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Avatar PM 2023 Update 2

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Product Requirements and Recommendations

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Recommended Update Level

Avatar PM 2023 Monthly Release 2023.02.02
RADplus 2023 Monthly Release 2023.02.02

Product Update Description

The 'Do Not Include Component Modifiers in Roll-Up Service' registry setting is added.

Required Updates

None

Included Updates

None

Details
NEW1 CHANGED0 FIXED0
New (1)
Roll-Up service definition - Component modifiers
The 'Do Not Include Component Modifiers in Roll-Up Service' registry setting is added.
Value Added: The user will have an option to not include the modifiers from the component services while compiling the Roll-Up definition.
Topics
• Compile/Edit/Post/Unpost Roll-up Services Worklist • NX • Registry Settings • Roll-Up Services Definition
 
Acceptance Tests
AV-83941 Summary | Details
Roll-Up service definition - Component modifiers
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Admission (Outpatient)
  • Client Charge Input
  • Client Ledger
  • Compile/Edit/Post/Unpost Roll-Up Services Worklist
  • Crystal Report Viewer
  • Diagnosis
  • Financial Eligibility
  • Posting/Adjustment Codes Definition
  • Registry Settings (PM)
  • Roll-Up Services Definition
  • Service Codes
  • Service Fee/Cross Reference Maintenance
  • SQL Query/Reporting
Scenario 1: Compile/Edit/Post/Unpost Roll-Up Services Worklist - 'Do Not Include Component Modifiers in Roll-Up Service' registry setting = 'Y'
Specific Setup:
  • Registry Setting:
  • The 'Do Not Include Component Modifiers in Roll-Up Service' registry setting is set to 'Y'.
  • Posting/Adjustment Code Definition:
  • An existing Write off posting code is identified or a new posting code is created to use for Write-Off Posting code.
  • Service Codes:
  • At least one Roll-Up and two component service codes are created. Note the service codes.
  • Service Fee/Cross Reference Maintenance:
  • A fee definition is created for each service code.
  • Admission:
  • An existing client is identified or a new client is admitted. Note the client id, Admission date/program.
  • Diagnosis:
  • A diagnosis record is created for the client.
  • Financial Eligibility:
  • An existing guarantor is assigned to the client. Note the guarantor code/name.
  • Roll-Up Definition:
  • Edit an existing or create a new 'Roll-Up Services Definition' with the following criteria:
  • A 'Roll-Up Description'.
  • A 'Roll-Up Service'.
  • Component Services.
  • 'Is This Roll-Up Service Dependent On Units, Duration Or None' = None.
  • A value is entered in 'Minimum Duration Required'.
  • A value is entered in 'Maximum Duration' that is greater than the value in 'Minimum Duration Required'.
  • A value is selected in 'Calculate Unit Charge By'.
  • A value is entered in 'Component Service Date Rules'.
  • 'Date Of First Component Service' is selected in 'Date Of Service For Roll-Up Service'.
  • 'Date Of First Component Service' is selected in 'Date To Bill Roll-Up Service'.
  • Client Charge Input:
  • A minimum of two component services have been rendered with the same modifiers to the client that will meet the 'Component Service Date Rules'. Note the service date and service code.
  • Client Ledger:
  • The services distributed correctly to the guarantor assigned to the client.
Steps
  1. Open ‘Compile/Edit/Post/Unpost Roll-Up Services Worklist’.
  2. Verify that the fields ‘Roll-Up Definitions’ and ‘Roll-Up Group’ are enabled.
  3. Enter the desired ‘From Date’ and ‘To Date’.
  4. Select a Roll-Up definition created during setup in the ‘Roll-Up Definitions’.
  5. Validate that no value can be selected in ‘Roll-Up Group’.
  6. Click [Compile Worklist].
  7. Click [OK].
  8. Close the form.
  9. Open ‘Compile/Edit/Post/Unpost Roll-Up Services Worklist’.
  10. Select the ‘Post Roll-Up Services Worklist’ section.
  11. Select the desired ‘Through Date’.
  12. Select the desired 'Write Off Posting Code’.
  13. Click [Post Worklist].
  14. Click [OK].
  15. Close the form.
  16. Open ‘Client Ledger’ for the desired client and date range. Select ‘Simple’ in the ‘Ledger Type’
  17. Click [Process] and validate that the services for the rules within the rule group have the value of ‘Roll-Up’ in ‘CLAIM NUMBER’. Validate that the service created from the roll-up process has a value of ‘OPEN’ in ‘CLAIM NUMBER’.
  18. Close the report.
  19. Close the form.
  20. Open the 'Crystal Report' or any other SQL data viewer.
  21. Query the 'SYSTEM.billing_tx_history' table.
  22. Verify the modifiers included with the component service are not included with the Roll-Up service.
Scenario 2: Compile/Edit/Post/Unpost Roll-Up Services Worklist - 'Do Not Include Component Modifiers in Roll-Up Service' registry setting - Group Roll-Up definition
Specific Setup:
  • Registry Setting:
  • The 'Do Not Include Component Modifiers in Roll-Up Service' registry setting is set to 'Y'.
  • Allow Roll-Up Rule Selection During Compile has a value of ‘2’.
  • Service Codes:
  • At least two Roll-Up and two component service codes for each roll-up service code are created. Note the service codes.
  • Service Fee/Cross Reference Maintenance:
  • A fee definition is created for each service code.
  • Admission:
  • An existing client is identified or a new client is admitted. Note the client id, Admission date/program.
  • Diagnosis:
  • A diagnosis record is created for the client.
  • Financial Eligibility:
  • An existing guarantor is assigned to the client. Note the guarantor code/name.
  • Roll-Up Definition:
  • Edit an existing or create at least two new 'Roll-Up Services Definition' with the following criteria. Open the 'Roll-Up Services Definition' section, select edit and note the value of 'Existing Roll-Up Definition' for at least two definition.
  • A 'Roll-Up Description'.
  • A 'Roll-Up Service'.
  • Component Services.
  • 'Is This Roll-Up Service Dependent On Units, Duration Or None' = None.
  • A desired value is entered in 'Minimum Duration Required'.
  • A desired value is entered in 'Maximum Duration' that is greater than the value in 'Minimum Duration Required'.
  • A desired value is selected in 'Calculate Unit Charge By'.
  • A desired value is entered in 'Component Service Date Rules'.
  • A desired value is selected in 'Date Of Service For Roll-Up Service'.
  • A desired value is selected in 'Date To Bill Roll-Up Service'.
  • Open the 'Roll-Up Group Definition' section:
  • A 'Roll-Up Group Definitions' is created. Select desired value in the ‘Post Roll-Up Rule Individually’.
  • Client Charge Input:
  • At a minimum, services that meet group roll-up definition exist for a minimum of one client. Note the client ID. Note the dates of service.
  • Client Ledger:
  • The services distributed correctly to the guarantor assigned to the client.
Steps
  1. Open ‘Compile/Edit/Post/Unpost Roll-Up Services Worklist’.
  2. Verify that the only roll-up definitions that can be selected are group definitions.
  3. Enter the desired ‘From Date’ and ‘To Date’ for the group definition with a value of 'Yes' in ‘Post Roll-Up Rule Individually’.
  4. Select the group definitions with a value of 'Yes' in ‘Post Roll-Up Rule Individually’.
  5. Click [Compile Worklist].
  6. Click [OK].
  7. Based on the light bulb message when 'Yes' is in ‘Post Roll-Up Rule Individually’, each roll-up rule is compiled and posted in order of execution before the next roll-up rule is compiled. This means that the user does not use the 'Post Roll-Up Services Worklist' section of the form.
  8. Close the form.
  9. Open ‘Client Ledger’ for the desired client and date range. Select ‘Simple’ in the ‘Ledger Type’
  10. Click [Process] and validate that the services for the rules within the rule group have the value of ‘Roll-Up’ in ‘CLAIM NUMBER’. Validate that the service created from the roll-up process has a value of ‘OPEN’ in ‘CLAIM NUMBER’.
  11. Close the report.
  12. Close the form.
  13. Open ‘Compile/Edit/Post/Unpost Roll-Up Services Worklist’.
  14. Enter the desired ‘From Date’ and ‘To Date’ for the group definition with a value of 'No' in ‘Post Roll-Up Rule Individually’.
  15. Select the group definitions with a value of 'Yes' in ‘Post Roll-Up Rule Individually’.
  16. Click [Compile Worklist].
  17. Click [OK].
  18. Based on the light bulb message when 'No' is in ‘Post Roll-Up Rule Individually’, each roll-up rule is compiled in the specified order of execution, then the entire compile is posted.
  19. Select the ‘Post Roll-Up Services Worklist’ section.
  20. Select the desired ‘Through Date’.
  21. Click [Post Worklist].
  22. Close the form.
  23. Open ‘Client Ledger’ for the desired client and date range. Select ‘Simple’ in the ‘Ledger Type’
  24. Click [Process] and validate that the services for the rules within the rule group have the value of ‘Roll-Up’ in ‘CLAIM NUMBER’. Validate that the service created from the roll-up process has a value of ‘OPEN’ in ‘CLAIM NUMBER’.
  25. Close the report.
  26. Close the form.
  27. Open the 'Crystal Report' or any other SQL data viewer.
  28. Query the 'SYSTEM.billing_tx_history' table.
  29. Verify the modifiers included with the component service are not included with the Roll-Up service.
Scenario 3: Registry setting validation - Do Not Include Component Modifiers in Roll-Up Service
Steps
  1. Open the 'Registry Setting' form.
  2. Set the 'Limit Registry Settings to the Following Search Criteria' input box to "Do Not Include Component Modifiers in R"
  3. Click [View Registry Settings].
  4. Validate the Registry Setting input box contains "Avatar PM->Billing->Roll-Up Billing->->->Do Not Include Component Modifiers in Roll-Up Service"
  5. Validate the Registry Setting Details text area contains "[FACILITY SPECIFIC] -------------------------------------------------------------------------------When set to 'Y' Roll-Up Services will not include the component
  6. Modifiers. Select 'N' for the default functionality."
  7. Set the Registry Setting Value input box to "0".
  8. Verify the error dialog contains "The selected value is not valid in the current system code for the following reason: Invalid Response - Example: 'Y' or 'N'.
  9. Click the [OK].
  10. Set the Registry Setting Value input box to "1".
  11. Validate the error dialog contains "The selected value is not valid in the current system code for the following reason: Invalid Response - Example: 'Y' or 'N'.
  12. Set the Registry Setting Value input box to "NO"
  13. Click [Submit].
  14. Validate the error dialog contains 'The selected value is not valid in the current system code for the following reason: More than 1 characters'.
  15. Click [OK].
  16. Set the Registry Setting Value input box to "Yes"
  17. Validate the error dialog contains 'The selected value is not valid in the current system code for the following reason: More than 1 characters'.
  18. Click [OK].
  19. Set the Registry Setting Value input box to "X".
  20. Validate the error dialog contains "The selected value is not valid in the current system code for the following reason: Invalid Response - Example: 'Y' or 'N'.
  21. Click [OK].
  22. Set the Registry Setting Value input box to "".
  23. Click [Submit].
  24. Validate the Filing Error dialog contains "The following fields are missing: Registry Setting Value"
  25. Click [OK].
  26. Set the Registry Setting Value input box to "N".
  27. Click [Submit].
  28. Validate the Filing Results text area contains "Results filing value N to Avatar PM->Billing->Roll-Up Billing->->->Do Not Include Component Modifiers in Roll-Up Service Successful filing in System Code SBOX."
  29. Click [OK].
  30. Set the Registry Setting Value input box to "Y".
  31. Click [Submit].
  32. Validate the Filing Results text area contains "Results filing value N to Avatar PM->Billing->Roll-Up Billing->->->Do Not Include Component Modifiers in Roll-Up Service Successful filing in System Code SBOX."
  33. Click [OK].
  34. Validate the Form Return dialog contains 'Registry Settings has completed. Do you wish to return to form?'.
  35. Click the [No].
Scenario 4: Compile/Edit/Post/Unpost Roll-Up Services Worklist - 'Do Not Include Component Modifiers in Roll-Up Service' registry setting = N
Specific Setup:
  • Registry Setting:
  • The 'Do Not Include Component Modifiers in Roll-Up Service' registry setting is set to 'N'.
  • Service Codes:
  • At least one Roll-Up and two component service codes are created. Note the service codes.
  • Service Fee/Cross Reference Maintenance:
  • A fee definition is created for each service code.
  • Admission:
  • An existing client is identified or a new client is admitted. Note the client id, Admission date/program.
  • Diagnosis:
  • A diagnosis record is created for the client.
  • Financial Eligibility:
  • An existing guarantor is assigned to the client. Note the guarantor code/name.
  • Roll-Up Definition:
  • Edit an existing or create a new 'Roll-Up Services Definition' with the following criteria:
  • A 'Roll-Up Description'.
  • A 'Roll-Up Service'.
  • Component Services.
  • 'Is This Roll-Up Service Dependent On Units, Duration Or None' = None.
  • A value is entered in 'Minimum Duration Required'.
  • A value is entered in 'Maximum Duration' that is greater than the value in 'Minimum Duration Required'.
  • A value is selected in 'Calculate Unit Charge By'.
  • A value is entered in 'Component Service Date Rules'.
  • 'Date Of First Component Service' is selected in 'Date Of Service For Roll-Up Service'.
  • 'Date Of First Component Service' is selected in 'Date To Bill Roll-Up Service'.
  • Client Charge Input:
  • A minimum of two component services have been rendered to the client that will meet the 'Component Service Date Rules'.
  • Desired value entered to the 'Modifier' field of all the component services. Note the service date/code and modifier entered for each of the service.
  • Client Ledger:
  • The services distributed correctly to the guarantor assigned to the client.
Steps
  1. Open ‘Compile/Edit/Post/Unpost Roll-Up Services Worklist’.
  2. Verify that the fields ‘Roll-Up Definitions’ and ‘Roll-Up Group’ are enabled.
  3. Enter the desired ‘From Date’ and ‘To Date’.
  4. Select a Roll-Up definition created during setup in the ‘Roll-Up Definitions’.
  5. Validate that no value can be selected in ‘Roll-Up Group’.
  6. Click [Compile Worklist].
  7. Click [OK].
  8. Select the ‘Post Roll-Up Services Worklist’ section.
  9. Select the desired ‘Through Date’.
  10. Select the desired 'Write Off Posting Code’.
  11. Click [Post Worklist].
  12. Click [OK].
  13. Close the form.
  14. Open ‘Client Ledger’ for the desired client and date range. Select ‘Simple’ in the ‘Ledger Type’
  15. Click [Process] and validate that the services for the rules within the rule group have the value of ‘Roll-Up’ in ‘CLAIM NUMBER’. Validate that the service created from the roll-up process has a value of ‘OPEN’ in ‘CLAIM NUMBER’.
  16. Close the report.
  17. Close the form.
  18. Open the 'Crystal Report' or any other SQL data viewer.
  19. Query the 'SYSTEM.billing_tx_history' table.
  20. Verify the modifiers included with the component service are included with the Roll-Up service when all the component services have same modifiers.
Topics
• Compile/Edit/Post/Unpost Roll-up Services Worklist • NX • Registry Settings • Roll-Up Services Definition