ABMMUDEF ;IHS/SD/SDR - MU Patient Volume DEF Report ;
;;2.6;IHS 3P BILLING SYSTEM;**7**;NOV 12, 2009
;
S ABMQ("RC")="COMPUTE^ABMMUDEF"
S ABMQ("RX")="POUT^ABMDRUTL"
S ABMQ("NS")="ABM"
S ABMQ("RP")="PRINT^ABMMUDEF"
D ^ABMDRDBQ
Q
COMPUTE ;
Q
PRINT ;
W !!,"Definitions used in this Report:"
W !!,$$EN^ABMVDF("HIN"),"CONTINUOUS 90-DAY PERIOD:",$$EN^ABMVDF("HIF")," Any rolling 90-day period within the reporting year."
W !
;
W !,$$EN^ABMVDF("HIN"),"MINIMUM PATIENT VOLUME:",$$EN^ABMVDF("HIF")," Medicaid or Needy Volume greater than or equal to 30%"
W !?3," for EPs and 20% Pediatricians"
W !
;
W !,$$EN^ABMVDF("HIN"),"Participation year:",$$EN^ABMVDF("HIF")," The calendar year (Jan. 01 - Dec. 31) in which the EP is"
W !?3,"participating in the Medicaid EHR Incentive program."
W !
;
W !,$$EN^ABMVDF("HIN"),"Qualification year:",$$EN^ABMVDF("HIF")," The calendar year (Jan. 01 - Dec. 31) immediately prior to"
W !?3,"the Participation year. Patient Volume is calculated on encounters that"
W !?3,"occurred during the Qualification Year."
W !
;
W !,$$EN^ABMVDF("HIN"),"MEDICAID PATIENT VOLUME ENCOUNTERS:",$$EN^ABMVDF("HIF")
W " Medicaid encounters include all patient"
W !?3,"visits paid for by Medicaid or an 1115 waiver program. For states where a"
W !?3,"single payment is made to a facility without regard to the number of"
W !?3,"encounters a patient has during a single day, each EP who has an encounter"
W !?3,"with the patient that day will have the encounter included in their Patient"
W !?3,"Volume calculation."
W !
;
I (IOST["C") D PAZ^ABMDRUTL Q:$D(DTOUT)!$D(DUOUT)!$D(DIROUT)
W !,$$EN^ABMVDF("HIN"),"MEDICAID INDIVIDUALS:",$$EN^ABMVDF("HIF")
W " Medicaid individuals are patients where Medicaid or a"
W !?3,"Medicaid demonstration project paid for part or all of any of the following:"
W !?3,"Service, Premiums, Co-payments and/or cost sharing."
W !?3,"They may be:"
W !?5,"1. Individuals enrolled in Medicaid, or"
W !?5,"2. Individuals enrolled in a Medicaid managed care plan, which includes"
W !?5,"patients enrolled in Managed Care Organizations (MCO's), Prepaid Inpatient"
W !?5,"Health Plans (PIHPs), or Prepaid Ambulatory Health Plans (PAHPs)."
W !
;
W !,$$EN^ABMVDF("HIN"),"NEEDY INDIVIDUAL PATIENT VOLUME ENCOUNTERS:",$$EN^ABMVDF("HIF")
W " The Needy Individual Patient Volume"
W !?3,"will be used for EPs who work predominately at an FQHC or RHC. An EP is"
W !?3,"considered to work predominantly at an FQHC or RHC when the FQHC/RHC is the"
W !?3,"clinical location for over 50% of all of the provider's total encounters for"
W !?3,"six (6) months in the most recent calendar year. FQHCs and RHCs use the"
W !?3,"Needy Individual encounter definition (expanded from the basic Medicaid"
W !?3,"encounter) for their encounters."
W !
;
W !,$$EN^ABMVDF("HIN"),"NEEDY INDIVIDUALS:",$$EN^ABMVDF("HIF")," Needy Individual encounters include all patient encounters"
W !?3,"paid for by:"
W !?5,"1. Medicaid-insurance type 'D' (includes 1115 Waivers)"
W !?5,"2. CHIP-insurance type 'K' billed as either Medicaid or Private Insurance"
W !?5,"3. Discounted (sliding scale) encounters"
W !?5,"4. Uncompensated care"
W !
;
W !,$$EN^ABMVDF("HIN"),"Note on Discounted Sliding Scale Encounters:",$$EN^ABMVDF("HIF")," Discounted (sliding scale)"
W !?3,"encounters are not included in this version of the report, as they are not"
W !?3,"currently captured in RPMS."
W !,$$EN^ABMVDF("HIN"),"Note on Uncompensated Care:",$$EN^ABMVDF("HIF")," Uncompensated care includes all unpaid encounters."
W !?3,"Unpaid Encounters = Encounters which were billed, but for which no payment"
W !?3,"was received for the report period. Unpaid Encounters are not affected by"
W !?3,"beneficiary status."
Q
ABMMUDEF ;IHS/SD/SDR - MU Patient Volume DEF Report ;
+1 ;;2.6;IHS 3P BILLING SYSTEM;**7**;NOV 12, 2009
+2 ;
+3 SET ABMQ("RC")="COMPUTE^ABMMUDEF"
+4 SET ABMQ("RX")="POUT^ABMDRUTL"
+5 SET ABMQ("NS")="ABM"
+6 SET ABMQ("RP")="PRINT^ABMMUDEF"
+7 DO ^ABMDRDBQ
+8 QUIT
COMPUTE ;
+1 QUIT
PRINT ;
+1 WRITE !!,"Definitions used in this Report:"
+2 WRITE !!,$$EN^ABMVDF("HIN"),"CONTINUOUS 90-DAY PERIOD:",$$EN^ABMVDF("HIF")," Any rolling 90-day period within the reporting year."
+3 WRITE !
+4 ;
+5 WRITE !,$$EN^ABMVDF("HIN"),"MINIMUM PATIENT VOLUME:",$$EN^ABMVDF("HIF")," Medicaid or Needy Volume greater than or equal to 30%"
+6 WRITE !?3," for EPs and 20% Pediatricians"
+7 WRITE !
+8 ;
+9 WRITE !,$$EN^ABMVDF("HIN"),"Participation year:",$$EN^ABMVDF("HIF")," The calendar year (Jan. 01 - Dec. 31) in which the EP is"
+10 WRITE !?3,"participating in the Medicaid EHR Incentive program."
+11 WRITE !
+12 ;
+13 WRITE !,$$EN^ABMVDF("HIN"),"Qualification year:",$$EN^ABMVDF("HIF")," The calendar year (Jan. 01 - Dec. 31) immediately prior to"
+14 WRITE !?3,"the Participation year. Patient Volume is calculated on encounters that"
+15 WRITE !?3,"occurred during the Qualification Year."
+16 WRITE !
+17 ;
+18 WRITE !,$$EN^ABMVDF("HIN"),"MEDICAID PATIENT VOLUME ENCOUNTERS:",$$EN^ABMVDF("HIF")
+19 WRITE " Medicaid encounters include all patient"
+20 WRITE !?3,"visits paid for by Medicaid or an 1115 waiver program. For states where a"
+21 WRITE !?3,"single payment is made to a facility without regard to the number of"
+22 WRITE !?3,"encounters a patient has during a single day, each EP who has an encounter"
+23 WRITE !?3,"with the patient that day will have the encounter included in their Patient"
+24 WRITE !?3,"Volume calculation."
+25 WRITE !
+26 ;
+27 IF (IOST["C")
DO PAZ^ABMDRUTL
IF $DATA(DTOUT)!$DATA(DUOUT)!$DATA(DIROUT)
QUIT
+28 WRITE !,$$EN^ABMVDF("HIN"),"MEDICAID INDIVIDUALS:",$$EN^ABMVDF("HIF")
+29 WRITE " Medicaid individuals are patients where Medicaid or a"
+30 WRITE !?3,"Medicaid demonstration project paid for part or all of any of the following:"
+31 WRITE !?3,"Service, Premiums, Co-payments and/or cost sharing."
+32 WRITE !?3,"They may be:"
+33 WRITE !?5,"1. Individuals enrolled in Medicaid, or"
+34 WRITE !?5,"2. Individuals enrolled in a Medicaid managed care plan, which includes"
+35 WRITE !?5,"patients enrolled in Managed Care Organizations (MCO's), Prepaid Inpatient"
+36 WRITE !?5,"Health Plans (PIHPs), or Prepaid Ambulatory Health Plans (PAHPs)."
+37 WRITE !
+38 ;
+39 WRITE !,$$EN^ABMVDF("HIN"),"NEEDY INDIVIDUAL PATIENT VOLUME ENCOUNTERS:",$$EN^ABMVDF("HIF")
+40 WRITE " The Needy Individual Patient Volume"
+41 WRITE !?3,"will be used for EPs who work predominately at an FQHC or RHC. An EP is"
+42 WRITE !?3,"considered to work predominantly at an FQHC or RHC when the FQHC/RHC is the"
+43 WRITE !?3,"clinical location for over 50% of all of the provider's total encounters for"
+44 WRITE !?3,"six (6) months in the most recent calendar year. FQHCs and RHCs use the"
+45 WRITE !?3,"Needy Individual encounter definition (expanded from the basic Medicaid"
+46 WRITE !?3,"encounter) for their encounters."
+47 WRITE !
+48 ;
+49 WRITE !,$$EN^ABMVDF("HIN"),"NEEDY INDIVIDUALS:",$$EN^ABMVDF("HIF")," Needy Individual encounters include all patient encounters"
+50 WRITE !?3,"paid for by:"
+51 WRITE !?5,"1. Medicaid-insurance type 'D' (includes 1115 Waivers)"
+52 WRITE !?5,"2. CHIP-insurance type 'K' billed as either Medicaid or Private Insurance"
+53 WRITE !?5,"3. Discounted (sliding scale) encounters"
+54 WRITE !?5,"4. Uncompensated care"
+55 WRITE !
+56 ;
+57 WRITE !,$$EN^ABMVDF("HIN"),"Note on Discounted Sliding Scale Encounters:",$$EN^ABMVDF("HIF")," Discounted (sliding scale)"
+58 WRITE !?3,"encounters are not included in this version of the report, as they are not"
+59 WRITE !?3,"currently captured in RPMS."
+60 WRITE !,$$EN^ABMVDF("HIN"),"Note on Uncompensated Care:",$$EN^ABMVDF("HIF")," Uncompensated care includes all unpaid encounters."
+61 WRITE !?3,"Unpaid Encounters = Encounters which were billed, but for which no payment"
+62 WRITE !?3,"was received for the report period. Unpaid Encounters are not affected by"
+63 WRITE !?3,"beneficiary status."
+64 QUIT
