Avatar PM 2023 Update 180

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Product Requirements and Recommendations

Avatar PM required
RADplus required

Recommended Update Level

Avatar PM 2023 Monthly Release 2023.03.02
RADplus 2023 Monthly Release 2023.03.02

Product Update Description

The following modifications to the Monthly Pro-Rate fee functionality are included: 1) The Pro-Rate fields in the 'Service Fee/Cross Reference Maintenance' form are now enabled when "Service" is selected in the 'Fee Type' field. 2) Billable Leaves with a 'Room And Board Billing Code Override' are no longer included in the number of valid days for non-leave days.

Required Updates

None

Included Updates

7, 10, 11, 16, 17, 18, 21, 25, 29, 31, 32, 33, 34, 35, 39, 44, 48, 56, 57, 58, 59, 62, 63, 64, 65, 66, 67, 72, 73, 76, 77, 78, 79, 82, 85, 86, 88, 89, 93, 94, 96, 98, 100, 101, 102, 103, 104, 105, 106, 109, 110, 115, 116, 119, 120, 121, 122, 125, 128, 129, 130, 133, 134, 135, 136, 139, 140, 143, 149, 154, 157, 159

Details

NEW1 CHANGED0 FIXED0

New (1)

AV-93385 Details | User Acceptance Tests

Pro-Rate Fees

The 'Service Fee/Cross Reference Maintenance' form is modified to enable the Pro-Rate fields when 'Service' is selected in the 'Fee Type' field. In addition, billable leaves with a 'Room And Board Billing Code Override' are not included in the number of valid days for non-leave days.

Value Added: Allows additional functionality for pro-rated fees.

Topics

• Pro Rated Fee

Acceptance Tests

AV-93385 Summary | Details

Pro-Rate Fees

Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:

Admission
App Dashboard
Client Ledger
Dictionary Update (PM)
Post Residential/Inpatient Worklist
Program Maintenance
Registry Settings (PM)
Service Codes
Service Fee/Cross Reference Maintenance
Diagnosis
Discharge
Financial Eligibility
Leaves

Scenario 1: Validate Pro-Rated Fees Calculation - Client without leave or discharge

Specific Setup:

Registry Settings:
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 Codes:
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:
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

Open ‘Compile Residential/Inpatient Charges’.
Select ‘Individual’ in ‘Individual Or All Units’.
Select desired Unit in ‘Select Unit(s)’.
Set the ‘Compile Charges From Date’ to desired value.
Set the ‘Compile Charges Through Date’ to desired value.
Select ‘Yes’ in ‘Do You Wish To Recreate The Residential/Inpatient Worklist’
Click [Process].
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.
Open ‘Post Residential/Inpatient Worklist’.
Select ‘Individual’ in ‘Individual Or All Units’.
Select desired Unit in ‘Select Unit(s)’.
Set the ‘Post Charges From Date’ to desired value.
Set the ‘Post Charges Through Date’ to desired value.
Click [Process].
Validate that the report fees are the same as above.
If desired, open ‘Client Ledger’ for the client and verify the fees for the date range and services.

Scenario 2: Validate Pro-Rated Fees Calculation - Client with leave only & Client with leave & discharge

Specific Setup:

Registry Settings:
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 Codes:
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.
Dictionary Update:
Client - Type of Leave From (757):
Extended Dictionaries:
Chargeable Leave Y/N = Y.
Room And Board Billing Code Override = a Room & Board Code that is not Service Code 1.
Client:
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. The service codes noted above are used in the 'Inpatient/Partial/Day Treatment' section of the form.
Client has a 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

Open ‘Compile Residential/Inpatient Charges’.
Select ‘Individual’ in ‘Individual Or All Units’.
Select desired Unit in ‘Select Unit(s)’.
Set the ‘Compile Charges From Date’ to desired value.
Set the ‘Compile Charges Through Date’ to desired value.
Select ‘Yes’ in ‘Do You Wish To Recreate The Residential/Inpatient Worklist’
Click [Process].
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.
Open ‘Post Residential/Inpatient Worklist’.
Select ‘Individual’ in ‘Individual Or All Units’.
Select desired Unit in ‘Select Unit(s)’.
Set the ‘Post Charges From Date’ to desired value.
Set the ‘Post Charges Through Date’ to desired value.
Click [Process].
Validate that the report fees are the same as above.
If desired, open ‘Client Ledger’ for the client and verify the fees for the date range and services.
In the next month, place the client on a billable leave on desired date. Return the client from leave on desired date. Discharge the client at least one day after returning from leave.
Repeat steps 1-17 for the new month of services.

Topics

• Pro Rated Fee

Table Changes

Table	Column	Change
SYSTEM.billing_tx_master_fee_table		Method change