IBCRBC1 ;ALB/ARH - RATES: BILL CALCULATION BILLABLE EVENTS ; 22 MAY 96
Source file <IBCRBC1.m>
| Name | Comments | DBIA/ICR reference |
|---|---|---|
| INPTBS(IBIFN,RS,CS) | ; Determine charges for INPATIENT BEDSECTION STAY billable events
; - the billable events are billable bedsections based on the patient movement treating specialties, ; these are pulled from the PTF record each time the charges are calculated (INPTPTF^IBCRCG) ; - each day of billable care is calculated separately in case a rate becomes inactive |
|
| OPTVST(IBIFN,RS,CS) | ; Determine charges for OUTPATIENT VISIT DATE billable events
; - the billable event is the outpatient visit date(s) on the bill (399,43) |
|
| RX(IBIFN,RS,CS) | ; Determine charges for PRESCRIPTION billable events
; - the billable event is an rx that has been added to the bill (362.4) ; - the insurance company Prescription Refill Rev Code (36,.15) is passed to the calculator to be used as ; the rev code for all Rx charges, all types, this overrides the rev codes for the set or item ; - on HCFA 1500, the site parameter Default Rx Refill CPT (350.9,1.3) is added as the CPT to all Rx RC entries |
|
| CPT(IBIFN,RS,CS) | ; Determine charges for PROCEDURE billable events
; - the billable event is a CPT procedure from the bill (399,304) ; - the item to be billed is a CPT, this may include Modifier ; - for each CPT found on the bill that has a modifier, will first check to see if that CPT-modifier ; combination is billable (ie. is defined as a charge item for the Billing Rate, does not have to be active) ; if it does not then assumes the charge should be the CPT charge ; - if the charge set is limited by region then either the CPT's division or if no CPT division then the bill's ; Default Division must be contained in the sets region ; - the billable CPT is added as the CPT of the charge entry, Division is also added if defined for the CPT ; - the procedures provider may affect the charges due to a provider discount ; - if an inpatient bill then the bedsection on date of procedure will be used as the default bedsection ; - different sets of charges apply to SNF and Inpatient care although the bill is defined as inpatient ; - the Default Rx CPT should not be billed the CPT charge, instead the Rx is charged |
|
| PI(IBIFN,RS,CS) | ; Determine charges for PROSTHETICS billable events
; - the billable event is a prosthetic item that has been added to the bill (362.5) |
