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Avatar PM 2024 Update 47

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Product Requirements and Recommendations

Avatar PM required
RADplus required

Recommended Update Level

Avatar PM 2024 Monthly Release 2024.01.02
RADplus 2024 Monthly Release 2024.01.02

Product Update Description

The following issues are resolved: 1) The option to update 'DRG Code Table' in form 'File Import' does not edit "SYSTEM.tabledrgcodes" table entries. 2) The error '[ILLEGAL VALUES]Dates^FinancialDetermination' that can occur on the 'Financial Determination' form when leap days are entered.

Required Updates

None

Included Updates

8, 9, 28, 31, 34, 42

Details
NEW0 CHANGED0 FIXED2
Fixed (2)
File Import - DRG Code Table
An issue is resolved where the DRG codes imported through the ‘File Import’ form to update an existing DRG code with leading zero were not updating the "SYSTEM.table_drg_codes” table entries. KB0076374 v0.01
Topics
• 837 Institutional • Diagnosis • File Import
 
Financial Determination - Field Verification
AN issue is resolved where Financial Determination was issuing an error when attempting to enter the effective date of 2/29/24 (leap year day). KB0076409 v0.01
A defect in the Financial Determination form has been addressed. Previously, an error was encountered when attempting to input the effective date as 2/29/24. This issue has now been resolved, and users can input this date without receiving the RADPlusException: [ILLEGAL VALUE]DATES+13^FinancialDetermination error. This fix enhances the overall user experience by ensuring date inputs are handled correctly by the system, even for special dates like leap year day.
Topics
• Financial Determination
 
Acceptance Tests
AV-96607 Summary | Details
File Import - DRG Code Table
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Crystal Report Viewer
  • Diagnosis
  • Electronic Billing
  • File Import
Scenario 1: PM - File Import - DRG Code Table - Validating an 837 institutional bill
Specific Setup:
  • Registry Settings:
  • The 'Enable DRG Codes' must be enabled.
  • The 'Import File Delimiter' registry setting is set to value to "2".. This will change the delimiter type to tabs.
  • Site Specific Section Modeling:
  • Field 'DRG Code (ICD-10)' must be added to Avatar PM 'Diagnosis' form.
  • The following file import files are created to add and/or update the DRG Code Table. Note the location and of the files.
  • File import file to add 2-digit DRG code in the system.
  • File import file to delete the 2-digit DRG code from the system.
  • File import file to update the 2-digit DRG code to 3-digit DRG code by adding leading zero in the system.
  • Guarantor/Program Billing Defaults:
  • The 'Enable Using DRG Code In 2300-HI-Diagnosis Related Group (DRG) Information' must be set to 'Yes' in applicable template for 837 Institutional billing file generation.
  • Access to Crystal Reports or other SQL reporting tool.
  • Guarantors/Payors:
  • An existing guarantor is identified to be used. Note the guarantor's code/name.
  • Service codes:
  • An existing service code is identified to be used. Note the service code/description.
  • Service Fee/ Cross Reference Maintenance:
  • A fee definition is created for the service code identified in the 'Service Codes' form.
  • Admission:
  • An existing client is identified, or a new client is admitted in the desired program. Note client id, admission program, admission date.
  • Financial Eligibility:
  • The guarantor identified in the 'Guarantors/Payors' form is assigned to the client as the primary guarantor.
  • Diagnosis:
  • Diagnosis record exists with value for 'DRG Code (ICD-10)' included/filed.
  • Client Charge Input:
  • A service is rendered to the client. Note service date, service code.
  • Client Ledger:
  • The service distributed correctly to the assigned guarantor.
  • Close Charges:
  • Create Interim Billing Batch File:
  • An interim billing batch is created to include client, services and guarantor in the batch. Note the batch number.
Steps
  1. Open 'File Import' form.
  2. Select "DRG Code Table" from the 'File Type'.
  3. Select "Upload New File" in the 'Action' field.
  4. Click [Process Action].
  5. Select 'DRG Code Table' import file to import 2-digit DRG code.
  6. Click [Open].
  7. Select "Compile/Validate File" in the 'Action' field.
  8. Select loaded import file.
  9. Click [Process Action].
  10. Verify that 'Compile/Validate File' action completes, and message 'Compiled' is displayed.
  11. Click 'OK' button.
  12. Select "Print File" in 'Action' field to view successfully compiled import data.
  13. Select compiled import file.
  14. Click [Process Action].
  15. In 'DRG Code Table' File Import Report, verify that all valid import row(s) are included in the report with segment/value details.
  16. Select "Post File" in 'Action' field to post successfully compiled import data.
  17. Select compiled import file.
  18. Click [Process Action].
  19. Verify that 'Compile/Validate File' action completes, and message 'Posted' is displayed.
  20. Open Crystal Reports or other SQL reporting tool.
  21. Access the SQL table 'SYSTEM.file_import_drg_codes'.
  22. Verify that all 'DRG Code Table' File Import rows are included in the table with values from the import data file.
  23. Access the 'SYSTEM.table_drg_codes' table.
  24. Verify that all successfully posted 'DRG Code Table' File Import rows are reflected as new (or updated) DRG Code entries in table.
  25. Repeat the steps from 1 through 24 to update the 2 digit code with leading zero.
  26. Open the 'Diagnosis' form.
  27. Add/update the diagnosis record for the client for the date of service.
  28. Select the updated DRG code to the diagnosis record.
  29. Submit the form.
  30. Open the 'Electronic Billing' form.
  31. Select 837 Institutional in 'Billing Form' field.
  32. Select values for 837 bill generation in the 'Type of Bill', 'Individual or All Guarantors' and 'Billing Type' fields.
  33. Select "Sort File" in the 'Billing Options' field.
  34. Select/enter values for service inclusion in 'All Clients or Interim Billing Batch', 'Program(s)'
  35. Select value for 'Create Claims' field (and enter value for 'Date of Claim' if 'Yes').
  36. Enter/select values 'First Date of Service to Include' and 'Last Date of Service to Include' fields.
  37. Enter/select values for any other bill sorting criteria fields as required/desired.
  38. Click [Process].
  39. Verify the bill compiles successfully.
  40. Select 'Dump File' in the 'Billing Options' field.
  41. Select 837 file generated.
  42. Click [Process].
  43. For 837 Institutional format billing files generated - ensure that the 'DRG Code (ICD-10)' value associated to applicable Diagnosis record/entries for service(s) included in bill is present in 2300-HI-Diagnosis Related Group (DRG) Information claim loop. (Example: 'HI*ABK:O2402:::::::Y~HI*ABJ:O24013~HI*DR:079')
  44. Close the report.
  45. Close the form.
Scenario 2: PM - 'File Import' - Add / Edit / Delete 'DRG Code Table' Import
Specific Setup:
  • Registry Settings:
  • The 'Enable DRG Codes' must be enabled.
  • The 'Import File Delimiter' registry setting is set to "2". This will change the delimiter type to tabs.
  • The file import record layout for the Avatar 'DRG Code Table' is available for the user.
  • The file import files are created for the Avatar 'DRG Code Table to add, update and delete the DRG Code Table. Note the location of the files.
  • Access to Crystal Reports or other SQL reporting tool
Steps
  1. Open 'File Import' form.
  2. Select "DRG Code Table" from the 'File Type' field.
  3. Select "Upload New File" in the 'Action' field.
  4. Click [Process Action].
  5. Select 'DRG Code Table' import file to add the new DRG code to the table.
  6. Click [Open].
  7. Select "Compile/Validate File" in the 'Action' field.
  8. Select recently loaded import file.
  9. Click [Process Action].
  10. Verify that 'Compile/Validate File' action completes, and message 'Compiled' is displayed.
  11. Click [OK].
  12. Select "Print File" in the 'Action' field to view successfully compiled import data.
  13. Select successfully compiled import file.
  14. Click [Process Action].
  15. Verify all valid import row(s) are included in the report.
  16. Select "Post File" in the 'Action' field to post successfully compiled import data.
  17. Select successfully compiled import file.
  18. Click [Process Action].
  19. Validate the message 'Posted' is displayed.
  20. Query - select * from SYSTEM.file_import_drg_codes
  21. Validate the' add_edit_code' cell is equal to "A".
  22. Validate the 'add_edit_value' cell is equal to "Add".
  23. Validate the 'Code_set_code' cell is equal to "ICD10".
  24. Validate the 'drg_code' cell is equal to the DRG code added in the import file.
  25. Validate the drg_value cell is equal to description of the code added in the import file.
  26. Verify the 'pkey' cell exists.
  27. Query - select * from SYSTEM.table_drg_codes.
  28. Validate the 'drg_code' cell is equal to the DRG code added in the import file.
  29. Validate the drg_value cell is equal to description of the code added in the import file.
  30. Validate the ID cell is equal to the system generated unique id which will be used in the 'pkey' column of the import file. Note the ID.
  31. Close the report.
  32. Repeat steps 1 through 19 to import the file import file to edit an existing DRG code in the table.
  33. Query - select * from SYSTEM.file_import_drg_codes
  34. Validate the' add_edit_code' cell is equal to "E".
  35. Validate the 'add_edit_value' cell is equal to "Edit".
  36. Validate the 'Code_set_code' cell is equal to "ICD10".
  37. Validate the 'drg_code' cell is equal to the updated DRG code as listed in the import file.
  38. Validate the drg_value cell is equal to description of the code added in the import file.
  39. Verify the 'pkey' cell exists.
  40. Validate the ‘pkey’ column displays the correct value as listed in the import file.
  41. Query - select * from SYSTEM.table_drg_codes.
  42. Validate the 'drg_code' cell is equal to the updated DRG code as listed in the import file.
  43. Validate the drg_value cell is equal to description of the code added in the import file.
  44. Verify the 'pkey' cell exists.
  45. Validate the ‘pkey’ column displays the correct value as listed in the import file.
  46. Close the report.
  47. Repeat steps 1 through 19 to import the file import file to delete an existing DRG code from the table.
  48. Query - select * from SYSTEM.file_import_drg_codes
  49. Validate the' add_edit_code' cell is equal to "D".
  50. Validate the 'add_edit_value' cell is equal to "Delete".
  51. Validate the 'Code_set_code' cell is equal to "ICD10".
  52. Validate the 'drg_code' cell is equal to the DRG code added in the import file.
  53. Validate the drg_value cell is equal to description of the code added in the import file.
  54. Verify the 'pkey' cell exists.
  55. Validate the ‘pkey’ column displays the correct value as listed in the import file.
  56. Query - select * from SYSTEM.table_drg_codes.
  57. Validate the 'drg_code' cell does not contain the deleted DRG code which is listed to be deleted in the import file.
  58. Close the report.
Topics
• 837 Institutional • Diagnosis • File Import
AV-96847 Summary | Details
Financial Determination - Field Verification
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
  • Financial Determination
Scenario 1: 'Financial Determination' - filing financial determination for a client
Specific Setup:
  • Dictionary Update:
  • User must populate the following Client dictionary tables: 7104, 7108, 7110, 7113, 7118, 7127, and 7131.
  • Registry Setting:
  • The 'Include Enhanced Limits' setting must be enabled.
  • Guarantors/Payors:
  • An existing guarantor is identified to be used. Note the guarantor's code/name.
  • Admission:
  • An existing client is identified, or a new client is admitted. Note client id, admission program, admission date.
  • Financial Eligibility:
  • The guarantor identified in the 'Guarantors/Payors' form is assigned to the client as the primary guarantor.
  • User Definition:
  • User has access to the 'Financial Determination Configuration' and 'Financial Determination' forms.
  • Financial Determination Configuration:
  • Select "Create New" in the 'Configuration' field.
  • Enter the leap year day (i.e. 2/29/2024) in the 'Effective Date' field.
  • Do not enter any value in the 'Expiration Date' field.
  • Enter desired amount in the 'Lump Sum Value Is Net Assets Plus' field.
  • Enter desired amount in the 'FICA Tax Rate' field.
  • Enter desired amount in the 'Room And Board' field.
  • Enter desired amount in the 'Default Income Percentage For Ability To Pay' field.
  • Enter desired amount in the 'Each Additional Dependent' field.
Steps
  1. Select desired client and access the 'Financial Determination' form.
  2. Enter the leap year day (ex. 02/29/2024) in the 'Effective Date' field.
  3. Do not enter any value in the 'Expiration Date' field.
  4. Verify the 'Expiration Date' field is auto populated with the desired date (i.e. 02/28/2025).
  5. Clear the date from the 'Expiration Date' field.
  6. Change the 'Effective Date' field to non leap year day (i.e. 02/28/2022).
  7. Verify the 'Expiration Date' field is auto populated with the desired date (i.e. 02/27/2023).
  8. Clear the date from the 'Expiration Date' field.
  9. Change the 'Effective Date' field to non leap year day (i.e. 04/20/2024).
  10. Verify the 'Expiration Date' field is auto populated with the desired date (i.e. 04/19/2025).
  11. Select desired value in the 'Active?' field.
  12. Select desired value in the 'Residence Type' field.
  13. Select "Create New" in the 'Determination Information' field.
  14. Select desired value in the 'Determination Method' field.
  15. Select "Create New" in the 'Included Assets' field.
  16. Select desired value in the 'Asset Type' field.
  17. Enter desired value in the 'Asset Value' field.
  18. Select "Create New" in the 'Expense' field.
  19. Select desired value in the 'Expense Type' field.
  20. Select "Monthly" in the 'Expense Time' field.
  21. Enter desired value in the 'Expense Value' field.
  22. Validate the 'Total Assets' field contains desired amount.
  23. Validate the 'Net Value Of Excluded Assets' field contains desired value.
  24. Validate the 'Total Liabilities' field contains desired value.
  25. Validate the 'Protected Assets' field contains desired value.
  26. Validate the 'Net Assets' field contains desired value.
  27. Validate the 'Total Income' field contains desired value.
  28. Validate the 'Total Expenses' field contains desired value.
  29. Validate the 'Protected Income' field contains desired value.
  30. Validate the 'Net Income' field contains desired value.
  31. Click [Submit].
  32. Validate all the fields filled out in the previous steps remain filled out.
  33. Close the form.
Topics
• Financial Determination
Table Changes
Table Column Change
SYSTEM.fileimportdrgcodes pkey Added