IBCRBC ;ALB/ARH - RATES: BILL CALCULATION OF CHARGES ; 22-MAY-1996
;;2.0;INTEGRATED BILLING;**52,80,106,51,137,245,370,516**;21-MAR-94;Build 123
;;Per VA Directive 6402, this routine should not be modified.
;
; Variable DGPTUPDT may be defined on entry/exit for inpt bills so the PTF will only be updated once per session
; Charges may be filed on the bill and if IBRSARR is passed but does not exist it may be updated
; otherwise there are no other outputs/results of this call.
;
BILL(IBIFN,IBRSARR) ; given a bill number calculate and store all charges
; if IBRSARR is defined it will be used to create charges rather than the standard set for the bills Rate Type
;
; MRD;IB*2.0*516 - Added the flag IBNOCALC. This flag is set two
; places in ^IBCCC -- when the user is CLONing a claim (cancel and
; copy) or CRDing a claim (correct rejected/denied). The first time
; this procedure is entered for the new claim, if the IBNOCALC flag is
; set, it will reset the flag and quit out. That is, it does not re-
; calculate the charges the first time it otherwise would if the user
; is doing either a CRD or CLON.
;
I $G(IBNOCALC) S IBNOCALC=0 Q
;
N IB0,IBU,IBBRT,IBBTYPE,IBCTYPE,DFN,PTF,IBDGPT,IBRS,IBCS,IBBEVNT Q:'$G(IBIFN)
K ^TMP($J,"IBCRCC"),^TMP($J,"IBCRCS")
;
S IB0=$G(^DGCR(399,+IBIFN,0)) Q:IB0="" S IBU=$G(^DGCR(399,+IBIFN,"U")) Q:'IBU
S IBBRT=+$P(IB0,U,7),IBBTYPE=$S($$INPAT^IBCEF(IBIFN):1,1:3),IBCTYPE=+$P(IB0,U,27),DFN=$P(IB0,U,2) Q:'DFN
;
; if who's responsible is insurer, but bill has no insurer defined quit
I $P(IB0,U,11)="i",'$G(^DGCR(399,+IBIFN,"MP")),'$$MCRWNR^IBEFUNC(+$$CURR^IBCEF2(IBIFN)) Q
;
; if inpt bill, PTF Status is Open, not a Fee Basis record and not previously done then Update the PTF record
I IBBTYPE<3,'$D(DGPTUPDT) S PTF=$P(IB0,U,8) Q:'PTF S IBDGPT=$G(^DGPT(+PTF,0)) Q:IBDGPT="" D
. I '$P(IBDGPT,U,6),'$P(IBDGPT,U,4) D UPDT^DGPTUTL S DGPTUPDT=""
;
;
D DSPDL^IBCRBC3,DELALLRC^IBCRBF(IBIFN) ; delete all existing auto charges on the bill
;
; get standard set of all rate schedules and charge sets available for entire date range of the bill
I '$D(IBRSARR) D RT^IBCRU3(IBBRT,IBBTYPE,$P(IBU,U,1,2),.IBRSARR,"",IBCTYPE) I 'IBRSARR G END
;
; process charge sets - set all charges for the bill into array
S IBRS=0 F S IBRS=$O(IBRSARR(IBRS)) Q:'IBRS D
. S IBCS=0 F S IBCS=$O(IBRSARR(IBRS,IBCS)) Q:'IBCS I +IBRSARR(IBRS,IBCS) D
.. S IBBEVNT=+$P($G(^IBE(363.1,+IBCS,0)),U,3) Q:'IBBEVNT S IBBEVNT=$$EMUTL^IBCRU1(IBBEVNT) Q:IBBEVNT=""
.. ;
.. I IBBEVNT["INPATIENT BEDSECTION STAY" D INPTBS^IBCRBC1(IBIFN,IBRS,IBCS)
.. I IBBEVNT["INPATIENT DRG" D INPTDRG^IBCRBC11(IBIFN,IBRS,IBCS)
.. I IBBEVNT["OUTPATIENT VISIT DATE" D OPTVST^IBCRBC1(IBIFN,IBRS,IBCS)
.. I IBBEVNT["PRESCRIPTION" D RX^IBCRBC1(IBIFN,IBRS,IBCS)
.. I IBBEVNT["PROSTHETICS" D PI^IBCRBC1(IBIFN,IBRS,IBCS)
.. I IBBEVNT["PROCEDURE" D CPT^IBCRBC1(IBIFN,IBRS,IBCS)
;
I '$D(^TMP($J,"IBCRCC")) G END
;
D SORTCI^IBCRBC3 I '$D(^TMP($J,"IBCRCS")) G END
;
D ADDBCHGS^IBCRBC3(IBIFN)
;
D MAILADD(IBIFN,IBBTYPE)
;
END I $D(^TMP("IBCRRX",$J)) D CLEANRX^IBCRBC3(IBIFN)
K ^TMP($J,"IBCRCC"),^TMP($J,"IBCRCS")
Q
;
MAILADD(IBIFN,BTYPE) ; update the bill mailing address: it may be based on the types of charges
; an outpatient bill may go to either the opt or rx mailing addresses depending on the types of charges
N DA,IB01,IB02
I $G(BTYPE)>2,+$G(IBIFN),$D(^IBA(362.4,"C",+IBIFN)),+$$CHGTYPE^IBCU(+IBIFN)=3 S DA=IBIFN D MAILA^IBCU5 D
. I '$D(ZTQUEUED),'$G(IBAUTO) W !!,"Updating Bill Mailing Address"
Q
;
BILLITEM(IBIFN,IBITMARR) ; add selected unassociated item charges to the bill
N IBRS,IBCS,IBBEVNT K ^TMP($J,"IBCRCC"),^TMP($J,"IBCRCS")
;
S IBRS=0 F S IBRS=$O(IBITMARR(IBRS)) Q:'IBRS D
. S IBCS=0 F S IBCS=$O(IBITMARR(IBRS,IBCS)) Q:'IBCS D
.. S IBBEVNT=+$P($G(^IBE(363.1,+IBCS,0)),U,3) Q:'IBBEVNT S IBBEVNT=$$EMUTL^IBCRU1(IBBEVNT) Q:IBBEVNT=""
.. ;
.. I IBBEVNT["UNASSOCIATED" D UNASSOC^IBCRBC11(IBIFN,IBRS,IBCS,.IBITMARR)
;
I $D(^TMP($J,"IBCRCC")) D SORTCI^IBCRBC3
;
I $D(^TMP($J,"IBCRCS")) D ADDBCHGS^IBCRBC3(IBIFN)
;
K ^TMP($J,"IBCRCC"),^TMP($J,"IBCRCS")
Q
;
;
;
; There are 3 types of charges/items:
; - ITEM: charge for an individual item: specific item has one or more charge entries in 363.2
; for the charge to be applied to the bill the specific item must be found on the bill
;
; - EVENT: charge for an event, not an item: items are defined in 363.2
; all charge items active on a date in the set define the charge for the event
; the item does not need to be defined on the bill for the charge to be applied to the bill
; the charge set on a date becomes the events charge, so effective date cuts across item and applies to event
; all charge items with the same effective date are used to calculate the event charge for that date
; each charge item effective date in the set overrides all previous entries in the set regardless of item
;
; - VA COST: charge for an individual item but no entries in 363.2
; instead the charge is calculated/obtained when it is needed from an interface with the source package
;
;
; Auto calculation and filing of a bills charges
;
; IBCRBC (BILL) - determine if charges can be calculated and which rates (RS/CS) should be used
; then find billable items/events, calculate and store the charges
; called anytime a bills charges need to be updated
;
; IBCRBC1 (event) - gather billable items/events for each billable event type
; then accumulate all charges for the bill for each billable event/item
;
; IBCRCGx (event) - pull billable items/events from the bill
; IBCRBC2 (BITMCHRG) - calculate charges for billable item/event
;
; IBCRBC3 (SORTCI) - sort accumulated charges into order to store on bill, combine if possible
; IBCRBC3 (ADDBCHRGS) - store the sorted accumulated charges on the bill
;
;
; The Billable Event of the Charge Set is directly related to the Type of charge assigned
; to the charges calculated for that Charge Set. So, Billable Event (363.1,.03) <-> Type (399,42,.1)
;
;
; ^TMP($J,"IBCRCC") - array containing raw charges for a bill and related data, created in IBRCBC2
; ^TMP($J,"IBCRCC",X) = 1 charge item ifn
; 2 charge set ifn
; 3 rate schedule ifn
; 4 item ptr (to source)
; 5 cpt modifier ptr
; 6 revenue code ptr
; 7 billable bedsection (bill)
; 8 event date (visit or st from or admission)
; 9 charge per unit/qty
; 10 units/qty (qty of item)
; 11 total charge per unit/qty
; 12 adjusted total charge per unit/qty
; 13 units (# item on bill)
; 14 CPT ptr
; 15 division ptr
; 16 item type (source)
; 17 item ptr (to source)
; 18 charge component
; 19 billable bedsection (for item)
; 20 procedure provider
; 21 procedures associated clinic
; 22 procedures Outpatient Encounter, pointer to #409.68
; 23 list of all the procedures modifiers, separated by ','
;
; ^TMP($J,"IBCRCC",X,"CC",x) = comments explaining charge adjustements
;
; ^TMP($J,"IBCRCS") - array of charges from IBCRCC in sorted order and with only data needed to save on bill
; ^TMP($J,"IBCRCS", BS, RV, X) = 1 revenue code ptr
; 2 bedsection ptr
; 3 charge per units (adjusted total charge)
; 4 units (# item on bill)
; 5 CPT ptr
; 6 division ptr
; 7 item type
; 8 item ptr
; 9 charge component
;
;
;
; Inpatient Bill Dates use follow rules:
; - admission date is counted as billable
; - the discharge date is not billable and is not counted
;
; - if admission movement is found in the Patient Movement file then the dates of admission and discharge
; will be used as the outside limits of the LOS, even if date range of the bill is longer (LOS^IBCU64)
;
; - a day is counted as billable to the bedsection the patient was in at the end of the day (ie. counted
; in LOS of next movement after midnight)
; - if there is a movement on any given date that date is included in the LOS of the bedsection the patient
; moved into (same as admission date)
; - if there is a movement on any given date that date is NOT included in the LOS of the bedsection the
; patient moved out of (same as discharge date)
;
; - if the time frame of the bill is:
; - either interim-first or interim-continuous the last date on the bill should be billed
; - if the last date is counted it is added to the LOS of the bedsection the patient was in at the end
; of the day
; - either NOT interim-first or interim-continuous (final bills) the last date on the bill
; should NOT be billed (i.e. this is considered the discharge date)
;
; - start with first bedsection after begin date, day is counted in the bedsection the patient is in at midnight
; - continuous: last bedsection counted is the bedsection the patient is in at midnight of the end date
; - final:last bedsection counted is the bedsection the patient is in at midnight of the day before the end date
;
--- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HIBCRBC 10070 printed Apr 09, 2024@21:35:28 Page 2
IBCRBC ;ALB/ARH - RATES: BILL CALCULATION OF CHARGES ; 22-MAY-1996
+1 ;;2.0;INTEGRATED BILLING;**52,80,106,51,137,245,370,516**;21-MAR-94;Build 123
+2 ;;Per VA Directive 6402, this routine should not be modified.
+3 ;
+4 ; Variable DGPTUPDT may be defined on entry/exit for inpt bills so the PTF will only be updated once per session
+5 ; Charges may be filed on the bill and if IBRSARR is passed but does not exist it may be updated
+6 ; otherwise there are no other outputs/results of this call.
+7 ;
BILL(IBIFN,IBRSARR) ; given a bill number calculate and store all charges
+1 ; if IBRSARR is defined it will be used to create charges rather than the standard set for the bills Rate Type
+2 ;
+3 ; MRD;IB*2.0*516 - Added the flag IBNOCALC. This flag is set two
+4 ; places in ^IBCCC -- when the user is CLONing a claim (cancel and
+5 ; copy) or CRDing a claim (correct rejected/denied). The first time
+6 ; this procedure is entered for the new claim, if the IBNOCALC flag is
+7 ; set, it will reset the flag and quit out. That is, it does not re-
+8 ; calculate the charges the first time it otherwise would if the user
+9 ; is doing either a CRD or CLON.
+10 ;
+11 IF $GET(IBNOCALC)
SET IBNOCALC=0
QUIT
+12 ;
+13 NEW IB0,IBU,IBBRT,IBBTYPE,IBCTYPE,DFN,PTF,IBDGPT,IBRS,IBCS,IBBEVNT
if '$GET(IBIFN)
QUIT
+14 KILL ^TMP($JOB,"IBCRCC"),^TMP($JOB,"IBCRCS")
+15 ;
+16 SET IB0=$GET(^DGCR(399,+IBIFN,0))
if IB0=""
QUIT
SET IBU=$GET(^DGCR(399,+IBIFN,"U"))
if 'IBU
QUIT
+17 SET IBBRT=+$PIECE(IB0,U,7)
SET IBBTYPE=$SELECT($$INPAT^IBCEF(IBIFN):1,1:3)
SET IBCTYPE=+$PIECE(IB0,U,27)
SET DFN=$PIECE(IB0,U,2)
if 'DFN
QUIT
+18 ;
+19 ; if who's responsible is insurer, but bill has no insurer defined quit
+20 IF $PIECE(IB0,U,11)="i"
IF '$GET(^DGCR(399,+IBIFN,"MP"))
IF '$$MCRWNR^IBEFUNC(+$$CURR^IBCEF2(IBIFN))
QUIT
+21 ;
+22 ; if inpt bill, PTF Status is Open, not a Fee Basis record and not previously done then Update the PTF record
+23 IF IBBTYPE<3
IF '$DATA(DGPTUPDT)
SET PTF=$PIECE(IB0,U,8)
if 'PTF
QUIT
SET IBDGPT=$GET(^DGPT(+PTF,0))
if IBDGPT=""
QUIT
Begin DoDot:1
+24 IF '$PIECE(IBDGPT,U,6)
IF '$PIECE(IBDGPT,U,4)
DO UPDT^DGPTUTL
SET DGPTUPDT=""
End DoDot:1
+25 ;
+26 ;
+27 ; delete all existing auto charges on the bill
DO DSPDL^IBCRBC3
DO DELALLRC^IBCRBF(IBIFN)
+28 ;
+29 ; get standard set of all rate schedules and charge sets available for entire date range of the bill
+30 IF '$DATA(IBRSARR)
DO RT^IBCRU3(IBBRT,IBBTYPE,$PIECE(IBU,U,1,2),.IBRSARR,"",IBCTYPE)
IF 'IBRSARR
GOTO END
+31 ;
+32 ; process charge sets - set all charges for the bill into array
+33 SET IBRS=0
FOR
SET IBRS=$ORDER(IBRSARR(IBRS))
if 'IBRS
QUIT
Begin DoDot:1
+34 SET IBCS=0
FOR
SET IBCS=$ORDER(IBRSARR(IBRS,IBCS))
if 'IBCS
QUIT
IF +IBRSARR(IBRS,IBCS)
Begin DoDot:2
+35 SET IBBEVNT=+$PIECE($GET(^IBE(363.1,+IBCS,0)),U,3)
if 'IBBEVNT
QUIT
SET IBBEVNT=$$EMUTL^IBCRU1(IBBEVNT)
if IBBEVNT=""
QUIT
+36 ;
+37 IF IBBEVNT["INPATIENT BEDSECTION STAY"
DO INPTBS^IBCRBC1(IBIFN,IBRS,IBCS)
+38 IF IBBEVNT["INPATIENT DRG"
DO INPTDRG^IBCRBC11(IBIFN,IBRS,IBCS)
+39 IF IBBEVNT["OUTPATIENT VISIT DATE"
DO OPTVST^IBCRBC1(IBIFN,IBRS,IBCS)
+40 IF IBBEVNT["PRESCRIPTION"
DO RX^IBCRBC1(IBIFN,IBRS,IBCS)
+41 IF IBBEVNT["PROSTHETICS"
DO PI^IBCRBC1(IBIFN,IBRS,IBCS)
+42 IF IBBEVNT["PROCEDURE"
DO CPT^IBCRBC1(IBIFN,IBRS,IBCS)
End DoDot:2
End DoDot:1
+43 ;
+44 IF '$DATA(^TMP($JOB,"IBCRCC"))
GOTO END
+45 ;
+46 DO SORTCI^IBCRBC3
IF '$DATA(^TMP($JOB,"IBCRCS"))
GOTO END
+47 ;
+48 DO ADDBCHGS^IBCRBC3(IBIFN)
+49 ;
+50 DO MAILADD(IBIFN,IBBTYPE)
+51 ;
END IF $DATA(^TMP("IBCRRX",$JOB))
DO CLEANRX^IBCRBC3(IBIFN)
+1 KILL ^TMP($JOB,"IBCRCC"),^TMP($JOB,"IBCRCS")
+2 QUIT
+3 ;
MAILADD(IBIFN,BTYPE) ; update the bill mailing address: it may be based on the types of charges
+1 ; an outpatient bill may go to either the opt or rx mailing addresses depending on the types of charges
+2 NEW DA,IB01,IB02
+3 IF $GET(BTYPE)>2
IF +$GET(IBIFN)
IF $DATA(^IBA(362.4,"C",+IBIFN))
IF +$$CHGTYPE^IBCU(+IBIFN)=3
SET DA=IBIFN
DO MAILA^IBCU5
Begin DoDot:1
+4 IF '$DATA(ZTQUEUED)
IF '$GET(IBAUTO)
WRITE !!,"Updating Bill Mailing Address"
End DoDot:1
+5 QUIT
+6 ;
BILLITEM(IBIFN,IBITMARR) ; add selected unassociated item charges to the bill
+1 NEW IBRS,IBCS,IBBEVNT
KILL ^TMP($JOB,"IBCRCC"),^TMP($JOB,"IBCRCS")
+2 ;
+3 SET IBRS=0
FOR
SET IBRS=$ORDER(IBITMARR(IBRS))
if 'IBRS
QUIT
Begin DoDot:1
+4 SET IBCS=0
FOR
SET IBCS=$ORDER(IBITMARR(IBRS,IBCS))
if 'IBCS
QUIT
Begin DoDot:2
+5 SET IBBEVNT=+$PIECE($GET(^IBE(363.1,+IBCS,0)),U,3)
if 'IBBEVNT
QUIT
SET IBBEVNT=$$EMUTL^IBCRU1(IBBEVNT)
if IBBEVNT=""
QUIT
+6 ;
+7 IF IBBEVNT["UNASSOCIATED"
DO UNASSOC^IBCRBC11(IBIFN,IBRS,IBCS,.IBITMARR)
End DoDot:2
End DoDot:1
+8 ;
+9 IF $DATA(^TMP($JOB,"IBCRCC"))
DO SORTCI^IBCRBC3
+10 ;
+11 IF $DATA(^TMP($JOB,"IBCRCS"))
DO ADDBCHGS^IBCRBC3(IBIFN)
+12 ;
+13 KILL ^TMP($JOB,"IBCRCC"),^TMP($JOB,"IBCRCS")
+14 QUIT
+15 ;
+16 ;
+17 ;
+18 ; There are 3 types of charges/items:
+19 ; - ITEM: charge for an individual item: specific item has one or more charge entries in 363.2
+20 ; for the charge to be applied to the bill the specific item must be found on the bill
+21 ;
+22 ; - EVENT: charge for an event, not an item: items are defined in 363.2
+23 ; all charge items active on a date in the set define the charge for the event
+24 ; the item does not need to be defined on the bill for the charge to be applied to the bill
+25 ; the charge set on a date becomes the events charge, so effective date cuts across item and applies to event
+26 ; all charge items with the same effective date are used to calculate the event charge for that date
+27 ; each charge item effective date in the set overrides all previous entries in the set regardless of item
+28 ;
+29 ; - VA COST: charge for an individual item but no entries in 363.2
+30 ; instead the charge is calculated/obtained when it is needed from an interface with the source package
+31 ;
+32 ;
+33 ; Auto calculation and filing of a bills charges
+34 ;
+35 ; IBCRBC (BILL) - determine if charges can be calculated and which rates (RS/CS) should be used
+36 ; then find billable items/events, calculate and store the charges
+37 ; called anytime a bills charges need to be updated
+38 ;
+39 ; IBCRBC1 (event) - gather billable items/events for each billable event type
+40 ; then accumulate all charges for the bill for each billable event/item
+41 ;
+42 ; IBCRCGx (event) - pull billable items/events from the bill
+43 ; IBCRBC2 (BITMCHRG) - calculate charges for billable item/event
+44 ;
+45 ; IBCRBC3 (SORTCI) - sort accumulated charges into order to store on bill, combine if possible
+46 ; IBCRBC3 (ADDBCHRGS) - store the sorted accumulated charges on the bill
+47 ;
+48 ;
+49 ; The Billable Event of the Charge Set is directly related to the Type of charge assigned
+50 ; to the charges calculated for that Charge Set. So, Billable Event (363.1,.03) <-> Type (399,42,.1)
+51 ;
+52 ;
+53 ; ^TMP($J,"IBCRCC") - array containing raw charges for a bill and related data, created in IBRCBC2
+54 ; ^TMP($J,"IBCRCC",X) = 1 charge item ifn
+55 ; 2 charge set ifn
+56 ; 3 rate schedule ifn
+57 ; 4 item ptr (to source)
+58 ; 5 cpt modifier ptr
+59 ; 6 revenue code ptr
+60 ; 7 billable bedsection (bill)
+61 ; 8 event date (visit or st from or admission)
+62 ; 9 charge per unit/qty
+63 ; 10 units/qty (qty of item)
+64 ; 11 total charge per unit/qty
+65 ; 12 adjusted total charge per unit/qty
+66 ; 13 units (# item on bill)
+67 ; 14 CPT ptr
+68 ; 15 division ptr
+69 ; 16 item type (source)
+70 ; 17 item ptr (to source)
+71 ; 18 charge component
+72 ; 19 billable bedsection (for item)
+73 ; 20 procedure provider
+74 ; 21 procedures associated clinic
+75 ; 22 procedures Outpatient Encounter, pointer to #409.68
+76 ; 23 list of all the procedures modifiers, separated by ','
+77 ;
+78 ; ^TMP($J,"IBCRCC",X,"CC",x) = comments explaining charge adjustements
+79 ;
+80 ; ^TMP($J,"IBCRCS") - array of charges from IBCRCC in sorted order and with only data needed to save on bill
+81 ; ^TMP($J,"IBCRCS", BS, RV, X) = 1 revenue code ptr
+82 ; 2 bedsection ptr
+83 ; 3 charge per units (adjusted total charge)
+84 ; 4 units (# item on bill)
+85 ; 5 CPT ptr
+86 ; 6 division ptr
+87 ; 7 item type
+88 ; 8 item ptr
+89 ; 9 charge component
+90 ;
+91 ;
+92 ;
+93 ; Inpatient Bill Dates use follow rules:
+94 ; - admission date is counted as billable
+95 ; - the discharge date is not billable and is not counted
+96 ;
+97 ; - if admission movement is found in the Patient Movement file then the dates of admission and discharge
+98 ; will be used as the outside limits of the LOS, even if date range of the bill is longer (LOS^IBCU64)
+99 ;
+100 ; - a day is counted as billable to the bedsection the patient was in at the end of the day (ie. counted
+101 ; in LOS of next movement after midnight)
+102 ; - if there is a movement on any given date that date is included in the LOS of the bedsection the patient
+103 ; moved into (same as admission date)
+104 ; - if there is a movement on any given date that date is NOT included in the LOS of the bedsection the
+105 ; patient moved out of (same as discharge date)
+106 ;
+107 ; - if the time frame of the bill is:
+108 ; - either interim-first or interim-continuous the last date on the bill should be billed
+109 ; - if the last date is counted it is added to the LOS of the bedsection the patient was in at the end
+110 ; of the day
+111 ; - either NOT interim-first or interim-continuous (final bills) the last date on the bill
+112 ; should NOT be billed (i.e. this is considered the discharge date)
+113 ;
+114 ; - start with first bedsection after begin date, day is counted in the bedsection the patient is in at midnight
+115 ; - continuous: last bedsection counted is the bedsection the patient is in at midnight of the end date
+116 ; - final:last bedsection counted is the bedsection the patient is in at midnight of the day before the end date
+117 ;
