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Avatar Cal-PM 2024 Update 47

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Product Requirements and Recommendations

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Recommended Update Level

Avatar Cal-PM 2024 Monthly Release 2024.01.02
RADplus 2024 Monthly Release 2024.01.02

Product Update Description

The issue is resolved where the 'Progress Note' forms were improperly linking primary codes as add-on codes when creating services with multiple co-practitioners. Existing services are also updated to correct the linking between the primary and add-on services.

Required Updates

None

Included Updates

25

Details
NEW0 CHANGED0 FIXED1
Fixed (1)
Electronic Billing - Claiming Services.
Issue is resolved where there was a problem with the Max LX per CLM setting not being respected when claiming a service that had co-practitioners and add-ons documented for the service in a progress note.
The issue was that the system would put all primary practitioner, and co-practitioner, primary and add-on services in one claim, even when the Max LX per CLM was set to '1'. When co-practitioners were documented, those co-practitioner (primary and add-on) services should not be in the same claim as the primary practitioner's (primary and add-on) services when the Max LX per CLM is set to '1'. A separate claim should be generated in the 837 file for each practitioner's specific primary and add-on services.
Topics
• Client Ledger • Edit Service Information • Progress Notes • Service Codes
 
Acceptance Tests
AV-96403 Summary | Details
Electronic Billing - Claiming Services.
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Client Ledger
  • Create Interim Billing Batch File
  • Electronic Billing
  • Progress Notes (Group and Individual)
Scenario 1: Progress Notes form - Creating notes for New services with both Primary and Co-Practitioners with add-on service.
Specific Setup:
  • Registry Settings:
  • The 'Enable Co-Practitioner Services From Progress Notes' registry setting is set to 'Y'.
  • The 'Enable Multiple Add-On Code Per Primary Code Functionality' registry setting to 'Y'.
  • Program Maintenance:
  • Identify an existing program to be used for client's admission. Note the program code/value, and associated service programs.
  • The 'Create Co-Practitioner Services From Progress Notes' field is set to 'Yes' for the above program.
  • Site Specific Section modeling:
  • Add-On service, Save Add-On, Add-On Duration, Co-Practitioner, Co-Practitioner Duration fields are added to the Progress Note form if they are not available on the form.
  • Dictionary Update:
  • File= 'Other Tabled File,
  • Data Element - 291 'Service Code Type'
  • Dictionary Code = Desired code
  • Dictionary Value = Desired value
  • Extended Dictionary = 'Allow Multiple Add-On Code Definition'
  • Extended Dictionary Value (Single Dictionary) = Yes
  • Service Codes:
  • A primary service code is created to have desired number of add-on with the following:
  • Service Code Category = Primary Code
  • Service Code Type = desired value
  • Type of Fee = desired value.
  • All other fields are populated as required/needed.
  • Note the code and definition.
  • An add-on service code is created with the following:
  • Service Code Category = Add-On Code
  • Service Code Type = desired value
  • Type of Fee = desired value.
  • Should Add-On Services Generate for Co-Practitioners for this Service Code? = Yes
  • All other fields are populated as required/needed.
  • Note the code and definition.
  • Service Fee/Cross Reference Maintenance:
  • A fee definition is created for both the service codes. Note the fee for each service code.
  • Two active practitioners are identified. One will be the primary practitioner, and one will be the co-practitioner. Note the practitioner IDs.
  • Admission:
  • An active client is identified, or a new client is created. Note the client's id, name.
  • Diagnosis:
  • The client has an active diagnosis record. Note the diagnosis codes.
  • Financial Eligibility:
  • The client has an active financial eligibility record. Note the financial class of the guarantor. Note the client ID. Note the episode and program.
  • Guarantor/Program Billing Defaults:
  • The guarantor used in the client's financial eligibility form has an active billing template with the section 837P filled with all the needed values.
Steps
  1. Open the 'Progress Notes (Group and Individual)' form.
  2. Select desired client in 'Select Client'.
  3. Select desired episode in 'Select Episode.
  4. Select ‘New Service’ in 'Progress Notes For'.
  5. Select any value in 'Note Type'.
  6. Enter any value in 'Notes Field'.
  7. Enter desired 'Date Of Service'.
  8. Enter primary service code in 'Service Charge Code'.
  9. Validate that 'Service Program' contains the service program associated to selected episode.
  10. Select desired practitioner in 'Practitioner'.
  11. Enter desired duration in 'Service Duration'.
  12. Select desired co-practitioner in 'Co-Practitioner'.
  13. Enter desired duration in 'Co-Practitioner Duration (Minutes)'.
  14. Click [File Note].
  15. Click [No].
  16. Open the 'Edit Service Information' form.
  17. Select desired client in 'Client ID'.
  18. Select desired episode in 'Episode Number',
  19. Click [Select Service(s) To Edit].
  20. Validate that there are services displayed for both primary and co-practitioner created from progress notes form.
  21. Select and edit both the services to have the 'Add-On Service' added.
  22. Click [Submit].
  23. Click [Yes].
  24. Click [Select Service(s) To Edit].
  25. Validate that there are services displayed for both primary and co-practitioner created from progress notes form.
  26. By selecting each services to edit, verify that the 'Selected Add-On Services' field has the add-on service code added.
  27. Click [Discard].
  28. Click [Yes].
  29. Open the 'Progress Notes (Group and Individual)' form.
  30. Validate the 'Select Client' field contains the client selected.
  31. Select desired episode in 'Select Episode'.
  32. Select ‘New Service’ in 'Progress Notes For'.
  33. Enter any value in 'Notes Field'.
  34. Enter the desired 'Date Of Service' that is different from the previous one.
  35. Enter primary service code in 'Service Charge Code'.
  36. Validate that 'Service Program' contains the service program associated to selected episode.
  37. Select desired practitioner in 'Practitioner'.
  38. Enter desired 'Service Duration'.
  39. Select desired co-practitioner in 'Co-Practitioner'.
  40. Enter desired duration in 'Co-Practitioner Duration (Minutes)'.
  41. Select desired codes in 'Add-On Services'.
  42. Enter desired value in 'Add-On Duration'.
  43. Click [Save Add-On Service].
  44. Verify the add-on service displays in the 'Selected Add-On Services' text area.
  45. Click [File Note].
  46. Validate a message is displays stating: 'Note Filed. Do you want to return to the Progress Notes form?'.
  47. Click [No].
  48. Open the 'Client Ledger' for the client.
  49. Verify the client ledger contains primary and add-on services created for both the practitioner and co-practitioner filed in the progress note.
  50. Close the form.
  51. Use any desired query viewer tool and query the table 'billing_tx_history' for the client.
  52. Validate that there are records displayed for both primary and co-practitioner of the primary and add-on services.
  53. Validate that the column 'JOIN_TO_TX_HISTORY' is displayed with the values for all the rows.
  54. Validate that the column 'join_to_co_staff_tx_history' is not having any values for the primary practitioner row.
  55. Validate that the column 'join_to_co_staff_tx_history' has the 'JOIN_TO_TX_HISTORY' value of respective service's primary practitioner row.
  56. Validate that the column 'join_to_tx_hist_for_addon' has the value only for the add-on services rows of both primary and secondary practitioners.
  57. Open the 'Create Interim Billing Batch File' form.
  58. Create an interim billing batch that covers the client, guarantor and services rendered to the client. Note the batch number.
  59. Close the form.
  60. Open the 'Close Charges' form.
  61. Close all the charges distributed to the guarantor.
  62. Close the form.
  63. Open the 'Client Ledger' for the client.
  64. Verify that primary and add-on services created for both the practitioner and co-practitioner are closed and marked as 'UNBILL'.
  65. Close the form.
  66. Open 'Guarantor/Program Billing Defaults' form.
  67. Select the desired template and edit the '837P' section to have the 'Maximum LX Per CLM' value as "1".
  68. Verify that the field 'Sort "Billing Pay To Provider" Group By Rendering Practitioner' is selected as 'No'.
  69. Click [Submit].
  70. Click [No].
  71. Open the 'Electronic Billing' form.
  72. Compile an 837 bill for the client without claiming the services.
  73. Verify the bill compiles successfully.
  74. Select 'Dump File' option from the billing options.
  75. Select the recently compiled 837 file.
  76. Review the file.
  77. Verify the primary and add-on services are created for both the primary and co-practitioners filed in the progress note.
  78. Validate that only the Primary and Add-On service for the same practitioner are included in a same claim segment.
  79. The Primary and Add-On service for the co-practitioner displayed in a separate claim segment.
  80. Close the report.
  81. Close the form.
  82. Open 'Guarantor/Program Billing Defaults' form.
  83. Select the desired template and edit the '837P' section to have the 'Maximum LX Per CLM' value as "1".
  84. Set the field 'Sort "Billing Pay To Provider" Group By Rendering Practitioner' to have 'Yes' selected.
  85. Click [Submit].
  86. Click [No].
  87. Repeat Step 10.
Topics
• Client Ledger • Edit Service Information • Progress Notes • Service Codes