ABMMUDEF.m

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