Automated billing for Medicare Demonstration Project.

March 7, 1996

Dear Client,

Enclosed are recent updated versions of several programs that should be of assistance to clients participating in the Medicare Demonstration project.

All clients, even those not participating in the Medicare Demonstration project, should load the enclosed diskettes.

Validation of Medicare Case Mix Index (Section R-2B)

Several of our clients have noted that after completing the entry of an MDS+ form and having RHS calculate the Medicare CMI, that subsequent changes to the form could cause the Medicare CMI to change without section R-2B being recalculated and updated. A user parameter option has been added to allow for several options to resolve this issue as follows.

(A) - Allow RHS to automatically update the Medicare CMI if any variable effecting the CMI changes.

(Y) or Blank - RHS will warn the user when an entry in R-2B (Medicare CMI) differs from the RHS calculated CMI.

(N) - RHS calculated CMI is displayed in section 'R' only. No warning message will be issued if R-2B differs from RHS calculated CMI. This is the method that was used in previous releases.

The default option is 'Y'. If this option is desired no action need be taken by the client. To use option 'A' or 'N' enter NHMA from any menu and in response to the field MDS Recacl RUGS3 enter in either 'A' or 'N'.

Revised Medicare MDS+ Scheduling Program

A newly revised version of the Print Medicare Schedule is being released. This enhanced version takes into consideration Medicare readmissions and status changes and will restart the schedule accordingly.

Pre-Release of Automatic Medicare Billing

A pre-release version of the Accounts Receivable billing program that supports automatic Medicare sub type billing is being released. A client using our MDS+ module will no longer be required to enter Medicare sub type census changes into the Census Module. The Medicare billing program now calls a subroutine that scans the MDS+ records and automatically will split the Medicare billing based on the MDS+ Medicare CMI. Please evaluate this new feature and give us your feedback. We believe we are the first vendor to offer this type of MDS+ to billing integration.

The Post Room and Board Charges program [GM, 8, 2, 1] has a new option. This option should only be filled in when posting room and board charges for the Medicare Demonstration project. Additionally, when using this option only Medicare should be selected in the billing types checkoff screen.

(A) - Automatic RHS Medicare sub type calculations - this option should be used by clients participating in the Medicare Demonstration project for Medicare billing only.

(B) - Use the Automatic Medicare sub type calculations, except where a valid Medicare sub type has been entered into the census module. This option will allow a user to override the automatic RHS sub type calculations.

(C) - Medicare sub types are determined from census data only. No MDS+ lookups or RHS calculations. This option is the default option. This option should be used for all billings other than Medicare billing by clients participating in the Medicare Demonstration project.

For assistance or for additional information please call our client services department at 718-338-2400. Thank you.

Sincerely,

Bud Westreich
Vice President, Systems Development

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