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Avatar Cal-PM 2023 Update 17

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Product Update Form Description

The 'User Defined Fee Unit' field is added to the 'Service Fee/Cross Reference Maintenance' form (Service Fee Maintenance section) to allow override default unit calculation logic for user defined fee service codes. Additionally, the existing field 'Unit' is renamed to 'Fixed Fee Unit' on the 'Service Fee/Cross Reference Maintenance' form (Service Fee Maintenance section).

Included Updates

3, 16

Required Updates

None

Details
NEW1 CHANGED0 FIXED0
New (1)
Avatar Cal-PM 'Service Fee/Cross Reference Maintenance' Form
The Avatar Cal-PM 'Service Fee/Cross Reference Maintenance' form is updated to support unit calculation overrides for service codes with user-defined fees.
The 'User Defined Fee Unit' field is added to the 'Service Fee/Cross Reference Maintenance' form ('Service Fee Maintenance' section). The 'User Defined Fee Unit' field will allow users the ability to override default unit calculation logic for user defined fee service codes. Additionally, the existing field 'Unit' is renamed to 'Fixed Fee Unit' on the 'Service Fee/Cross Reference Maintenance' form ('Service Fee Maintenance' section).
The Avatar Cal-PM File Import format for 'Service Fee/Cross Reference' file type has also been updated to include the 'User Defined Fee Unit' field.
Value Added: Adds 'User Defined Fee Unit' field in 'Service Fee/Cross Reference Maintenance' form to support additional unit calculation overrides
Topics
• 837 Institutional • 837 Professional • Client Charge Input • Edit Service Information • Electronic Billing • File Import • NX • Scheduling Calendar • Service Fee/Cross Reference Maintenance
 
Acceptance Tests
AV-86277 Summary | Details
Avatar Cal-PM 'Service Fee/Cross Reference Maintenance' Form
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • File Import
  • File Import - Compile/Post Report
  • File Import - Error Report
  • Service Fee/Cross Reference Maintenance
  • Service Fee/Cross Reference Maintenance Report
  • Client Charge Input
  • Client Charge Input (Charge Fee Access and Diagnosis Entry)
  • Client Charge Input (Charge Fee Access)
  • Client Charge Input With Diagnosis Entry
  • Client Ledger
  • Edit Service Information (Charge Fee Access)
  • Recurring Client Charge Input (Charge Fee Access and Diagnosis Entry)
  • Recurring Client Charge Input (Charge Fee Access)
  • Recurring Client Charge Input (Diagnosis Entry)
  • Spreadsheet Edit Service Information
  • Post Staff Member Schedule
  • Verify Staff Member Appointments
  • Electronic Billing
Scenario 1: 'Service Fee/Cross Reference Maintenance' - Form Validation (Avatar Cal-PM)
Specific Setup:
  • Crystal Reports or other SQL reporting tool
Steps
  1. Open Avatar Cal-PM 'Service Fee/Cross Reference Maintenance' form.
  2. Select 'Enter New' or 'Edit Existing' in the 'Enter New Or Edit Existing Fee/Cross Reference' field.
  3. Enter/select values for 'Service Code' and 'From Date' fields (and select Service Fee/Cross Reference entry for edit if applicable).
  4. Enter/select values for 'Practitioner Category', 'Location', 'Practitioner' and/or 'Program' Service Fee/Cross Reference entry criteria if desired.
  5. Ensure that 'Fixed Fee Unit' and 'User Defined Fee Unit' fields are present in form.
  6. In case where selected Service Code is defined as 'User Defined' (via Avatar Cal-PM 'Service Codes' form 'Type Of Fee' field) - ensure that the 'Fixed Fee Unit' field is disabled (as field only applies to Fixed Fee Service Codes).
  7. In case where selected Service Code is defined as 'Fixed Fee' (via Avatar Cal-PM 'Service Codes' form 'Type Of Fee' field) - ensure that the 'User Defined Fee Unit' field is disabled (as field only applies to User Defined Fee Service Codes).
  8. Ensure user help message is present in form for 'User Defined Fee Unit' field (lightbulb icon), containing the following information:
  9. "A value entered in this field will make the 'Duration Range' field required. The Unit Quantity amount and gross charge amount generated for the service will be based on the integer entered in this field."
  10. Ensure that if value is entered for 'User Defined Fee Unit' field, the 'Duration Range' fee criteria field is required.
  11. Enter/select values for 'Duration Range', 'Fee', 'Fixed Fee Unit' and/or 'User Defined Fee Unit' fields (and any other Service Fee/Cross Reference definition fields as desired/required).
  12. Click 'Submit' button to file 'Service Fee/Cross Reference Maintenance' form/entry; ensure user is presented with filing confirmation dialog noting 'Service Fee/Cross Reference Maintenance has completed. Do you wish to return to form?'; Click 'Yes' button to return to form.
  13. Select 'Edit Existing' in the 'Enter New Or Edit Existing Fee/Cross Reference' field.
  14. Enter/select values for 'Service Code' and 'From Date' fields, using same code/date as previously filed Service Fee/Cross Reference entry, and select previously entered/filed Service Fee/Cross Reference entry for view/edit.
  15. Ensure previously entered/filed values are present in all form fields for selected Service Fee/Cross Reference entry (including values for 'Fixed Fee Unit' and 'User Defined Fee Unit' fields where applicable).
  16. Click 'Service Fee/Cross Reference Definition Report' button to launch report displaying all defined Service Fee/Cross Reference entries.
  17. In Service Fee/Cross Reference Definition Report, ensure that existing Service Fee/Cross Reference entries are present, including values for 'Units' field where value defined.
  18. Note, 'Units' field in Service Fee/Cross Reference Definition Report will display value of 'Fixed Fee Unit' if present for Fixed Fee Service Codes, and will display value of 'User Defined Fee Unit' if present for User Defined Fee Service Codes
  19. Open Crystal Reports or other SQL reporting tool.
  20. In Avatar Cal-PM SQL table 'SYSTEM.billing_tx_master_fee_table' (and 'SYSTEM.billing_tx_master_fee_audit' for deleted entries), ensure that data rows are present for all Service Fee/Cross Reference entries filed/updated in system, including values for 'fixed_fee_units' and 'user_defined_fee_units' fields.
Scenario 2: 'File Import' - Verification of 'Service Fee/Cross Reference' Import (Avatar Cal-PM)
Specific Setup:
  • Avatar Cal-PM 'Service Fee/Cross Reference' File Import file containing one or valid rows, including value for 'User Defined Fee Unit' (Field/Segment 35)
  • Updated import file layout document 'Avatar_Cal-PM_File_Import_Record_Layouts.xls' included with update package
  • Crystal Reports or other SQL reporting tool
Steps
  1. Open Avatar Cal-PM 'File Import' form.
  2. Select File Type 'Service Fee/Cross Reference'.
  3. Select 'Upload New File' in 'Action' field and Click 'Process Action' button.
  4. Select Avatar Cal-PM 'Service Fee/Cross Reference' import file and click 'Open' button.
  5. Select 'Compile/Validate File' in 'Action' field.
  6. Select loaded import file and click 'Process Action' button.
  7. Ensure that 'Compile/Validate File' action completes, and message 'Compiled' or '(File Name) contains one or more errors. These errors can be reviewed using 'Print Errors' action' is displayed.
  8. Click 'OK' button.
  9. Select 'Print Errors' in 'Action' field if errors encountered in compile; Select compiled import file with errors and click 'Process Action' button.
  10. In 'Service Fee/Cross Reference' File Import Error Report, ensure that all invalid/errored import row(s) are included in report with segment/value reference and error message detail.
  11. Ensure that if 'User Defined Fee Unit' value is included in file but no value for 'Duration Range' is included, import row(s) produce error 'Missing required field (Duration Range)' on compile
  12. Select 'Print File' in 'Action' field to view successfully compiled import data; Select compiled import file and click 'Process Action' button.
  13. In 'Service Fee/Cross Reference' File Import Report, ensure that all valid import row(s) are included in report with segment/value details, including 'User Defined Fee Unit' field/segment where included.
  14. Select 'Post File' in 'Action' field to post successfully compiled import data; Select compiled import file and click 'Process Action' button.
  15. Ensure that 'Compile/Validate File' action completes, and message 'Posted' and/or 'The selected file contains one or more lines with compilation errors. Only those lines without compilation errors will be posted' is displayed.
  16. Open Crystal Reports or other SQL reporting tool.
  17. In new Avatar Cal-PM SQL table 'SYSTEM.file_import_svc_fee', ensure that all 'Service Fee/Cross Reference' File Import rows are included in table with values from import data file, including 'user_defined_fee_units' field/segment where included.
  18. Open Avatar Cal-PM 'Service Fee/Cross Reference Maintenance' form.
  19. Select 'Edit Existing' in the 'Enter New Or Edit Existing Fee/Cross Reference' field.
  20. Enter/select 'Service Code' and 'From Date' field values for Service Fee/Cross Reference entry posted via File Import, and select imported Service Fee/Cross Reference entry for view/edit.
  21. Ensure values for all fields are present as filed via import, including values for 'Fixed Fee Unit' and 'User Defined Fee Unit' fields where applicable.
Scenario 3: 'Client Charge Input' - Verification of 'User Defined Fee Units' Service Fee Override Calculation
Specific Setup:
  • Service Code where 'Type of Fee' is set to 'User Defined' and (via Avatar Cal-PM 'Service Codes' form)
  • Service Fee/Cross Reference entry applicable to Service Code/Date of Service where 'User Defined Fee Unit' value is specified (via Avatar Cal-PM 'Service Fee/Cross Reference Maintenance' form)
  • Client record eligible for 'Client Charge Input' form service entry
Steps
  1. Open Avatar Cal-PM 'Client Charge Input' form.
  2. Note, Acceptance Testing may also be confirmed via one or more of the following Avatar Cal-PM forms:
  3. 'Client Charge Input (Charge Fee Access)'
  4. 'Client Charge Input With Diagnosis Entry'
  5. 'Client Charge Input (Charge Fee Access and Diagnosis Entry)'
  6. 'Recurring Client Charge Input'
  7. 'Recurring Client Charge Input (Charge Fee Access)'
  8. 'Recurring Client Charge Input (Diagnosis Entry)'
  9. 'Recurring Client Charge Input (Charge Fee Access and Diagnosis Entry)'
  10. 'Edit Service Information'
  11. 'Edit Service Information (Charge Fee Access)'
  12. 'Spreadsheet Edit Service Information'
  13. Enter value for 'Date of Service'.
  14. Enter/select values for 'Client ID', 'Episode Number', 'Program', 'Service Code' and 'Practitioner' fields (and any other fields as desired/required).
  15. Enter value for 'Duration (Minutes)' field.
  16. Where 'User Defined Fee Unit' value is specified for Service Fee/Cross Reference entry - ensure that 'Cost of Service' value in 'Client Charge Input' form is calculated based on 'User Defined Fee Unit' and 'Fee' from Service Fee/Cross Reference entry applicable to Service Code/Date of Service and 'Duration (Minutes)' entry for User Defined Fee Service Code (Service Fee/Cross Reference 'User Defined Fee Unit' value overrides Service Code 'Minutes Per Unit'/service entry 'Duration (Minutes)' values for calculation of 'Cost of Service').
  17. Example, 'User Defined Fee Units' value specified for Service Fee/Cross Reference entry:
  18. Service Code 'Minutes Per Unit' = 1
  19. Service Fee/Cross Reference entries as follows:
  20. 'Duration Range' 0-59, 'User Defined Fee Unit' = 30 and 'Fee' = 10
  21. 'Duration Range' 60-119, 'User Defined Fee Unit' = 90 and 'Fee' = 10
  22. 'Duration Range' 120-999, 'User Defined Fee Unit' = 180 and 'Fee' = 10
  23. If 'Duration (Minutes)' entry = 10, 'Cost of Service' = 300
  24. If 'Duration (Minutes)' entry = 30, 'Cost of Service' = 300
  25. If 'Duration (Minutes)' entry = 50, 'Cost of Service' = 300
  26. If 'Duration (Minutes)' entry = 60, 'Cost of Service' = 900
  27. If 'Duration (Minutes)' entry = 90, 'Cost of Service' = 900
  28. If 'Duration (Minutes)' entry = 100, 'Cost of Service' = 900
  29. If 'Duration (Minutes)' entry = 120, 'Cost of Service' = 1800
  30. If 'Duration (Minutes)' entry = 180, 'Cost of Service' = 1800
  31. If 'Duration (Minutes)' entry = 360, 'Cost of Service' = 1800
  32. Where 'User Defined Fee Unit' value is not specified for Service Fee/Cross Reference entry - ensure that 'Cost of Service' value in 'Client Charge Input' form is calculated based on Service Code 'Minutes Per Units' value and 'Fee' from Service Fee/Cross Reference entry applicable to Service Code/Date of Service and 'Duration (Minutes)' entry for User Defined Fee Service Code (Service Code 'Minutes Per Unit' and service entry 'Duration (Minutes)' values used for calculation of 'Cost of Service').
  33. Example, 'User Defined Fee Units' value not specified for Service Fee/Cross Reference entry:
  34. Service Code 'Minutes Per Unit' = 1
  35. Service Fee/Cross Reference entries as follows:
  36. 'Duration Range' 0-59, 'Fee' = 10
  37. 'Duration Range' 60-119, 'Fee' = 10
  38. 'Duration Range' 120-999, 'Fee' = 10
  39. If 'Duration (Minutes)' entry = 10, 'Cost of Service' = 100
  40. If 'Duration (Minutes)' entry = 50, 'Cost of Service' = 500
  41. If 'Duration (Minutes)' entry = 60, 'Cost of Service' = 600
  42. If 'Duration (Minutes)' entry = 100, 'Cost of Service' = 1000
  43. If 'Duration (Minutes)' entry = 120, 'Cost of Service' = 1200
  44. If 'Duration (Minutes)' entry = 360, 'Cost of Service' = 3600
  45. Enter/select/edit values for any other client charge/service entry information fields as required/desired.
  46. Click 'Submit' button to file 'Client Charge Input' form/service.
  47. Where 'User Defined Fee Unit' value is specified for Service Fee/Cross Reference entry - ensure that service(s) is/are added to system with 'Units' and 'Charge'/'Cost of Service' values from 'User Defined Fee Unit' and 'Fee' for applicable Service Fee/Cross Reference entry.
  48. 'Units' and 'Charge'/'Cost of Service' values for service(s) may be confirmed via 'Client Ledger' form
Scenario 4: Appointment Scheduling Services - Verification of 'User Defined Fee Units' Service Fee Override Calculation
Specific Setup:
  • Service Code where 'Type of Fee' is set to 'User Defined' and (via Avatar Cal-PM 'Service Codes' form)
  • Service Fee/Cross Reference entry applicable to Service Code/Date of Service where 'User Defined Fee Unit' value is specified (via Avatar Cal-PM 'Service Fee/Cross Reference Maintenance' form)
  • Client record eligible for Appointment Scheduling appointment/service entry
Steps
  1. Open Avatar Cal-PM 'Scheduling Calendar' form.
  2. Select calendar date and practitioner; right click and select 'Add Appointment' for new Appointment/Service entry.
  3. Enter/select values for 'Appointment Start Time'/'Appointment End Time' and/or 'Duration' fields.
  4. Enter/select/update values for 'Service Code', 'Appointment Status', 'Recurrence Schedule', 'Client', 'Episode Number', 'Practitioner' and 'Program' fields.
  5. Enter/select values for any other Appointment/Service entry fields as required/desired, and click 'Submit' button to save Appointment/Service entry.
  6. Repeat Appointment/Service entry process as desired in 'Scheduling Calendar' form for additional services; click 'Dismiss' button to close 'Scheduling Calendar' form when complete.
  7. Verify Appointments for Practitioner/Staff Member for Appointment/Service entry dates (via Avatar Cal-PM 'Verify Staff Member Appointments' form).
  8. Post Appointment/Service schedule entries for Practitioner/Staff Member to create service(s) in system for entered Appointments (via Avatar Cal-PM 'Post Staff Member Schedule' form).
  9. For services created via Appointment Scheduling entries, where 'User Defined Fee Unit' value is specified for applicable Service Fee/Cross Reference entry - ensure that 'Cost of Service'/'Total Charge'/Units' values for service are calculated based on 'User Defined Fee Unit' and 'Fee' from Service Fee/Cross Reference entry applicable to Service Code/Date of Service and Appointment 'Duration' value for User Defined Fee Service Code (Service Fee/Cross Reference 'User Defined Fee Unit' value overrides Service Code 'Minutes Per Unit'/Appointment entry 'Duration' values for calculation of 'Cost of Service').
  10. Example, 'User Defined Fee Units' value specified for Service Fee/Cross Reference entry:
  11. Service Code 'Minutes Per Unit' = 1
  12. Service Fee/Cross Reference entries as follows:
  13. 'Duration Range' 0-59, 'User Defined Fee Unit' = 30 and 'Fee' = 10
  14. 'Duration Range' 60-119, 'User Defined Fee Unit' = 90 and 'Fee' = 10
  15. 'Duration Range' 120-999, 'User Defined Fee Unit' = 180 and 'Fee' = 10
  16. If 'Duration' entry for Appointment = 10, 'Cost of Service' = 300
  17. If 'Duration' entry for Appointment = 30, 'Cost of Service' = 300
  18. If 'Duration' entry for Appointment = 50, 'Cost of Service' = 300
  19. If 'Duration' entry for Appointment = 60, 'Cost of Service' = 900
  20. If 'Duration' entry for Appointment = 90, 'Cost of Service' = 900
  21. If 'Duration' entry for Appointment = 100, 'Cost of Service' = 900
  22. If 'Duration' entry for Appointment = 120, 'Cost of Service' = 1800
  23. If 'Duration' entry for Appointment = 180, 'Cost of Service' = 1800
  24. If 'Duration' entry for Appointment = 360, 'Cost of Service' = 1800
  25. 'Units' and 'Charge'/'Cost of Service' values for service(s) may be confirmed via 'Client Ledger' form
Scenario 5: 'Electronic Billing' - Verification of 'User Defined Fee Units' Service Fee/Units Override Calculation
Specific Setup:
  • Service Code where 'Type of Fee' is set to 'User Defined' and (via Avatar Cal-PM 'Service Codes' form)
  • Service Fee/Cross Reference entry applicable to Service Code/Date of Service where 'User Defined Fee Unit' value is specified (via Avatar Cal-PM 'Service Fee/Cross Reference Maintenance' form)
  • One or more service(s) eligible for Avatar Cal-PM 837 Professional or 837 Institutional file inclusion
Steps
  1. Open Avatar Cal-PM 'Electronic Billing' form.
  2. Note, acceptance testing may also be confirmed via Avatar Cal-PM 'Quick Billing' form/functionality.
  3. Select '837 Professional' or '837 Institutional' in the 'Billing Form' field.
  4. Select 'Sort File' in the 'Billing Options' field.
  5. Enter/select 837 Professional/837 Institutional file sorting criteria.
  6. Click 'Process' button to sort/generate 837 Professional/837 Institutional file.
  7. Select 'Dump File' in the 'Billing Options' field (or select 'Create File On Server' to review output file directly).
  8. Select 'Print' in the 'Print Or Delete Report' field.
  9. Select 837 Professional/837 Institutional file sorted which includes services where 'User Defined Fee Unit' value is specified for applicable Service Fee/Cross Reference entry and click 'Process' button to display 837 outbound file data.
  10. In Avatar PM 837 Professional/837 Institutional format outbound electronic billing file data including services where 'User Defined Fee Unit' value is specified for applicable Service Fee/Cross Reference entry - ensure 'Cost of Service'/'Total Charge'/Units' values for service in 2400 SV1/SV2 Service Line Number information are reported from/same as calculated values based on 'User Defined Fee Unit' and 'Fee' from Service Fee/Cross Reference entry applicable to Service Code/Date of Service and 'Duration' value for User Defined Fee Service Code (Service Fee/Cross Reference 'User Defined Fee Unit' value overrides Service Code 'Minutes Per Unit'/service entry 'Duration' values for calculation/reporting of 'Cost of Service').
  11. Example, 'User Defined Fee Units' value specified for Service Fee/Cross Reference entry:
  12. Service Code 'Minutes Per Unit' = 1
  13. Service Fee/Cross Reference entries as follows:
  14. 'Duration Range' 0-59, 'User Defined Fee Unit' = 30 and 'Fee' = 10
  15. 'Duration Range' 60-119, 'User Defined Fee Unit' = 90 and 'Fee' = 10
  16. 'Duration Range' 120-999, 'User Defined Fee Unit' = 180 and 'Fee' = 10
  17. If 'Duration' entry for service = 0-59, 'Cost of Service' = 300
  18. 837 2400 SV1/SV2 example:
  19. SV1*HC:90806*300*UN*30*11**1~
  20. SV2*914**300*UN*30~
  21. If 'Duration' entry for service = 60-119, 'Cost of Service' = 900
  22. 837 2400 SV1/SV2 example:
  23. SV1*HC:90806*900*UN*90*11**1~
  24. SV2*914**900*UN*90~
  25. If 'Duration' entry for service = 120-999, 'Cost of Service' =1800
  26. 837 2400 SV1/SV2 example:
  27. SV1*HC:90806*1800*UN*180*11**1~
  28. SV2*914**1800*UN*180~
  29. Note - 837 Professional/837 Institutional 2400 SV1/SV2 values are subject to 'Service Unit of Measurement Code' value if defined in Service Fee/Cross Reference entry; if 'Minutes' is selected, 'Duration' entry/value for services will be reported in 2400 SV1/SV2 (including where 'User Defined Fee Unit' override was used in service cost calculation)
  30. Examples:
  31. SV1*HC:90806*300*MJ*45*11**1~
  32. SV1*HC:90806*900*MJ*100*11**1~
  33. SV1*HC:90806*1800*MJ*360*11**1~
  34. Note - 837 Professional/837 Institutional 2400 SV1/SV2 values are subject to 'Quantity' override value if defined in Service Fee/Cross Reference entry and will be reported in 2400 SV1/SV2
  35. Examples:
  36. SV1*HC:90806*300*UN*2*11**1~
  37. SV1*HC:90806*900*UN*2*11**1~
  38. SV1*HC:90806*1800*UN*2*11**1~
Topics
• 837 Institutional • 837 Professional • Client Charge Input • Edit Service Information • Electronic Billing • File Import • NX • Scheduling Calendar • Service Fee/Cross Reference Maintenance
Table Changes
Table Column Change
SYSTEM.BillingTxMasterFeeDef user_defined_fee_units ADD
SYSTEM.BillingTxMasterFeeAudit user_defined_fee_units ADD
file_import_svc_fee user_defined_fee_units ADD