ABMM2DEF ;IHS/SD/SDR - MU Patient Volume DEF Report ;
;;2.6;IHS 3P BILLING SYSTEM;**11,12**;NOV 12, 2009;Build 187
;IHS/SD/SDR - 2.6*12 - Updated FQHC/RHC/Tribal to include Urban
;
S ABMQ("RC")="COMPUTE^ABMM2DEF"
S ABMQ("RX")="POUT^ABMDRUTL"
S ABMQ("NS")="ABM"
S ABMQ("RP")="PRINT^ABMM2DEF"
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"
;start old code abm*2.6*10 HEAT61752
;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."
;start old code abm*2.6*12
;;end old code start new code HEAT61752
;W !?3,"will be used for EPs who work predominately at an FQHC, RHC or Tribal clinic."
;W !?3,"An EP is considered to work predominantly at an FQHC, RHC or Tribal clinic"
;W !?3,"when the FQHC/RHC/Tribal clinic is the clinical location for over 50% of all"
;W !?3,"of the provider's total encounters for six (6) months in the most recent"
;W !?3,"calendar year. FQHCs, RHCs and Tribal clinics use the Needy Individual"
;W !?3,"encounter definition (expanded from the basic Medicaid encounter) for their"
;W !?3,"encounters."
;;end new code HEAT61752
;end old code start new code abm*2.6*12
W !?3,"will be used for EPs who work predominately at an FQHC, RHC, Tribal or Urban"
W !?3,"clinic. An EP is considered to work predominantly at an FQHC, RHC, Tribal or"
W !?3,"Urban clinic when the FQHC/RHC/Tribal/Urban clinic is the clinical location"
W !?3,"for over 50% of all of the provider's total encounters for six (6) months in"
W !?3,"the most recent calendar year. FQHCs, RHCs, Tribal and Urban clinics use the"
W !?3,"Needy Individual encounter definition (expanded from the basic Medicaid"
W !?3,"encounter) for their encounters."
;end new code abm*2.6*12
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
ABMM2DEF ;IHS/SD/SDR - MU Patient Volume DEF Report ;
+1 ;;2.6;IHS 3P BILLING SYSTEM;**11,12**;NOV 12, 2009;Build 187
+2 ;IHS/SD/SDR - 2.6*12 - Updated FQHC/RHC/Tribal to include Urban
+3 ;
+4 SET ABMQ("RC")="COMPUTE^ABMM2DEF"
+5 SET ABMQ("RX")="POUT^ABMDRUTL"
+6 SET ABMQ("NS")="ABM"
+7 SET ABMQ("RP")="PRINT^ABMM2DEF"
+8 DO ^ABMDRDBQ
+9 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 ;start old code abm*2.6*10 HEAT61752
+42 ;W !?3,"will be used for EPs who work predominately at an FQHC or RHC. An EP is"
+43 ;W !?3,"considered to work predominantly at an FQHC or RHC when the FQHC/RHC is the"
+44 ;W !?3,"clinical location for over 50% of all of the provider's total encounters for"
+45 ;W !?3,"six (6) months in the most recent calendar year. FQHCs and RHCs use the"
+46 ;W !?3,"Needy Individual encounter definition (expanded from the basic Medicaid"
+47 ;W !?3,"encounter) for their encounters."
+48 ;start old code abm*2.6*12
+49 ;;end old code start new code HEAT61752
+50 ;W !?3,"will be used for EPs who work predominately at an FQHC, RHC or Tribal clinic."
+51 ;W !?3,"An EP is considered to work predominantly at an FQHC, RHC or Tribal clinic"
+52 ;W !?3,"when the FQHC/RHC/Tribal clinic is the clinical location for over 50% of all"
+53 ;W !?3,"of the provider's total encounters for six (6) months in the most recent"
+54 ;W !?3,"calendar year. FQHCs, RHCs and Tribal clinics use the Needy Individual"
+55 ;W !?3,"encounter definition (expanded from the basic Medicaid encounter) for their"
+56 ;W !?3,"encounters."
+57 ;;end new code HEAT61752
+58 ;end old code start new code abm*2.6*12
+59 WRITE !?3,"will be used for EPs who work predominately at an FQHC, RHC, Tribal or Urban"
+60 WRITE !?3,"clinic. An EP is considered to work predominantly at an FQHC, RHC, Tribal or"
+61 WRITE !?3,"Urban clinic when the FQHC/RHC/Tribal/Urban clinic is the clinical location"
+62 WRITE !?3,"for over 50% of all of the provider's total encounters for six (6) months in"
+63 WRITE !?3,"the most recent calendar year. FQHCs, RHCs, Tribal and Urban clinics use the"
+64 WRITE !?3,"Needy Individual encounter definition (expanded from the basic Medicaid"
+65 WRITE !?3,"encounter) for their encounters."
+66 ;end new code abm*2.6*12
+67 WRITE !
+68 ;
+69 WRITE !,$$EN^ABMVDF("HIN"),"NEEDY INDIVIDUALS:",$$EN^ABMVDF("HIF")," Needy Individual encounters include all patient encounters"
+70 WRITE !?3,"paid for by:"
+71 WRITE !?5,"1. Medicaid-insurance type 'D' (includes 1115 Waivers)"
+72 WRITE !?5,"2. CHIP-insurance type 'K' billed as either Medicaid or Private Insurance"
+73 WRITE !?5,"3. Discounted (sliding scale) encounters"
+74 WRITE !?5,"4. Uncompensated care"
+75 WRITE !
+76 ;
+77 WRITE !,$$EN^ABMVDF("HIN"),"Note on Discounted Sliding Scale Encounters:",$$EN^ABMVDF("HIF")," Discounted (sliding scale)"
+78 WRITE !?3,"encounters are not included in this version of the report, as they are not"
+79 WRITE !?3,"currently captured in RPMS."
+80 WRITE !,$$EN^ABMVDF("HIN"),"Note on Uncompensated Care:",$$EN^ABMVDF("HIF")," Uncompensated care includes all unpaid encounters."
+81 WRITE !?3,"Unpaid Encounters = Encounters which were billed, but for which no payment"
+82 WRITE !?3,"was received for the report period. Unpaid Encounters are not affected by"
+83 WRITE !?3,"beneficiary status."
+84 QUIT
