| 1 | IBJDU1 ;ALB/CPM - UTILIZATION WORKLOAD REPORT ; 24-DEC-96
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| 2 |  ;;Version 2.0 ; INTEGRATED BILLING ;**69**; 21-MAR-94
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| 3 |  ;
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| 4 | EN ; Option entry point.
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| 5 |  ;
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| 6 |  W !!,"This report provides a measure of the number of Insurance Reviews"
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| 7 |  W !,"which are conducted in the Medical Center.",!
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| 8 |  ;
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| 9 |  D DATE^IBOUTL I IBBDT=""!(IBEDT="") G ENQ
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| 10 |  ;
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| 11 |  W !!,"This report only requires an 80 column printer."
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| 12 |  ;
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| 13 |  W !!,"   Note:  This report may take a while to run."
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| 14 |  W !?10,"You should queue this report to run after normal business hours.",!
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| 15 |  ;
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| 16 |  ; - select a device
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| 17 |  S %ZIS="QM" D ^%ZIS G:POP ENQ
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| 18 |  I $D(IO("Q")) D  G ENQ
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| 19 |  .S ZTRTN="DQ^IBJDU1",ZTDESC="IB - UTILIZATION WORKLOAD REPORT"
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| 20 |  .F I="IBBDT","IBEDT" S ZTSAVE(I)=""
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| 21 |  .D ^%ZTLOAD
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| 22 |  .W !!,$S($D(ZTSK):"This job has been queued.  The task number is "_ZTSK_".",1:"Unable to queue this job.")
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| 23 |  .K ZTSK,IO("Q") D HOME^%ZIS
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| 24 |  ;
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| 25 |  U IO
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| 26 |  ;
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| 27 | DQ ; Tasked entry point.
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| 28 |  ;
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| 29 |  K IB F I=1:1:10 S IB(I)=0
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| 30 |  ;
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| 31 |  ; - count admissions within the user-specified date range
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| 32 |  S IBDT=IBBDT-.000000001,IBQ=0
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| 33 |  F  S IBDT=$O(^DGPM("AMV1",IBDT)) Q:'IBDT!(IBDT>(IBEDT+.24))  D  Q:IBQ
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| 34 |  .S DFN=0 F  S DFN=$O(^DGPM("AMV1",IBDT,DFN)) Q:'DFN  D  Q:IBQ
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| 35 |  ..S IBPM=0 F  S IBPM=$O(^DGPM("AMV1",IBDT,DFN,IBPM)) Q:'IBPM  D  Q:IBQ
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| 36 |  ...;
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| 37 |  ...I IBPM#100=0 S IBQ=$$STOP^IBOUTL("Utilization Workload Report") Q:IBQ
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| 38 |  ...;
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| 39 |  ...S IB(1)=IB(1)+1 ;                  total admissions
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| 40 |  ...;
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| 41 |  ...Q:'$$INSURED^IBCNS1(DFN,IBDT)
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| 42 |  ...;
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| 43 |  ...S IB(2)=IB(2)+1 ;                  insured admissions
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| 44 |  ...D ELIG^VADPT
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| 45 |  ...I VAEL(3) S IB(3)=IB(3)+1 Q  ;     insured SC admissions
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| 46 |  ...S IB(4)=IB(4)+1 ;                  insured NSC admissions
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| 47 |  ;
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| 48 |  I IBQ G ENQ
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| 49 |  ;
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| 50 |  ; - count insurance reviews
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| 51 |  K ^TMP("IBJDU1",$J)
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| 52 |  S IBDT=IBBDT-.000000001
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| 53 |  F  S IBDT=$O(^IBT(356.2,"B",IBDT)) Q:'IBDT!(IBDT>(IBEDT+.9))  D  Q:IBQ
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| 54 |  .S IBTRC=0 F  S IBTRC=$O(^IBT(356.2,"B",IBDT,IBTRC)) Q:'IBTRC  D  Q:IBQ
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| 55 |  ..;
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| 56 |  ..I IBTRC#100=0 S IBQ=$$STOP^IBOUTL("Utilization Workload Report") Q:IBQ
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| 57 |  ..;
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| 58 |  ..S IBTRCD=$G(^IBT(356.2,+IBTRC,0)) Q:IBTRCD=""
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| 59 |  ..S IBTRN=$P(IBTRCD,"^",2)
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| 60 |  ..Q:$P(IBTRCD,"^",19)<10  ;              review is not complete
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| 61 |  ..Q:'IBTRN  ;                            no corresponding CT entry
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| 62 |  ..S IBPM=$P($G(^IBT(356,IBTRN,0)),"^",5)
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| 63 |  ..Q:'IBPM  ;                             review not for an admission
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| 64 |  ..;
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| 65 |  ..; - get contact type
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| 66 |  ..S IBRTY=$P($G(^IBE(356.11,+$P(IBTRCD,"^",4),0)),"^",2)
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| 67 |  ..;
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| 68 |  ..; - appeals
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| 69 |  ..I IBRTY=60!(IBRTY=65) D  Q
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| 70 |  ...I '$D(^TMP("IBJDU1",$J,IBTRN)) S ^(IBTRN)="",IB(10)=IB(10)+1
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| 71 |  ..;
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| 72 |  ..; - admission reviews
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| 73 |  ..I IBRTY=10!(IBRTY=15)!(IBRTY=20) D  Q
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| 74 |  ...S IB(5)=IB(5)+1
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| 75 |  ...;
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| 76 |  ...; - count reviews where the entire admission was denied
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| 77 |  ...Q:'$P($G(^IBT(356.2,IBTRC,1)),"^",7)
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| 78 |  ...;
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| 79 |  ...S IB(7)=IB(7)+1
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| 80 |  ...S X=$G(^DGPM(IBPM,0)),Y=+$G(^DGPM(+$P(X,"^",17),0))\1
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| 81 |  ...S:'Y Y=DT
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| 82 |  ...S IB(9)=IB(9)+$$FMDIFF^XLFDT(Y,+X\1)
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| 83 |  ..;
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| 84 |  ..; - continued stay reviews
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| 85 |  ..I IBRTY=30 D
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| 86 |  ...S IB(6)=IB(6)+1
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| 87 |  ...;
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| 88 |  ...; - look at denials
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| 89 |  ...Q:$P($G(^IBE(356.7,+$P(IBTRCD,"^",11),1)),"^",3)'=20
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| 90 |  ...S IB(8)=IB(8)+1
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| 91 |  ...S X=$P(IBTRCD,"^",15),Y=$P(IBTRCD,"^",16) S:'Y Y=X
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| 92 |  ...I X S IB(9)=IB(9)+$$FMDIFF^XLFDT(Y,X)+1
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| 93 |  ;
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| 94 |  I IBQ G ENQ
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| 95 |  ;
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| 96 |  ; - print the reports
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| 97 |  S (IBPAG,IBQ)=0 D NOW^%DTC S IBRUN=$$DAT2^IBOUTL(%)
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| 98 |  D SUM
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| 99 |  ;
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| 100 | ENQ K ^TMP("IBJDU1",$J)
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| 101 |  I $D(ZTQUEUED) S ZTREQ="@" G ENQ1
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| 102 |  ;
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| 103 |  D ^%ZISC
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| 104 | ENQ1 K IB,IBQ,IBBDT,IBEDT,IBDT,IBPM,IBPAG,IBRUN,IBTRC,IBTRCD,IBTRN,IBRTY
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| 105 |  K %,%ZIS,DFN,IBPERI,IBPERS,POP,X,Y,VA,VAERR,VAEL,ZTDESC,ZTRTN,ZTSAVE
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| 106 |  Q
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| 107 |  ;
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| 108 |  ;
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| 109 |  ;
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| 110 | SUM ; Print the Summary Report.
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| 111 |  I $E(IOST,1,2)="C-" W @IOF,*13
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| 112 |  ;
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| 113 |  ; - print overall summary header
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| 114 |  W !!?30,"UTILIZATION WORKLOAD"
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| 115 |  W !?33,"SUMMARY REPORT"
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| 116 |  W !!?22,"For Reviews from ",$$DAT1^IBOUTL(IBBDT)," - ",$$DAT1^IBOUTL(IBEDT)
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| 117 |  W !!?24,"Run Date: ",IBRUN
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| 118 |  W !?24,$$DASH(31),!!
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| 119 |  ;
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| 120 |  ; - print overall summary statistics
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| 121 |  S IBPERI=$S('IB(1):0,1:$J(IB(2)/IB(1)*100,0,2))
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| 122 |  S IBPERS=$S('IB(2):0,1:$J(IB(3)/IB(2)*100,0,2))
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| 123 |  W ?21,"Total Number of Admissions:",?60,$J(IB(1),7)
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| 124 |  W !?6,"Total Number of Admissions with Insurance:",?60,$J(IB(2),7),"  (",IBPERI,"%)"
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| 125 |  W !?39,"SC:",?60,$J(IB(3),7),"  (",IBPERS,"%)"
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| 126 |  W !?38,"NSC:",?60,$J(IB(4),7),"  (",$J(100-IBPERS,0,2),"%)"
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| 127 |  ;
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| 128 |  W !!?7,"Total Number of Admission Reviews completed"
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| 129 |  W !?9,"on Insurance Patients (including pre-certifications):",?65,$J(IB(5),7)
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| 130 |  W !?13,"Total Number of Continued Stay Reviews completed:",?65,$J(IB(6),7)
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| 131 |  W !?5,"Total Number of Admission Denials by Insurance Companies:",?65,$J(IB(7),7)
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| 132 |  W !,"Total Number of Continued Stay Denials by Insurance Companies:",?65,$J(IB(8),7)
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| 133 |  W !?11,"Total Number of days denied by Insurance Companies:",?65,$J(IB(9),7)
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| 134 |  W !?31,"Total Number of Appealed Cases:",?65,$J(IB(10),7)
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| 135 |  ;
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| 136 |  D PAUSE
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| 137 |  Q
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| 138 |  ;
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| 139 | DASH(X) ; Return a dashed line.
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| 140 |  Q $TR($J("",X)," ","=")
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| 141 |  ;
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| 142 | PAUSE ; Page break
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| 143 |  Q:$E(IOST,1,2)'="C-"
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| 144 |  N IBX,DIR,DIRUT,DUOUT,DTOUT,DIROUT,X,Y
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| 145 |  F IBX=$Y:1:(IOSL-3) W !
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| 146 |  S DIR(0)="E" D ^DIR I $D(DIRUT)!($D(DUOUT)) S IBQ=1
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| 147 |  Q
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