| DESCRIPTION | This option is intended to identify costs for fee services which may beable to be recovered. The user selects the primary service facility(s) and date range. Allactive fee programs are reviewed for the selected search criteria. The data is sorted by division, patient, fee program, and vendor and date.The data displayed/printed is similar to the payment outputs, only forpatients that are means test category C/agree to pay deductible ornot exempt from LTC copay or for non-service connected treatment.Insurance information is also displayed/printed.The user is able to filter data to include Copays or Insurance onlyrelated information using prompt: Include (P)atient Co-pays / (I)nsurance / (B)oth If the user selects (P) or (B),the following propmpt will allow the user to include Mean Test or LTC copays only or Both: Include (M)eans Test Co-pays /(L)TC Co-pays /(B)oth Since July 5,2002 all LTC related payments are flagged in the report with anappropriate message. If the veteran doesn't have LTC test on file thenthe LTC related payment is flagged with "1010EC missing" message. Outpatient program (FBPCR2) - uses date finalized for date range sort. o For each service on a treatment date, the value of the SERVICE CONNECTED Y/N field is checked. If set to no, then software uses IB call to determine if patient is insured on treatment date o Check is also made if patient was Cat C and agreed to pay deductible or was not exempt from LTC copay on INITIAL TREATMENT DATE. If true, flag to collect from patient is set. o If service is for C&P, or both of the above two flags are negative, the record is bypassed. Pharmacy program (FBPCR3) - uses date certified for payment for date range sort. o For each invoice number, RX number for a patient within the specified date range, the value of the DATE PRESCRIPTION FILLED field is obtained and checked against the authorization in the FEE BASIS PATIENT file. A check is made to see if the value of the POTENTIAL COST RECOVERY field is yes for an authorization which encompasses the RX FILL DATE. If yes, then software uses IB call to determine if patient is insured on date certified for payment. o Check is also made if patient was Cat C and agreed to pay deductible on DATE PRESCRIPTION FILLED and agreed to pay deductible. If true, flag to collect from patient is set. o If both of the above two flags are negative, record is bypassed. CH/CNH program (FBPCR67*) - uses date finalized for date range sort o For each record, for a patient within the specified date range, the value of the TREATMENT FROM date is obtained and checked against the authorization in the FEE BASIS PATIENT file. A check is made to see if the value of the POTENTIAL COST RECOVERY field is set to yes for an authorization which encompasses the TREATMENT FROM DATE. If yes, then software uses IB call to determine if patient is insured on FROM/TO dates. o Check is also made if patient was Cat C and agreed to pay deductible or was not exempt from LTC copay on TREATMENT FROM DATE or TREATMENT TO DATE. If true on at least one of those dates, flag to collect from patient is set. o If both of the above two flags are negative, record is bypassed. |