.1,IEN,15,LNLVL,1,GLVL)) Q:'GLVL S GLVLD=^(GLVL,0) D ;
130 . . S GRPCD=$P(GLVLD,U),RLVL=0
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 ;
132 . . . I GRPCD="PR",RSNCD="AAA" Q ;exception
133 . . . I GRPCD="OA",RSNCD="AB3" Q ;exception
134 . . . I GRPCD="LQ" Q ;exception
135 . . . ; set Claim Adjustment only if none were found at the claim level (don't check for group code)
136 . . . I RCLMADJ[(","_RSNCD_",") S CLMADJ=CLMADJ+$P(RLVLD,U,2)
137 . . . ; Coinsurance
138 . . . I GRPCD="PR",RCOINS[(","_RSNCD_",") S IBCOINS=IBCOINS+$P(RLVLD,U,2) Q
139 . . . ; Deductible
140 . . . I GRPCD="PR" I RCDED[(","_RSNCD_",") S IBDED=IBDED+$P(RLVLD,U,2) Q
141 . . . I GRPCD="CO" D ;
142 . . . . ; Contractual Adjustment
143 . . . . I RCTADJ[(","_RSNCD_",") S IBCTADJ=IBCTADJ+$P(RLVLD,U,2)
144 . . . . ; Noncovered Charges
145 . . . . I RCNCVR'[(","_RSNCD_",") S NCVRCHRG=NCVRCHRG+$P(RLVLD,U,2)
146 Q ;LINELVL
147 ;
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