Patch019 – December 2005 Update

This patch contains the latest updates for: 1) RUGS '53' Grouper Version 5.20 (effective January 1, 2006),  2) Medicaid Part 'D' Rate Code revisions (effective January 1, 2006), 3) Payout Analysis for '1199' Banked Sick Days, and 4) 2006 Federal, New York State, and New York City Tax Rate Tables. See also and print Year end notes 2005.

Rugs ‘53’ Grouper Version 5.20 (effective January 1, 2006) - This patch updates the software previously released September '05:

Version 5.20 implements the 2005 refinement to the RUGS-III grouper model. This makes use of a ’53-group’ model replacing the ’44-group’ model starting in January 2006. This model places the combined Rehabilitation/Extensive groups at the top of the hierarchy. The ’53-group’ model will be used in the Medicare SNF payment system beginning January 1, 2006.

Rug-44  will be used for billing all SNF days of services through December 31, 2005.

Rug-53 will be used for billing all SNF days of services starting with January 1, 2006.

The earliest PPS assessment ARD (assessment reference date) that could require a Rug-53 (for billed days of service on or after 01/01/2006) is 11/22/2005. The ARD window for a PPS 60-day assessment starts 11 days before the corresponding 60-day assessment payment period and the 60-day assessment lasts for up to 30 days.

When billing Medicare Part A for service dates after January 1, 2006, that are dependent on MDS assessments between 11/22/05 and 12/31/05, the CHARTS billing program will recalculate the RUG score using the new RUG-53 model. Additionally, the billing program will recalculate an MDS assessment with an ARD date after 01/01/2006 that affects 2005 billing. This can occur when a resident is admitted in late December 2005 and the MDS 5-day assessment is done in early January 2006.

We have modified the Rugs III Grouper printout to allow a client to see what the score for past assessments would have been had the Rug-53 Grouper already been in place. To run this program,  type M2R3 from any Charts menu and type ‘Y” in response to the question ‘Pretest M2 Rugs 5.20 Grouper’. Those assessments with an ‘*’ after the score indicate that the MDS would score differently under the Rugs-53 grouper.

                             MDS 2.0 Rugs III Grouper

              Resident: A▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬ - ZZ▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬▬
              Date    : 01/01/2005           - 12/31/2099
              Bed     :                      - ZZ 99999  

              Types- 1-Admission             : Y
                     2-Annual                : Y
                     3-Significant Change    : Y
                     4-Significant Correction: Y
                     5-Quarterly             : Y
                     9-Reentry               : Y
                 6/7/8-Discharge             : Y
                     0-Other                 : Y

              Name/Bed/Unit/SS# order        : N
              Latest                         : N
              Print option                   : S
              Print Active Residents Only    : N
              Verify MDS 2.0 record          : N   Pretest Rugs 5.20 Grouper: Y

Note: If you are not using CHARTS MDS to store the entire MDS record then the following option must be set in User-Parameters before doing your December billing:  In [UP, 14] set option #25,  Bypass Rugs 53 to Y.

If you are not using CHARTS MDS you will also need, in January and in February, to manually reset the RUGs score to the "Rugs 53 Grouper" score when it has changed.

RUGS 53 Grouper (The new categories, i.e., the first 9, are in bold.)

The Medicare Rates for New York City have been updated on this release - please reload the rates even if already loaded

The update include the October 2005 and the January 2006 rate revisions for Medicare.

To update your rates type ‘RHSTF’ from any CHARTS menu.

The R.H.S. Table File should be initialized to RATE06. Leave all other fields as initialized. Press Enter.

Load RHS table file to client


          R.H.S. Table File: RATE06  Library: CHARTS▬▬  Volume: VOLB▬▬

          Client Table File: TFFILE▬▬  Library: ________  Volume: VOLB▬▬

          Delete the Specific Table before copying  : N  (Yes, No, Default)

          When using default, if RHS file="NEWTF"  it won't delete.
                              if RHS file="NEWTF2" it will  delete.

The updated rates can be viewed by printing the Table File: PTF, 8, 25 Medicare Rates, or modified by changing Table File: CTF, 8, 25 Medicare Rates.

Please note that the RHS Table File Code in the Medicare Rates and Dates table for the the nine new RUG 3 groups are as follows:  

Medicaid: New Rate Codes for Part D Eligible

Effective January 1, 2006, as a result of the the new Medicare Part D drug program, New York State facilities are required to bill differently for Medicaid room and board charges.

The NYS Department of Health has established new rate codes for the new Medicaid Part D benefit. The proper rate code is based on the recipient's eligibility for Medicare Part D and Part B benefits. The CHARTS software takes these new rate codes into account for all New York Medicaid Billing starting January 1, 2006.

The following 2 steps are required to comply with the new Part D changes:

Step 1.    Enter the four (4) new rates for each Medicaid bill type (Geriatric, Vent, HIV, ...).

Step 2.    Identify each resident as being either eligible or non-eligible for Medicare Part D.

Once the above steps are accomplished the billing can proceed in the usual manner.

Step 1.  Entering the four (4) new Medicaid rates for 2006.

Step 1a. Find 2 Available/Unused Medicaid "Rate & Dates" Codes for each Medicaid type (i.e., Geri, Vent, HIV, etc.):

Type PTF 8, 12 to list all "Rate & Date" codes currently used. Continue to press Enter until you notice a gap in the codes as illustrated below.

                    RATES AND DATES
CODE YEAR       DESCRIPTION
  DATE 1   DATE 2   DATE 3   DATE 4   DATE 5   DATE 6   DATE 7   DATE 8   DATE 9
  RATE     RATE     RATE     RATE     RATE     RATE     RATE     RATE     RATE
-------- -------- -------- -------- -------- -------- -------- -------- --------
  19  0005 PVT
01/01/05
  350.00      .00      .00      .00      .00      .00      .00      .00      .00

  20  0004
01/01/04
   20.00      .00      .00      .00      .00      .00      .00      .00      .00

  25  0002 MA ADD ON
04/01/02
   14.68      .00      .00      .00      .00      .00      .00      .00      .00

        (Return)Next 1)Print ^15)Print scrn 4)Prev (5^5)Last/First     (16) Exit

Note that in the above, codes 21, 22, 23, and 24 are available. Your gaps may be different.

Step 1b. Review and complete the new Part D Bill Codes Table file (CTF 1, 21) records.

By loading this release a new table file record, Part D Bill Codes is created for each Medicaid type.

Type CTF, 1, 21 to modify the new Part D Bill Codes table for each Medicaid type.

At 'Enter Main Key' press PF 2 for a listing of all your codes. Type the first Medicaid number (e.g., 11) and the following screen appears:

                                                                Change (219-PTD)
                                Part D bill Codes
  Enter Main Key : 11                     Secondary Key: MA▬▬
  Description    : MEDICAID▬▬▬▬▬▬▬▬▬▬▬▬

                              Part D Eligible  RateCode
                Elig Part B : XX XX XX XX XX     3839  
                Not Elig  B : YY YY YY YY YY     3838  

                          Not Eligible Part D  RateCode
                Elig Part B : 01 01 01 01 01     3812  <--- Leave as initialized
                Not Elig  B : 02 02 02 02 02     3810  <--- Leave as initialized

    Enter (F) To File (I) To Ignore: F

The new Part D Eligible codes - The top part of the screen shaded in yellow:

In the above screen replace all the 'XX' with the first available/unused number determined in Step 1a above.

In the above screen replace all the 'YY' with the second available/unused number determined in Step 1a above.

If the Rate Codes above are initialized as blank verify then verify they are stored in UP, 2, (see documentation following step 1c.) in which case you should leave them blank on the above screen. If the Rate Codes for the two (2) new Part D Eligible types are not blank verify that they are correct based on the following: 

The old Not Eligible Part D codes - The bottom of the screen shaded in Green.

The information in the Not Eligible Part D area in the above screen is initialized from the Billing Types table.

In the illustration above - '01' corresponds to the previous "Elig Part B only" rate, and '02' corresponds to the previous "Not Elig Part B or D" rate.

Leave these fields as initialized.

Repeat this Step 1b. for each Medicaid type.

Step 1c. Entering your new Medicaid rates for 2006

Type ATF, 8, 12 and the following screen appears:

                                                                   Add (071-RTD)
                              RATES AND DATES TABLE
                              ---------------------
  Code: ▬▬  Year: ▬▬     Monthly/Daily:       Description:
                                              Percent to use for BedHold:
                                Rate       Date (MM/DD/YY)
                                        -
                                        -
                                        -
                                        -
                                        -
                                        -
                                        -
                                        -               Rate is percent(/P):
    Enter (F) To File (I) To Ignore:

For each Medicaid level of care (i.e., Geri, HIV, Vent, and Neuro) in your facility you must enter four rates corresponding to:

Old  - Eligible Part B but not eligible Part D

Old  - Not Eligible Part B and not eligible Part D

New - Eligible Part B and Eligible Part D

New - Not Eligible Part B but Eligible Part D

At Code specify the first code in Step 1b. above (i.e., the codes represented by 'XX', 'YY', etc.).

At Year type 06

Press Enter.

At Rate type your Medicaid rate.

At Date type 01/01/06

Repeat this step 1c for all four Medicaid codes.

Important: In many facilities the Rate Codes for one level of care are not stored in the Billing Table File but in User Parameters, Medicaid Information [UP, 2]. In those cases the Rate Codes in the Part D Bill Codes table will be blank (as shown in the shaded area below), and the User Parameter Medicaid Information screen [UP, 2] should be checked to verify that all four required Rate Codes are present.

                                Part D bill Codes
  Enter Main Key : 11                     Secondary Key: MA▬▬
  Description    : MEDICAID▬▬▬▬▬▬▬▬▬▬▬▬
                              Part D Eligible  RateCode
                Elig Part B : XX XX XX XX XX   ______  		
                Not Elig  B : YY YY YY YY YY   ______   

                          Not Eligible Part D  RateCode
                Elig Part B : 01 01 01 01 01   ______   
                Not Elig  B : 02 02 02 02 02   ______   

    Enter (F) To File (I) To Ignore: F

For Rate Codes that are not stored in the Billing Table File (and are blank above) verify that those four Rate Codes are present in User Parameters by typing UP, 2 for the Medicaid Information Screen as shown below.

                           M E D I C A I D  INFORMATION
 Provider ID:           Locator Code:     Category of Service      Census Ind ▬
 Rate Codes-Elig B: 3812  Not Elig: 3810  Elig B and D: 3839 Elig D Only: 3838
 Address- 3":     5":     Tape:      Billing on 3/5/Tape:       Use Defaults:
 Tape Supplier #:         MDS2 Contact :                      Tel:
 Schd Billing:                             MDS2 Spacing:
 Rates&Dates From TF:    Bill Pending :    Stand Alone MDS :    Cert bed type:
 Ancl-Rcv/Wrt off/Trk    Bill Regular :    MDS Cognitives  :    Pat Part. Adj:
 CR pd if P/T/D/A   :    No Medicaid #:    MDS Auto Display:    Init ICD9    :
 PF Pre# Ck SW      :    Open BD File :    MDS Recalc RUGS3:    Using MDS+   :
 Co-Insurance       :    Open PF File :    Init MDS from PM:    Using MDS Trg:

The ultimate responsibility for verifying that the proper rate codes are being billed rests with the client.

January 2006 Medicaid Rate Codes 

Step 2.  Identifying each resident as Part D Eligible

A facility default is available to provide a short cut instead of updating each resident master file.

UP, 14, item # 28 'Part D Default'.

  1.   Validate Diagnosis   21.   Global Passwords     41.
  2.   Show Extended Diags  22.   835 CR - Post Denial 42.
  3.   Ancil Download 'M'   23.   AP Ledger Order 1/2  43.
  4.   UB92 Facility Addr   24.   ENS/Proxymed/Other   44.
  5.   Copy Back Not Kermit 25.   Bypass Rugs 53       45.
  6.   Show C/R Svcdate Pvt 26.   Auto Post Deposits   46.
  7.   Benefits-Use Vac Max 27.   Use Emp State as Tax 47.
  8.   Pvt Bill Adjustment  28.   PartD Default Y/N/B  48.
  9.   Benefits-Sick Max    29.                        49.
 10.   FSINFO Misc 3 = Lang 30.                        50.
 11.   Use Medco PF Screens 31.                        51.
 12.   PR Master Info Only  32.                        52.
 13.   Pvt-Proj in Open Bal 33.                        53.
 14.   Option #1 - see BW   34.                        54.
 15.   Santosa Facility     35.                        55.
 16.   Using E2 File        36.                        56.
 17.   MDS 2 - Init Therapy 37.                        57.
 18.   Accrl Per Hr/Month   38.                        58.
 19.   Embosser Print Class 39.                        59.
 20.   Bed List Message     40.                        60.

The Part D indicator for each resident can be set in any of the following programs:

Change Resident File [CC, 5, 1]

Additional UB92 Information [CC, 14, 5]

Additional Face Sheet Information [CC, 14, 6]

Medicaid Part D Information [CC, 14, 10]. This program can also be used to identify the RX plan and cardholder information.

The Eligible Part D field can be displayed in the Resident Report Generator [RI, 7] by using report generator field 'X73'.

Payout analysis for local 1199 Banked Sick Days

Based on the recent collective bargaining agreement the union contract allows for three (3) banked sick days per year. These three (3) sick days are not to be paid when the employer pays for unused sick leave. Upon retirement, all banked days shall be paid at that time. If the employee resigns or it terminated that individual loses any sick days that had been banked in previous years.

To facilitate the facility in paying out sick days this year end the benefits program has been modified to include a payout analysis that takes the banked sick days requirement into account.

For example, an employee that works 35 hours a week and accrues 120 hours per year would be paid 91 hours of unused sick time (120 - 21). The remaining 21 hours would be moved into carryover at year end. It is important to note that when running the Benefits Carryover program that sick pay should be carried over for local 1199 employees.

In User Parameters, Payroll Information screen #5 - [UP, 5] 'BankSick Days' should be set to the maximum number of sick days the facility employees are allowed to bank (maximum 3).

   P A Y R O L L  INFORMATION                 P/R Cash Acnt:           Bank
 Union Dues:    401k - Amt/Percent:           Deduct.No    Max       Min
 Init. Fees:          Match/Offset:           Prenumbered Checks Indicator :
 Address on Check:   OT Wage Avg ( /A):       Print YTD Totals on the Stub :
 BankSick Days: 3  Max:     Inc Totals:       Overtime Based on Screen Rate:
 History by Pay Date or To Date (P/T) :       Prompt OT Rate with Base Rate:
 Last - Check #:          Emp. ID:            Facility Pay Frequency       :
 Union Options- Slotted per week(fund):       Locality Tax: Table file #:
                Worked per month(Wlfr):         Combine With City Tax (W-2):
 Funds- Full-time slotted <850 hrs    :         Rate Basis (F/S/C/TF)      :
        >850 hrs, for unfunded portion:       Deduct # YTD to Print on Chk :
 Hol          Sck          Vac          Per       Accrl on Chk   From
 TF# Checking/Saving/Acct 3/Reserve                  Ck Mailers:   Split Dept:
    Child Support        Bank:    Kronos$       Institution:    OT begins:
      Volume Library  Filename    AddOn Code           Sick        Vacation
   EM                            Accrue hr/mnth :
   EH                            Wt pd Accr/Aval:
   DE                            % Pyout/Crryovr:
   SP                            Max crryovr hrs:
   TX                            Faclty Spec Opt:

 If for a specific department the employees in that department have a different maximum number of banked days allowed, then in the Union Funds Maintenance Table [CTF, 10, 18] - the field 'Max Bank Sick Days' should be set to the maximum numbers of days for that department.

                                                                Change (190-UN )
                             Union Information Table
  Main Key: 0100.0000 Secondary Key:           Description:

  Hrs Per Day:                   Union A           Union B         Union C
  Shift Mult :            Fund 1.
  Max Bank Sick Days: 1  Rates 2.
                               3.
                               4.
                               5.
                               6.

                                Adjustment Information
                   UNION A              UNION B             UNION C
             * Day   Eve/Night    * Day   Eve/Night   * Day   Eve/Night
 Adj.Percent:
 Base Amount:

                                                   * Day Employees
                                               Shift = ' ' or "D" or "1"
    Enter (F) To File (I) To Ignore:           Auto Diff = ' ' or "N"

To run the Benefits Payout Analysis, run the Benefits Accrued Report [PR, 4, 1] in Employee Order 'E', set Sick to 'Y' and all other benefits (Vacation, Holiday and Personal) to "N" and set the field 'Payout Percentage Analysis (Y/N)'  to 'Y'.

                                  P A Y R O L L
                          -  BENEFITS ACCRUED REPORT  -

        Processing Order --> E-employee, D-department: E

        From: A        ▬▬▬▬▬▬▬▬▬▬▬▬       To: ZZ            ▬▬▬▬▬▬▬

        From Date: 01/01/2005             To: 12/31/2005

        Vacation / Sick / Holiday / Personal (Y/N): N Y N N

        Detail/Summary/Both (D/S/B): S    Payout Percentage Analysis (Y/N)  : Y
        Print Option: S                   Separate Page Per Employee (Y/N)  : N
        Print Init Date on Report  : N    Print Terminated Employees (Y/N/A): N
        Show Amounts on Report: Y                      (A-Active Depts Only)
        Anniversary (MMDD): 0101 - 1231   Calculate Accrl Until Anniversary : N
        Include Union (' '-all): ▬
        If Department Order: From employee  A▬▬▬▬▬▬▬▬▬▬▬▬▬▬ to ZZ▬▬▬▬▬▬▬▬▬▬▬▬▬
                             Department Summary Only (Y/N): N
                             Print Employee Summary  (Y/N): N

See also and print Year end notes 2005.

END