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Avatar PM 2024 Update 107

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Product Requirements and Recommendations

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RADplus required

Recommended Update Level

Avatar PM 2024 Monthly Release 2024.01.02
RADplus 2024 Monthly Release 2024.01.02

Product Update Description

The 'Modifiers by Practitioner Category' form is updated to support multiple modifier definitions for a given 'Guarantor', 'Program', 'Practitioner Category' and 'CPT Code' combination.

Required Updates

None

Included Updates

8, 9, 16, 17, 23, 28, 29, 31, 34, 35, 42, 44, 46, 47, 57, 60, 61, 70, 77, 80, 84, 88, 93, 101

Details
NEW3 CHANGED0 FIXED0
New (3)
SQL table
A new table 'SYSTEM.mods_by_category' has been added to the system. Please review the release note to see the table details.
Value Added: Allows users to query a table to see the data results,
Topics
• Database Tables
 
Modifiers by Practitioner Category
The 'Modifiers by Practitioner Category' form and the report launched from the form are updated to support multiple modifier definitions for a given 'Guarantor', 'Program', 'Practitioner Category' and 'CPT Code' combination.
  1. The billing functionality for the 'Modifiers by Practitioner Category' has been updated to support multiple modifier definitions for a given 'Guarantor', 'Program', 'Practitioner Category' and 'CPT Code' combination.
  2. A new table 'SYSTEM.mods_by_category' has been added to the system. Please review the release note for details.
Value Added: Increases flexibility of the Modifiers by Practitioner Category processes.
Topics
• Modifiers by Practitioner
 
File Import - Modifiers by Practitioner Category
Multiple rows can now exist with the same Guarantor, Program, Category and CPT combination, if the rows have no overlapping date ranges.
Value Added: Increases flexibility of the Modifiers by Practitioner Category processes.
Topics
• File Import • Modifiers by Practitioner
 
Acceptance Tests
AV-99009 Summary | Details
SQL table
Internal Test Only
Topics
n/a
AV-99010 Summary | Details
Modifiers by Practitioner Category
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Admission (Outpatient)
  • Client Charge Input
  • Create Interim Billing Batch File
  • Crystal Report Viewer
  • Diagnosis
  • Electronic Billing
  • Financial Eligibility
  • MODIFIERS BY PRACTITIONER CATEGORY
Scenario 1: Modifiers by Practitioner Category - workflow
Specific Setup:
  • Form Designer: If previously used to modify the 'Modifiers By Practitioner Category' form, it may be necessary to revert to 'Netsmart Produced Changes'.
  • Registry Settings:
  • Set the 'Enable Duplicate Service Modifiers' registry setting to "Y".
  • Program Maintenance:
  • Identify a minimum of two outpatient programs: Program 1 & Program 2.
  • Guarantors/Payor:
  • Identify a minimum of two guarantors in different Financial Classes: Guarantor 1 & Guarantor 2.
  • Practitioner Enrollment:
  • Identify a minimum of two practitioners in different Practitioner Categories. Practitioner Category 1 & Practitioner Category 2.
  • CPT Code:
  • Identify a minimum of two CPT Codes. CPT Code 1 & CPT Code 2.
  • Service Codes:
  • Service Code 1: An existing service code is identified that contains CPT Code 1, or a new Service Code is created. The service code has a fee record.
  • Service Code 2: An existing service code is identified that contains CPT Code 2, or a new Service Code is created. The service code has a fee record.
  • Clients:
  • Client 1:
  • Is admitted to Program 1.
  • Diagnosis records are created for the client.
  • The financial eligibility record contains Guarantor 1 as the primary guarantor.
  • Client Charge Input is used to create a minimum of one service for each service code.
  • Client Ledger validates that the charges distributed to Guarantor 1.
  • Close Charges has been used to close the charges.
  • If desired, create an interim billing batch.
  • Client 2:
  • Is admitted to Program 2
  • Diagnosis records are created for the client.
  • The financial eligibility record contains Guarantor 2 as the primary guarantor.
  • Client Charge Input is used to create a minimum of one service for each service code.
  • Client Ledger validates that the charges distributed to Guarantor 2.
  • Close Charges has been used to close the charges.
  • If desired, create an interim billing batch.
Steps
  1. Open the "Modifiers by Practitioner Categories" form.
  2. Validate that the form has the following fields:
  3. Guarantor ID - required
  4. Financial Class Selection
  5. Program - required
  6. Treatment Setting Selection
  7. CPT Code - required
  8. Practitioner Category - required
  9. Start Date
  10. End Date
  11. Modifier - required
  12. Duplicate Service Modifiers
  13. Delete Modifiers button
  14. Print Modifiers button
  15. Export Modifiers button
  16. If desired, click [Print Modifiers] to receive a report of records already filed in the system.
  17. Select the classes for 'Guarantor 1' and 'Guarantor 2' in 'Financial Class Selection'.
  18. Verify that only guarantors in those classes display in 'Guarantor ID'.Select 'Guarantor 1' and 'Guarantor 2' in 'Guarantor ID'.
  19. Select 'Outpatient' in 'Treatment Setting Selection'.
  20. Verify that only 'Outpatient' programs display in 'Program'.
  21. Select 'Program 1 in 'Program'.
  22. Select 'CPT Code 1' in 'CPT Code'.
  23. Select 'Practitioner Category 1' in 'Practitioner Category'.
  24. Validate that the 'Modifier' field is marked as required.
  25. Enter an invalid format values in 'Duplicate Service Modifiers' similar to "Invalid_Test".
  26. Verify that an error displays "Invalid Format" with an 'OK' button.
  27. Click [OK].
  28. Enter up to two values for 'Duplicate Service Modifiers' similar to "D1,D2".
  29. Verify that the 'Modifier' field is no longer required.
  30. Enter up to four values in 'Modifiers' similar to "M1,M2".
  31. Enter the 'Start Date' and 'End Date' values.
  32. Select [Submit].
  33. Select the same parameters just submitted:
  34. Click [Print Modifiers.] and validate that report contains the requested record.
  35. Click [Export Modifiers] and validate that the export file contains the requested record.
  36. Close the form.
  37. Create a query of the SQL table:' SYSTEM.mods_by_category' and validate that the Modifiers filed above are added in the table as individual rows.
  38. Note that there may be pre-existing data in the table.
  39. If desired, select a row of data that can be deleted in the form. Note the details.
  40. Close the query.
  41. Open the "Modifiers By Practitioner Category" form.
  42. If desired, enter the details noted in the table and click [Delete Modifiers].
  43. Verify that a message displays: 'You Are About To Delete Modifiers. Are You Sure You Want To Continue?' and that the message has 'OK' and 'Cancel' buttons. Continue as desired.
  44. Select 'Guarantor 2' in 'Guarantor ID'.
  45. Select 'Outpatient' in 'Treatment Setting Selection'.
  46. Select 'Program 2' in 'Program'.
  47. Select 'CPT Code 2' in 'CPT Code'.
  48. Select 'Practitioner Category 2' in 'Practitioner Category'.
  49. Enter desired values for 'Modifiers' similar to "M3,M4".
  50. Enter desired values for 'Duplicate Service Modifiers' similar to "D3,D4".
  51. Enter the 'Start Date' and 'End Date' values.
  52. Select [Submit].
  53. If desired, print the report for the parameters just submitted and validate the data,
  54. If desired, create a query of the SQL table:' SYSTEM.mods_by_category' and validate that the record filed above is added to the table.
  55. Close the query.
  56. Open the "Electronic Billing" form.
  57. Create the 837 Professional bills for each client.
  58. Review the dump file.
  59. Validate that the modifiers are correct in the service level 'SV1' segment.
  60. Close the report.
  61. Close the form.
Topics
• Modifiers by Practitioner
AV-99012 Summary | Details
File Import - Modifiers by Practitioner Category
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Crystal Report Viewer
  • File Import
  • MODIFIERS BY PRACTITIONER CATEGORY
  • Registry Settings (PM)
Scenario 1: File Import - Modifiers by Practitioner Category
Specific Setup:
  • Registry Settings: 'Enable Duplicate Service Modifiers' is set to "Y".
  • The following files exist for File Import - Modifiers by Practitioner Category:
  • File A: Will add a record with desired values. Note the values.
  • File B: Will edit the record created when File A is posted. Note the values.
  • The 'Avatar_PM_File_Import_Record_Layouts' will be included in the update zip file.
Steps
  1. Open "File Import".
  2. Select the 'Modifiers By Practitioner Category' file type.
  3. Select the 'Upload New File' action radio button.
  4. Click [Process].
  5. Select 'File A'.
  6. Compile, print and post the file.
  7. Close the form.
  8. Open "Modifiers By Practitioner Category".
  9. Based on the contents of 'File A' select the desired 'Guarantor ID ', 'Program', 'CPT Code ', 'Practitioner Category', and 'Modifier'.
  10. Click [Print Modifiers].
  11. Validate the report contents.
  12. Close the report.
  13. Close the form.
  14. Repeat steps 1 - 13 for 'File 'B.
Topics
• File Import • Modifiers by Practitioner
Table Changes
Table Column Change
SYSTEM.mods_by_category Table Added
SYSTEM.mods_by_category ID Added
SYSTEM.mods_by_category FACILITY Added
SYSTEM.mods_by_category cpt_code Added
SYSTEM.mods_by_category cpt_val Added
SYSTEM.mods_by_category data_entry_by Added
SYSTEM.mods_by_category data_entry_by_option Added
SYSTEM.mods_by_category data_entry_date Added
SYSTEM.mods_by_category data_entry_offset Added
SYSTEM.mods_by_category data_entry_source Added
SYSTEM.mods_by_category data_entry_time Added
SYSTEM.mods_by_category data_entry_time_j Added
SYSTEM.mods_by_category data_entry_timezone_info_all Added
SYSTEM.mods_by_category data_entry_timezone_short Added
SYSTEM.mods_by_category data_entry_user_id Added
SYSTEM.mods_by_category data_entry_user_name Added
SYSTEM.mods_by_category data_entry_utc Added
SYSTEM.mods_by_category duplicate_modifier Added
SYSTEM.mods_by_category end_date Added
SYSTEM.mods_by_category guarantor_code Added
SYSTEM.mods_by_category guarantor_val Added
SYSTEM.mods_by_category modifier Added
SYSTEM.mods_by_category option_desc Added
SYSTEM.mods_by_category option_id Added
SYSTEM.mods_by_category pract_cat_code Added
SYSTEM.mods_by_category pract_cat_val Added
SYSTEM.mods_by_category program_code Added
SYSTEM.mods_by_category program_val Added
SYSTEM.mods_by_category start_date Added