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Routine: ABMM2DEF

ABMM2DEF.m

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  1. ABMM2DEF ;IHS/SD/SDR - MU Patient Volume DEF Report ;
  1.  ;;2.6;IHS 3P BILLING SYSTEM;**11,12**;NOV 12, 2009;Build 187
  1.  ;IHS/SD/SDR - 2.6*12 - Updated FQHC/RHC/Tribal to include Urban
  1.  ;
  1.  S ABMQ("RC")="COMPUTE^ABMM2DEF"
  1.  S ABMQ("RX")="POUT^ABMDRUTL"
  1.  S ABMQ("NS")="ABM"
  1.  S ABMQ("RP")="PRINT^ABMM2DEF"
  1.  D ^ABMDRDBQ
  1.  Q
  1. COMPUTE ;
  1.  Q
  1. PRINT ;
  1.  W !!,"Definitions used in this Report:"
  1.  W !!,$$EN^ABMVDF("HIN"),"CONTINUOUS 90-DAY PERIOD:",$$EN^ABMVDF("HIF")," Any rolling 90-day period within the reporting year."
  1.  W !
  1.  ;
  1.  W !,$$EN^ABMVDF("HIN"),"MINIMUM PATIENT VOLUME:",$$EN^ABMVDF("HIF")," Medicaid or Needy Volume greater than or equal to 30%"
  1.  W !?3," for EPs and 20% Pediatricians"
  1.  W !
  1.  ;
  1.  W !,$$EN^ABMVDF("HIN"),"Participation year:",$$EN^ABMVDF("HIF")," The calendar year (Jan. 01 - Dec. 31) in which the EP is"
  1.  W !?3,"participating in the Medicaid EHR Incentive program."
  1.  W !
  1.  ;
  1.  W !,$$EN^ABMVDF("HIN"),"Qualification year:",$$EN^ABMVDF("HIF")," The calendar year (Jan. 01 - Dec. 31) immediately prior to"
  1.  W !?3,"the Participation year.  Patient Volume is calculated on encounters that"
  1.  W !?3,"occurred during the Qualification Year."
  1.  W !
  1.  ;
  1.  W !,$$EN^ABMVDF("HIN"),"MEDICAID PATIENT VOLUME ENCOUNTERS:",$$EN^ABMVDF("HIF")
  1.  W " Medicaid encounters include all patient"
  1.  W !?3,"visits paid for by Medicaid or an 1115 waiver program. For states where a"
  1.  W !?3,"single payment is made to a facility without regard to the number of"
  1.  W !?3,"encounters a patient has during a single day, each EP who has an encounter"
  1.  W !?3,"with the patient that day will have the encounter included in their Patient"
  1.  W !?3,"Volume calculation."
  1.  W !
  1.  ;
  1.  I (IOST["C") D PAZ^ABMDRUTL Q:$D(DTOUT)!$D(DUOUT)!$D(DIROUT)
  1.  W !,$$EN^ABMVDF("HIN"),"MEDICAID INDIVIDUALS:",$$EN^ABMVDF("HIF")
  1.  W " Medicaid individuals are patients where Medicaid or a"
  1.  W !?3,"Medicaid demonstration project paid for part or all of any of the following:"
  1.  W !?3,"Service, Premiums, Co-payments and/or cost sharing."
  1.  W !?3,"They may be:"
  1.  W !?5,"1. Individuals enrolled in Medicaid, or"
  1.  W !?5,"2. Individuals enrolled in a Medicaid managed care plan, which includes"
  1.  W !?5,"patients enrolled in Managed Care Organizations (MCO's), Prepaid Inpatient"
  1.  W !?5,"Health Plans (PIHPs), or Prepaid Ambulatory Health Plans (PAHPs)."
  1.  W !
  1.  ;
  1.  W !,$$EN^ABMVDF("HIN"),"NEEDY INDIVIDUAL PATIENT VOLUME ENCOUNTERS:",$$EN^ABMVDF("HIF")
  1.  W " The Needy Individual Patient Volume"
  1.  ;start old code abm*2.6*10 HEAT61752
  1.  ;W !?3,"will be used for EPs who work predominately at an FQHC or RHC.  An EP is"
  1.  ;W !?3,"considered to work predominantly at an FQHC or RHC when the FQHC/RHC is the"
  1.  ;W !?3,"clinical location for over 50% of all of the provider's total encounters for"
  1.  ;W !?3,"six (6) months in the most recent calendar year.  FQHCs and RHCs use the"
  1.  ;W !?3,"Needy Individual encounter definition (expanded from the basic Medicaid"
  1.  ;W !?3,"encounter) for their encounters."
  1.  ;start old code abm*2.6*12
  1.  ;;end old code start new code HEAT61752
  1.  ;W !?3,"will be used for EPs who work predominately at an FQHC, RHC or Tribal clinic."
  1.  ;W !?3,"An EP is considered to work predominantly at an FQHC, RHC or Tribal clinic"
  1.  ;W !?3,"when the FQHC/RHC/Tribal clinic is the clinical location for over 50% of all"
  1.  ;W !?3,"of the provider's total encounters for six (6) months in the most recent"
  1.  ;W !?3,"calendar year.  FQHCs, RHCs and Tribal clinics use the Needy Individual"
  1.  ;W !?3,"encounter definition (expanded from the basic Medicaid encounter) for their"
  1.  ;W !?3,"encounters."
  1.  ;;end new code HEAT61752
  1.  ;end old code start new code abm*2.6*12
  1.  W !?3,"will be used for EPs who work predominately at an FQHC, RHC, Tribal or Urban"
  1.  W !?3,"clinic.  An EP is considered to work predominantly at an FQHC, RHC, Tribal or"
  1.  W !?3,"Urban clinic when the FQHC/RHC/Tribal/Urban clinic is the clinical location"
  1.  W !?3,"for over 50% of all of the provider's total encounters for six (6) months in"
  1.  W !?3,"the most recent calendar year.  FQHCs, RHCs, Tribal and Urban clinics use the"
  1.  W !?3,"Needy Individual encounter definition (expanded from the basic Medicaid"
  1.  W !?3,"encounter) for their encounters."
  1.  ;end new code abm*2.6*12
  1.  W !
  1.  ;
  1.  W !,$$EN^ABMVDF("HIN"),"NEEDY INDIVIDUALS:",$$EN^ABMVDF("HIF")," Needy Individual encounters include all patient encounters"
  1.  W !?3,"paid for by:"
  1.  W !?5,"1. Medicaid-insurance type 'D' (includes 1115 Waivers)"
  1.  W !?5,"2. CHIP-insurance type 'K' billed as either Medicaid or Private Insurance"
  1.  W !?5,"3. Discounted (sliding scale) encounters"
  1.  W !?5,"4. Uncompensated care"
  1.  W !
  1.  ;
  1.  W !,$$EN^ABMVDF("HIN"),"Note on Discounted Sliding Scale Encounters:",$$EN^ABMVDF("HIF"),"  Discounted (sliding scale)"
  1.  W !?3,"encounters are not included in this version of the report, as they are not"
  1.  W !?3,"currently captured in RPMS."
  1.  W !,$$EN^ABMVDF("HIN"),"Note on Uncompensated Care:",$$EN^ABMVDF("HIF"),"  Uncompensated care includes all unpaid encounters."
  1.  W !?3,"Unpaid Encounters = Encounters which were billed, but for which no payment"
  1.  W !?3,"was received for the report period. Unpaid Encounters are not affected by"
  1.  W !?3,"beneficiary status."
  1.  Q