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Routine: FBAA79A

Package: Fee Basis

Routine: FBAA79A


Information

FBAA79A ;AISC/GRR-PRINT 7079 CONTINUED ;1/12/98

Source Information

Source file <FBAA79A.m>

Interaction Calls

Name Line Occurrences
Function Call: WRITE
  • Prompt: !,?40,"FOR VA USE ONLY",!,UL
  • Line Location: FBAA79A+6
Function Call: WRITE
  • Prompt: !," (5) STATE CODE | (6) COUNTY CODE | (7) TYPE OF | (8) YEAR OF BIRTH | (9) WAR | (10) PURPOSE |",!,?16,"|",?34,"|",?37,"PATIENT",?48,"|",?68,"|",?78,"|",?93,"|"
  • Line Location: FBAA79A+7
Function Call: WRITE
  • Prompt: !,?7,FBI(5),?16,"|",?23,CC,?34,"|",?41,FBPATT,?48,"|",?58,YOB,?68,"|",?74,POS,?78,"|",?87,POV,?93,"|",!,UL
  • Line Location: FBAA79A+8
Function Call: WRITE
  • Prompt: !,"STATION OF JURISDICTION",?48,"|",?78,"|",?80," (11) CODE",?100,"| (12) SEX",!,?48,"|",?78,"|",?100,"|"," ",$S(SEX="F":"FEMALE",1:"MALE")
  • Line Location: FBAA79A+9
Function Call: WRITE
  • Prompt: !,"Veterans Administration",?48,"|",?78,"|",?100,"|",$E(UL,101,120)
  • Line Location: FBAA79A+10
Function Call: WRITE
  • Prompt: !,FBS(2),?48,"|",?78,"|",?80,$S(CODE=1:"SHORT TERM - 1",CODE=2:"HOME NURSING - 2",CODE=3:"ID CARD STATUS - 3",1:""),?100,"| (13) POW"
  • Line Location: FBAA79A+11
Function Call: WRITE
  • Prompt: !,?48,$E(UL,49,120)
  • Line Location: FBAA79A+13
Function Call: WRITE
  • Prompt: !,?48,"| APPROVED BY (Name and Title)",?110,"(",$S($D(^VA(200,DUZ,0)):$P(^(0),"^",2),1:""),")",!,?48,"|"
  • Line Location: FBAA79A+14
Function Call: WRITE
  • Prompt: !,"TELEPHONE: ",FBS(7),?48,"|",?50,FBS(8),!,?48,"|",?50,FBS(9),!,UL
  • Line Location: FBAA79A+15
Function Call: WRITE
  • Prompt: !,?32,"Information On Veterans Administration Program",!
  • Line Location: FBAA79A+16
Function Call: WRITE
  • Prompt: !,"Acceptance of this request to render the prescribed services will constitute an agreement which is subject",!,"to the following: ",!
  • Line Location: FBAA79A+17
Function Call: WRITE
  • Prompt: !,?3,"I. SERVICES. If services are not initiated, please return this document to the Station of Jurisdiction with a brief"
  • Line Location: FBAA79A+18
Function Call: WRITE
  • Prompt: !,?5,"explanation. Unless approved by the VA, services are limited in type and extent to those shown.",!
  • Line Location: FBAA79A+19
Function Call: WRITE
  • Prompt: !,?3,"II. PERIOD OF VALIDITY. Service must be performed within the period of validity indicated.",!,?5,"If a longer time is needed, please request an extension.",!
  • Line Location: FBAA79A+20
Function Call: WRITE
  • Prompt: !,?3,"III. REPORTS. Clinical reports are required when an examination only has been requested. Please ",!,?5,"submit reports promptly to the Station Of Jurisdiction.",!
  • Line Location: FBAA79A+21
Function Call: WRITE
  • Prompt: !,?3,"IV. STATEMENT OF ACCOUNTS. Submit a Statement of Account in your usual manner. Your statement must",!,?5,"include: (1) Patient's Name; (2) Identification NO.; (3) Treatment (CPT) and Dates Rendered; and (4) Fees.",!
  • Line Location: FBAA79A+22
Function Call: WRITE
  • Prompt: !,?3,"V. FEES. Fees claimed may not exceed those made to the general public for like services.",!
  • Line Location: FBAA79A+23
Function Call: WRITE
  • Prompt: !,?3,"VI. PAYMENT. Payment by the VA for services rendered and approved is payment in full.",!
  • Line Location: FBAA79A+24
Function Call: WRITE
  • Prompt: !,?3,"VII. HOSPITALIZATION. When a need for hospital care is indicated, please call the Station of Jurisdiction",!,?5,"for assistance in admitting the veteran to a VA hospital.",!
  • Line Location: FBAA79A+25
Function Call: WRITE
  • Prompt: !,?3,"VIII. INQUIRIES. Additional information when required may be obtained by contacting the Station Of Jurisdiction.",!
  • Line Location: FBAA79A+26
Function Call: WRITE
  • Prompt: !,?3,"IX. When submitting claims for payment you must include the NPI and Taxonomy Code of the rendering practitioner, and"
  • Line Location: FBAA79A+27
Function Call: WRITE
  • Prompt: !,?5,"the NPI and Taxonomy Code of your organization. If, under the HIPAA NPI Final Rule"
  • Line Location: FBAA79A+28
Function Call: WRITE
  • Prompt: !,?5,"[http://www.cms.hhs.gov/NationalProvIdentStand], your organization is an ""atypical"" provider furnishing services such as"
  • Line Location: FBAA79A+29
Function Call: WRITE
  • Prompt: !,?5,"taxi, home and vehicle modifications, insect control, habilitation, and respite services and is therefore ineligible"
  • Line Location: FBAA79A+30
Function Call: WRITE
  • Prompt: !,?5,"for an NPI, it is important that you indicate ""Ineligible for NPI"" on your claim form ."
  • Line Location: FBAA79A+31
Function Call: WRITE
  • Prompt: !,UL
  • Line Location: FBAA79A+32
Function Call: WRITE
  • Prompt: !?3,"VA Form 10-7079"
  • Line Location: FBAA79A+33
Function Call: WRITE
  • Prompt: ?85,"Date Printed: ",$$FMTE^XLFDT(DT),!
  • Line Location: FBAA79A+34
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