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Avatar PM 2022 Update 8

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Product Update Form Description

The issue with 'Compile Residential/Inpatient Charges' where the charge may not be calculated correctly for the last day of the month for 'Daily Charge Code 3', 'Daily Charge Code 4', or 'Daily Charge Code 5' is resolved.

Included Updates

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Required Updates

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Details
NEW0 CHANGED0 FIXED1
Fixed (1)
Service Fee/Cross Reference Maintenance - Pro-Rated Fees
The functionality for Pro-Rated Fees has been updated to correctly calculate the fee for all billable days. KB0068427 v0.01
Topics
• NX • Pro Rated Fee
 
Acceptance Tests
AV-75449 Summary | Details
Service Fee/Cross Reference Maintenance - Pro-Rated Fees
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Admission
  • App Dashboard
  • Client Ledger
  • Diagnosis
  • Dictionary Update (PM)
  • Dynamic Form - Admission - Client
  • Dynamic Form - OCR Template Import - Warning
  • Dynamic Form - Registry Settings - Registry Editor Filing
  • Financial Eligibility
  • Post Residential/Inpatient Worklist
  • Program Maintenance
  • Registry Settings (PM)
  • Discharge
  • Leaves
Scenario 1: Validate Pro-Rated Fees Calculation - Client without leave or discharge
Specific Setup:
  • The following registry setting has a value of '2', at a minimum: Avatar PM->System Maintenance->Service Code Maintenance->->->Additional Service Fee Configuration Fields.
  • The following registry setting has a value of '5': Avatar PM->Services->Inpatient/Residential->->->Number Of Daily Charge Codes.
  • Guarantors/Payors 1 is an active guarantor.
  • Service Code 1: Is an active service code that will be used for pro-rated services room and board charges.
  • Service Code 2: Is an active service code that will be used for pro-rated services daily charge (1).
  • Service Code 3: Is an active service code that will be used for pro-rated services daily charge (2).
  • Service Code 4: Is an active service code that will be used for pro-rated services daily charge (3).
  • Service Code 5: Is an active service code that will be used for pro-rated services daily charge (4).
  • Service Code 6: Is an active service code that will be used for pro-rated services daily charge (5).
  • Service Fee/Cross Reference Maintenance:
  • Service Code 1 - Service Code 6:
  • From Date = desired date.
  • Fee = desired amount, which is distributed across the monthly services. Note each value.
  • UB-94 Revenue Code = desired value.
  • Fee type = Monthly.
  • Pro-Rate Fee For = desired values.
  • Pro-Rated Fee Calculation = Fee/Monthly Days.
  • Client A:
  • Is admitted to an inpatient program on or after the earliest 'Service Fee/Cross Reference Maintenance', 'From Date'. Note the ‘Unit’ the client is assigned to. Client has not been placed on leave or discharged during the month.
  • Has a 'Financial Eligibility' record for Guarantors/Payors 1.
  • Equations are used for fee verification based on the value in 'Pro-Rated Fee Calculation'
  • The value of 'Pro-Rated Fee Calculation' is 'Fee/Monthly Days'. The equation is: the 'Fee' divided by the number of days in the month, times the number of valid days, divided by the number of days in the month.
  • Example 1: Fee is 350.00. Days in month = 31. Valid days = 31. 350/31 = 11.29 for days 1-30, and 11.30 for day 31.
  • Example 2: Fee is 120.00. Days in month = 30. Valid days = 15. 120.00/30x15/30 = 2.00 for the valid days.
Steps
  1. Open ‘Compile Residential/Inpatient Charges’.
  2. Select ‘Individual’ in ‘Individual Or All Units’.
  3. Select desired Unit in ‘Select Unit(s)’.
  4. Set the ‘Compile Charges From Date’ to desired value.
  5. Set the ‘Compile Charges Through Date’ to desired value.
  6. Select ‘Yes’ in ‘Do You Wish To Recreate The Residential/Inpatient Worklist’
  7. Click [Process].
  8. Validate that the report fees are correct for each service code, ensuring that at a minimum the first and last page of the report are verified. Calculate the fees to verify that the fee in ‘Service Fee/Cross Reference Maintenance’ is correct for the valid number of days in the month.
  9. Open ‘Post Residential/Inpatient Worklist’.
  10. Select ‘Individual’ in ‘Individual Or All Units’.
  11. Select desired Unit in ‘Select Unit(s)’.
  12. Set the ‘Post Charges From Date’ to desired value.
  13. Set the ‘Post Charges Through Date’ to desired value.
  14. Click [Process].
  15. Validate that the report fees are the same as above.
  16. If desired, open ‘Client Ledger’ and verify the fees for the date range and services.
Scenario 2: Validate Pro-Rated Fees Calculation - Discharged client
Specific Setup:
  • The following registry setting has a value of '2', at a minimum: Avatar PM->System Maintenance->Service Code Maintenance->->->Additional Service Fee Configuration Fields.
  • The following registry setting has a value of '5': Avatar PM->Services->Inpatient/Residential->->->Number Of Daily Charge Codes.
  • Guarantors/Payors 1 is an active guarantor.
  • Service Code 1: Is an active service code that will be used for pro-rated services room and board charges.
  • Service Code 2: Is an active service code that will be used for pro-rated services daily charge (1).
  • Service Code 3: Is an active service code that will be used for pro-rated services daily charge (2).
  • Service Code 4: Is an active service code that will be used for pro-rated services daily charge (3).
  • Service Code 5: Is an active service code that will be used for pro-rated services daily charge (4).
  • Service Code 6: Is an active service code that will be used for pro-rated services daily charge (5).
  • Service Fee/Cross Reference Maintenance:
  • Service Code 1 - Service Code 6:
  • From Date = desired date.
  • Fee = desired amount, which is distributed across the monthly services. Note each value.
  • UB-94 Revenue Code = desired value.
  • Fee type = Monthly.
  • Pro-Rate Fee For = desired values.
  • Pro-Rated Fee Calculation = Fee/Monthly Days.
  • Client A:
  • Is admitted to an inpatient program on or after the earliest 'Service Fee/Cross Reference Maintenance', 'From Date'. Note the ‘Unit’ the client is assigned to. Client has not been placed on leave during the month. The client has been discharged before the end of the month. Note how many days that client was in the program.
  • Has a 'Financial Eligibility' record for Guarantors/Payors 1.
  • Equations are used for fee verification based on the value in 'Pro-Rated Fee Calculation'
  • The value of 'Pro-Rated Fee Calculation' is 'Fee/Monthly Days'. The equation is: the 'Fee' divided by the number of days in the month, times the number of valid days, divided by the number of days in the month.
  • Example 1: Fee is 350.00. Days in month = 31. Valid days = 31. 350/31 = 11.29 for days 1-30, and 11.30 for day 31.
Steps
  1. Open ‘Compile Residential/Inpatient Charges’.
  2. Select ‘Individual’ in ‘Individual Or All Units’.
  3. Select desired Unit in ‘Select Unit(s)’.
  4. Set the ‘Compile Charges From Date’ to desired value.
  5. Set the ‘Compile Charges Through Date’ to desired value.
  6. Select ‘Yes’ in ‘Do You Wish To Recreate The Residential/Inpatient Worklist’
  7. Click [Process].
  8. Validate that the report fees are correct for each service code, ensuring that at a minimum the first and last page of the report are verified. Calculate the fees to verify that the fee in ‘Service Fee/Cross Reference Maintenance’ is correct for the valid number of days in the month. Validate that the fees are not calculated after the client was discharged.
  9. Open ‘Post Residential/Inpatient Worklist’.
  10. Select ‘Individual’ in ‘Individual Or All Units’.
  11. Select desired Unit in ‘Select Unit(s)’.
  12. Set the ‘Post Charges From Date’ to desired value.
  13. Set the ‘Post Charges Through Date’ to desired value.
  14. Click [Process].
  15. Validate that the report fees and days are the same as above.
  16. If desired, open ‘Client Ledger’ and verify the fees for the date range and services.
Scenario 3: Validate Pro-Rated Fees Calculation - Client with leave
Specific Setup:
  • The following registry setting has a value of '2', at a minimum: Avatar PM->System Maintenance->Service Code Maintenance->->->Additional Service Fee Configuration Fields.
  • The following registry setting has a value of '5': Avatar PM->Services->Inpatient/Residential->->->Number Of Daily Charge Codes.
  • Guarantors/Payors 1 is an active guarantor.
  • Service Code 1: Is an active service code that will be used for pro-rated services room and board charges.
  • Service Code 2: Is an active service code that will be used for pro-rated services daily charge (1).
  • Service Code 3: Is an active service code that will be used for pro-rated services daily charge (2).
  • Service Code 4: Is an active service code that will be used for pro-rated services daily charge (3).
  • Service Code 5: Is an active service code that will be used for pro-rated services daily charge (4).
  • Service Code 6: Is an active service code that will be used for pro-rated services daily charge (5).
  • Service Fee/Cross Reference Maintenance:
  • Service Code 1 - Service Code 6:
  • From Date = desired date.
  • Fee = desired amount, which is distributed across the monthly services. Note each value.
  • UB-94 Revenue Code = desired value.
  • Fee type = Monthly.
  • Pro-Rate Fee For = desired values. If 'Missing Service Code' is not selected in the field, leave days will be counted as valid days.
  • Pro-Rated Fee Calculation = Fee/Monthly Days.
  • Client A:
  • Is admitted to an inpatient program on or after the earliest 'Service Fee/Cross Reference Maintenance', 'From Date'. Note the ‘Unit’ the client is assigned to. Client has a non-billable leave during the month. Note the number of leave days. The client has not been discharged during the month.
  • Has a 'Financial Eligibility' record for Guarantors/Payors 1.
  • Equations are used for fee verification based on the value in 'Pro-Rated Fee Calculation'
  • The value of 'Pro-Rated Fee Calculation' is 'Fee/Monthly Days'. The equation is: the 'Fee' divided by the number of days in the month, times the number of valid days, divided by the number of days in the month.
  • Example 1: Fee is 350.00. Days in month = 31. Valid days = 31. 350/31 = 11.29 for days 1-30, and 11.30 for day 31.
  • Example 2: Fee is 120.00. Days in month = 30. Valid days = 15. 120.00/30x15/30 = 2.00 for the valid days.
Steps
  1. Open ‘Compile Residential/Inpatient Charges’.
  2. Select ‘Individual’ in ‘Individual Or All Units’.
  3. Select desired Unit in ‘Select Unit(s)’.
  4. Set the ‘Compile Charges From Date’ to desired value.
  5. Set the ‘Compile Charges Through Date’ to desired value.
  6. Select ‘Yes’ in ‘Do You Wish To Recreate The Residential/Inpatient Worklist’
  7. Click [Process].
  8. Validate that the report fees are correct for each service code, ensuring that at a minimum the first and last page of the report are verified. Calculate the fees to verify that the fee in ‘Service Fee/Cross Reference Maintenance’ is correct for the valid number of days in the month.
  9. Open ‘Post Residential/Inpatient Worklist’.
  10. Select ‘Individual’ in ‘Individual Or All Units’.
  11. Select desired Unit in ‘Select Unit(s)’.
  12. Set the ‘Post Charges From Date’ to desired value.
  13. Set the ‘Post Charges Through Date’ to desired value.
  14. Click [Process].
  15. Validate that the report fees are the same as above.
  16. If desired, open ‘Client Ledger’ and verify the fees for the date range and services.
Topics
• NX • Pro Rated Fee

 

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