Section Specifications for EXF
Round 69
Created on 5/9/2014 6:07:42 PM
Box Instructions
IF COST DATA FROM THE PREVIOUS ROUND REMAINS TO BE COLLECTED, GO TO BOX EXS1A.
ELSE GO TO BOX EXBEG.
Other Programming Instructions
Background Variable Assignments
Load all PreloadBPERs and BPROs into current round arrays.
Variable Name |
Assignment Instructions |
WRITEBAS |
If PERS.WRITEBAS = EMPTY, NULL and PreloadSP.WRITEBAS <> EMPTY, NULL, then PERS.WRITEBAS = PreloadSP.WRITEBAS |
WRITEANC |
If PERS.WRITEANC = EMPTY, NULL and PreloadSP.WRITEANC <> EMPTY, NULL, then PERS.WRITEANC = PreloadSP.WRITEANC |
EXFCAID |
If PERS.EXFCAID = EMPTY, NULL and PreloadSP.EXFCAID <> EMPTY, NULL, then PERS.EXFCAID = PreloadSP.EXFCAID |
EXFCARE |
If PERS.EXFCARE = EMPTY, NULL and PreloadSP.EXFCARE <> EMPTY, NULL, then PERS.EXFCARE = PreloadSP.EXFCARE |
EXSPCAID |
If PERS.EXSPCAID = EMPTY, NULL and PreloadSP.EXSPCAID <> EMPTY, NULL, then PERS.EXSPCAID = PreloadSP.EXSPCAID |
BAS10FLG |
If PERS.BAS10FLG = EMPTY, NULL and PreloadSP.BAS10FLG <> EMPTY, NULL, then PERS.BAS10FLG = PreloadSP.BAS10FLG |
ANC10FLG |
If PERS.ANC10FLG = EMPTY, NULL and PreloadSP.ANC10FLG <> EMPTY, NULL, then PERS.ANC10FLG = PreloadSP.ANC10FLG |
EXDISP |
EXDISP = 93/BreakOff |
Design Notes
All dollar amounts (collected or calculated) are to be stored with two decimal places throughout the section.
Box Instructions
IF FIRST/NEXT PRELOAD BPER HAS PreloadBPRO.ANCLPOST = 0/No, DK or PreloadBPRO.ANYANCIL = DK, GO TO EX15PRES1 - EX15PRCT.
ELSE GO TO EX20S1PRE - BASSMINT.
Other Programming Instructions
Background Variable Assignments
Create current round BPRO.
Variable Name |
Assignment Instructions |
BPROBPER |
BPRO.BPROBPER = BPERNUM |
BPRORNDC |
BPRO.BPRORNDC = current round |
Question Text
The
next questions are about health-related services received by (SP) for
which there was a separate charge, that is, your (facility/home)'s
ancillary services.
(Please do not include
non-health-related services such as hairdressing, television, or
telephone).
PRESS
F1 FOR EXAMPLES OF NON-HEALTH-RELATED ANCILLARIES.
PRESS
"1" TO CONTINUE.
Field 1: EX15PRCT
Field 1 Routing
Value |
Label |
Route |
1 |
CONTINUE |
BOX EXS2 |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
EX15SLONG |
FACR.EX15SLONG = current round |
Box Instructions
If PreloadBPRO.ANCLPOST = 0/No, DK, GO TO EX16S1 - ANCLPOST.
ELSE GO TO EX17S1 - ANYANCIL.
Question Text
Have all charges for ancillaries been posted for the period from (BP START DATE) to (BP END DATE)?
Field 1: ANCLPOST
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
BOX EX7BS1 |
1 |
YES |
EX17S1 - ANYANCIL |
|
Don't Know |
BOX EX7BS1 |
|
Refused |
BOX EX7BS1 |
Other Programming Instructions
Design Notes
Store on BPRO.
Question Text
Does (SP) have any ancillary charges between (BP START DATE) and (BP END DATE)?
Field 1: ANYANCIL
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
BOX EX7BS1 |
1 |
YES |
EX18S1 - ANCILAMT |
|
Don't Know |
BOX EX7BS1 |
|
Refused |
BOX EX7BS1 |
Other Programming Instructions
Design Notes
Store on BPRO.
Question Text
Altogether, what was the total charge for those health-related ancillary services?
Field 1: ANCILAMT
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
BOX EX7BS1 |
|
Don't Know |
BOX EX7BS1 |
|
Refused |
BOX EX7BS1 |
Question Text
The
next questions are about (SP)'s expenditures for room
and board
while a resident of (FACILITY).
Field 1: BASSMINT
Field 1 Routing
Value |
Label |
Route |
1 |
CONTINUE |
BOX EX7BS1 |
Box Instructions
IF PreloadBPRO.RECDBASP = 0/No, GO TO EX20S1 - RECDBASP.
ELSE IF PreloadBPRO.RECDANCP = 0/No or EX17S1 - ANYANCIL = 1/Yes, GO TO EX28S1 - RECDANCP.
ELSE GO TO EX33BS1 - EXSBKCT.
Question Text
Have you received all of the payments for basic care you expect to receive for (SP) during the [READ BILLING PERIOD ABOVE] billing period?
Field 1: RECDBASP
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
BOX EX14S1 |
1 |
YES |
EX21AAS1 - ADDSOP1 |
Other Programming Instructions
Design Notes
Store on BPRO.
Question Text
Do you need to add any Source(s) of Payment for (SP)'s basic care for [READ BILLING PERIOD ABOVE]?
Field 1: ADDSOP1
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
EX21ACS1 - BASRATE |
1 |
YES |
EX21ABS1 - PAYMPLN1 |
Other Programming Instructions
Report Display
Display
report above question text:
# OF BILLED DAYS:
(PreloadBPER.BILLDAYS)
TOTAL BILLED: $(TOTAL BILLED)
AMOUNT
REMAINING: $(AMOUNT REMAINING)
Display Sources of Payment
in the following order:
(1 = MEDICAID)
2 = PRIVATE PAY OR
SP/FAMILY INCOME
(3 = SOCIAL SECURITY)
(5 = PRIVATE
INSURANCE)
(6 = PENSION)
7 = MEDICARE
(8 = VA
CONTRACT)
(9 = HMO CONTRACT (SPECIFY))
(10 = SUPPLEMENTAL
SECURITY INCOME (SSI))
(91 = OTHER)
Display
1/MEDICAID if there is a current or previous round Medicaid payment
or PERS.INCAID = 1/Yes or PERS.HCAIDNM <> DK, RF, EMPTY,
NULL.
If PERS.GAPCOV = 1/Yes or PERS.LTCCOV = 1/Yes or there is
a current or previous round PRIVATE INSURANCE payment, then display
5/PRIVATE INSURANCE.
Display 3/SOCIAL SECURITY if there is a
current or previous round SOCIAL SECURITY payment.
Display
6/PENSION if there is a current or previous round PENSION payment.
If PERS.AFHIST = 1/Yes or there is a current or previous round
VA payment, then display 8/VA CONTRACT.
Display PAYM.PAYMTEXT
for 9/HMO CONTRACT if there is a current or previous round HMO
CONTRACT payment.
Display 10/SUPPLEMENTAL SECURITY INCOME (SSI)
if there is a current or previous round SSI payment.
Display
PAYM.PAYMTEXT for each 91/Other SOP with a current or previous round
PAYM record.
Background Variable Assignments
Variable Name |
Assignment Instructions |
PAYMBPER |
PAYM.PAYMBPER = BPER.BPERNUM |
PAYMNUM |
PAYM.PAYMNUM = number portion of each SOP displayed in EX21AAS1 - ADDSOP1 report |
PAYMRNDC |
PAYM.PAYMRNDC = current round |
PAYMTEXT |
If PAYM.PAYMNUM = 9/HMOContract or 91/Other, then PAYM.PAYMTEXT = PAYMTEXT from most recent current or previous round PAYM |
Design Notes
"VA CONTRACT" will be displayed in the report if the respondent ever said the SP was in the Armed Forces in BQ12.
Question Text
What Source(s) of Payment do you need to add for (SP)'s basic care for [READ BILLING PERIOD ABOVE]?
SELECT
ALL THAT APPLY.
SEPARATE RESPONSES BY USING THE SPACEBAR.
IF
NO RESPONSES ARE AVAILABLE, BACK UP AND CORRECT YOUR RESPONSE.
Field 1: PAYMPLN1
Field 1 Routing
Value |
Label |
Route |
1 |
MEDICAID |
EX21ACS1 - BASRATE |
2 |
PRIVATE PAY OR SP/FAMILY INCOME |
EX21ACS1 - BASRATE |
3 |
SOCIAL SECURITY |
EX21ACS1 - BASRATE |
4 |
SP/FAMILY INCOME |
EX21ACS1 - BASRATE |
5 |
PRIVATE INSURANCE |
EX21ACS1 - BASRATE |
6 |
PENSION |
EX21ACS1 - BASRATE |
7 |
MEDICARE |
EX21ACS1 - BASRATE |
8 |
VA CONTRACT |
EX21ACS1 - BASRATE |
9 |
HMO CONTRACT |
EX21ABS1 - HMOOS1 |
10 |
SUPPLEMENTAL SECURITY INCOME (SSI) |
EX21ACS1 - BASRATE |
91 |
OTHER |
EX21ABS1 - SOPOS1 |
|
Don't Know |
EX21ACS1 - BASRATE |
|
Refused |
EX21ACS1 - BASRATE |
Field 2: HMOOS1
HMO CONTRACT (SPECIFY)
Field 2 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
EX21ACS1 - BASRATE |
Field 3: SOPOS1
OTHER (SPECIFY)
Field 3 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
EX21ACS1 - BASRATE |
Other Programming Instructions
Report Display
Display
report above grid:
# OF BILLED DAYS:
(PreloadBPER.BILLDAYS)
TOTAL BILLED: $(TOTAL BILLED)
AMOUNT
REMAINING: $(AMOUNT REMAINING)
Display Sources of Payment
in the following order:
(1 = MEDICAID)
2 = PRIVATE PAY OR
SP/FAMILY INCOME
(3 = SOCIAL SECURITY)
(5 = PRIVATE
INSURANCE)
(6 = PENSION)
7 = MEDICARE
(8 = VA
CONTRACT)
(9 = HMO CONTRACT (SPECIFY))
(10 = SUPPLEMENTAL
SECURITY INCOME (SSI))
(91 = OTHER)
Display
1/MEDICAID if there is a current or previous round Medicaid payment
or PERS.INCAID = 1/Yes or PERS.HCAIDNM <> DK, RF, EMPTY,
NULL.
If PERS.GAPCOV = 1/Yes or PERS.LTCCOV = 1/Yes or there is
a current or previous round PRIVATE INSURANCE payment, then display
5/PRIVATE INSURANCE.
Display 3/SOCIAL SECURITY if there is a
current or previous round SOCIAL SECURITY payment.
Display
6/PENSION if there is a current or previous round PENSION payment.
If PERS.AFHIST = 1/Yes or there is a current or previous round
VA payment, then display 8/VA CONTRACT.
Display PAYM.PAYMTEXT
for 9/HMO CONTRACT if there is a current or previous round HMO
CONTRACT payment.
Display 10/SUPPLEMENTAL SECURITY INCOME (SSI)
if there is a current or previous round SSI payment.
Display
PAYM.PAYMTEXT for each 91/Other SOP with a current or previous round
PAYM record.
Background Variable Assignments
Variable Name |
Assignment Instructions |
PAYMBPER |
PAYM.PAYMBPER = BPER.BPERNUM |
PAYMNUM |
PAYM.PAYMNUM = EX21ABS1 - PAYMPLN1 |
PAYMRNDC |
PAYM.PAYMRNDC = current round |
PAYMTEXT |
If EX21ABS1-PAYMPLN1 = 9/HMOContract and PAYM.PAYMNUM = 9/HMOContract, then PAYM.PAYMTEXT = EX21ABS1-HMOOS1. Else if EX21ABS1 - PAYMPLN1 = 91/Other and PAYM.PAYMNUM = 91/Other, then PAYM. PAYMTEXT = EX21ABS1-SOPOS1. |
Question Text
What is the total amount each source paid for [READ BILLING PERIOD ABOVE]?
Field 1: BASRATE
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
BOX EX7CS1 |
|
Don't Know |
BOX EX7CS1 |
|
Refused |
BOX EX7CS1 |
Other Programming Instructions
Roster/Grid Instructions
Display
Sources of Payment in the following order:
(1 = MEDICAID)
2
= PRIVATE PAY OR SP/FAMILY INCOME
(3 = SOCIAL SECURITY)
(5
= PRIVATE INSURANCE)
(6 = PENSION)
7 = MEDICARE
(8 =
VA CONTRACT)
(9 = HMO CONTRACT (SPECIFY))
(10 =
SUPPLEMENTAL SECURITY INCOME (SSI))
(91 = OTHER)
Display
1/MEDICAID if there is a current or previous round Medicaid payment
or PERS.INCAID = 1/Yes or PERS.HCAIDNM <> DK, RF, EMPTY, NULL
or if added at EX21ABS1 - PAYMPLN1.
If PERS.GAPCOV = 1/Yes or
PERS.LTCCOV = 1/Yes or there is a current or previous round PRIVATE
INSURANCE payment, or if added at EX21ABS1 - PAYMPLN1, then display
5/PRIVATE INSURANCE.
Display 3/SOCIAL SECURITY if there is a
current or previous round SOCIAL SECURITY payment or if added at
EX21ABS1 - PAYMPLN1.
Display 6/PENSION if there is a current or
previous round PENSION payment or if added at EX21ABS1 - PAYMPLN1.
If PERS.AFHIST = 1/Yes or there is a current or previous round
VA payment or if added at EX21ABS1 - PAYMPLN1, then display 8/VA
CONTRACT.
Display PAYM.PAYMTEXT for 9/HMO CONTRACT if there is a
current or previous round HMO CONTRACT payment or if added at
EX21ABS1 - PAYMPLN1.
Display 10/SUPPLEMENTAL SECURITY INCOME
(SSI) if there is a current or previous round SSI payment or if added
at EX21ABS1 - PAYMPLN1.
Display PAYM.PAYMTEXT for each 91/Other
SOP with a current or previous round PAYM record or if added at
EX21ABS1 - PAYMPLN1.
Roster/Grid Display
Column # |
Header |
Instructions |
1 |
SOP Name |
Display source of payment name. Display Only. |
2 |
SOP Payment |
BASRATE. Input field 1. |
Report Display
Display
report above grid:
# OF BILLED DAYS:
(PreloadBPER.BILLDAYS)
TOTAL BILLED: $(TOTAL BILLED)
AMOUNT
REMAINING: $(AMOUNT REMAINING)
Background Variable Assignments
Variable Name |
Assignment Instructions |
BASICPAY |
If any PAYM for PAYMNUM = BPERNUM has BASRATE = DK, RF, then BPER.BASICPAY = DK. Else BPER.BASICPAY = sum of all PAYM.BASRATE for PAYMNUM = BPERNUM |
Design Notes
We
need to calculate BASICPAY as each SOP is collected.
Store on
EX21ACS1-BASRATE PAYM.
Box Instructions
IF MEDICARE IS IDENTIFIED AS A SOURCE OF PAYMENT FOR BASIC CARE AND THERE IS NO STAY IN A HOSPITAL BETWEEN (BP START DATE - 60 DAYS) AND (BP END DATE + 60 DAYS) AND THIS WAS NOT EXPLAINED THIS ROUND, GO TO EX21BS1 - VEXPTXTB.
ELSE GO TO BOX EX8S1.
Question Text
Medicare
has been reported as a payment source for basic care for (SP) for
[READ BILLING PERIOD ABOVE], but I have not recorded any preceding
hospital stays for (him/her).
Please tell me why Medicare
paid for (SP) during this billing period.
RECORD
VERBATIM BELOW. IF NECESSARY, BACK UP TO CORRECT.
IF
HOSPITAL STAY IS REPORTED, RECORD DATES OF STAY BELOW.
Field 1: VEXPTXTB
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
BOX EX8S1 |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
EX21BFLG |
PERS.EX21BFLG = current round |
Design Notes
Store on bEX.
Box Instructions
IF BPER.BASICAMT = DK, RF OR BPER.BASICPAY = DK OR ((BASICPAY >= BASICAMT*0.9) AND (BASICPAY <= BASICAMT*1.1)) OR (MEDICAID IS A SOURCE OF PAYMENT AND (BASICPAY >= BASICAMT*0.7) AND (BASICPAY <= BASICAMT*1.1)) OR (A WRITE-OFF WAS PREVIOUSLY REPORTED AND EX22S1 - BAS10PCT WAS ASKED THIS BP ROUND AND (BASICPAY >= BASICAMT*0.7) AND (BASICPAY <= BASICAMT*1.1)), GO TO BOX EX9S1.
ELSE GO TO EX22S1 - BAS10PCT.
Question Text
There seems to be a difference between what (FACILITY) billed between (BP START DATE) and (BP END DATE) and the payments received. The total amount billed I have entered for this billing period is (TOTAL AMOUNT BILLED FOR THIS BILLING PERIOD) and the total payments for the period are (SUM OF EX21 PAYMENTS). Why is that?
PRESS F1 FOR DEFINITION OF "MEDICAID WRITE-OFF".
Field 1: BAS10PCT
Field 1 Routing
Value |
Label |
Route |
1 |
MEDICAID WRITE-OFF/ADJUSTMENT |
BOX EX9S1 |
2 |
OTHER WRITE-OFF/ADJUSTMENT |
BOX EX9S1 |
91 |
OTHER |
EX22S1 - BAS10POS |
|
Don't Know |
BOX EX9S1 |
|
Refused |
BOX EX9S1 |
Field 2: BAS10POS
OTHER (SPECIFY)
Field 2 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
BOX EX9S1 |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
BAS10FLG |
PERS.BAS10FLG = BPER.BPERRNDC |
WRITEBAS |
If EX22S1-BAS10PCT = 1/MedicaidWriteOff or 2/OtherWriteOff, then PERS.WRITEBAS = 1/Indicated. |
Box Instructions
IF (MEDICAID IS IDENTIFIED AS A PAYMENT SOURCE AND FACILITY IS NOT MEDICAID CERTIFIED AND FACILITY HAS NEVER CONFIRMED), GO TO EX23A1S1 - EX23A1S1C.
ELSE GO TO BOX EX9AAS1.
Question Text
I
seem to have recorded some discrepant information. Earlier, I
recorded that (FACILITY) is not certified by Medicaid but I have
identified Medicaid as a payment source.
Is Medicaid
indeed paying for (SP)'s care?
IF
YES, PRESS '1' TO CONTINUE.
IF NO, BACK UP TO MAKE
APPROPRIATE CORRECTIONS.
Field 1: EX23A1S1C
Field 1 Routing
Value |
Label |
Route |
1 |
CONTINUE |
BOX EX9AAS1 |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
EXFCAID |
IF EX23A1S1 - EX23A1S1C = 1/Continue, then PERS.EXFCAID = current round |
Design Notes
Store on bEX.
Box Instructions
IF (MEDICARE IS IDENTIFIED AS A PAYMENT SOURCE AND FACILITY IS NOT MEDICARE CERTIFED AND FACILITY HAS NEVER CONFIRMED), GO TO EX23A2S1 - EX23A2S1C.
ELSE GO TO BOX EX9AS1.
Question Text
I
seem to have recorded some discrepant information. Earlier, I
recorded that (FACILITY) is not certified by Medicare but I have
identified Medicare as a payment source.
Is Medicare
indeed paying for (SP)'s care?
IF
YES, PRESS '1' TO CONTINUE.
IF NO, BACK UP TO MAKE
APPROPRIATE CORRECTIONS.
Field 1: EX23A2S1C
Field 1 Routing
Value |
Label |
Route |
1 |
CONTINUE |
BOX EX9AS1 |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
EXFCARE |
IF EX23A2S1 - EX23A3S1C = 1/Continue, then PERS.EXFCARE = current round |
Design Notes
Store on bEX.
Box Instructions
IF (THIS IS THE FIRST TIME MEDICAID IS IDENTIFIED AS A PAYMENT SOURCE FOR AN SP WHOSE MEDICAID STATUS IN THIS ROUND IS "PENDING" OR WHOSE MEDICAID NUMBER IS UNKNOWN), GO TO EX23AS1 - ECAIDNUM.
ELSE GO TO BOX EX11S1.
Question Text
Please tell me (SP)'s [(PREFERRED NAME(S) FOR MEDICAID)/MEDICAID] ID number.
Field 1: ECAIDNUM
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
EX23BS1 - ECAIDVR1 |
|
Don't Know |
BOX EX10S1 |
|
Refused |
BOX EX10S1 |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
ECAIDNM |
PERS.ECAIDNM = EX23AS1-ECAIDNUM |
Design Notes
Store on bEX.
Question Text
I'd like to verify the [(PREFERRED NAME(S) FOR MEDICAID)/MEDICAID] ID number that I have recorded. I have entered (MEDICAID ID NUMBER). Is this correct?
Field 1: ECAIDVR1
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
BOX EX10S1 |
1 |
YES |
BOX EX10S1 |
|
Don't Know |
BOX EX10S1 |
|
Refused |
BOX EX10S1 |
Other Programming Instructions
Design Notes
Store on bEX.
Box Instructions
IF EX23AS1 - ECAIDNUM = DK, RF OR EX23BS1 - ECAIDVR1 = DK, RF, GO TO EX24AS1 - EX24AS1C.
ELSE GO TO BOX EX11S1.
Variable Name |
Assignment Instructions |
EXSPCAID |
PERS.EXSPCAID = current round |
MCAIDFLG |
If PERS.ECAIDNM =
RF, then PERS.MCAIDFLG = 1/RForNWK |
Question Text
Earlier,
I recorded that (SP) was not a Medicaid recipient, but I have
identified Medicaid as a source of payment.
Is Medicaid
indeed paying for (SP)'s care?
IF
YES, PRESS '1' TO CONTINUE.
IF NO, BACK UP TO MAKE
APPROPRIATE CORRECTIONS.
Field 1: EX24AS1C
Field 1 Routing
Value |
Label |
Route |
1 |
CONTINUE |
BOX EX11S1 |
Other Programming Instructions
Design Notes
Store on bEX.
Box Instructions
IF MEDICAID IS NOT IDENTIFIED AS A PAYMENT SOURCE FOR THE CURRENT BILLING PERIOD BUT APPEARS IN THE PRECEDING BILLING PERIOD, GO TO EX25S1 - EX25S1C.
ELSE GO TO BOX EX12S1.
Question Text
It
seems that I might have made a mistake in identifying the various
sources of payment for (SP)'s care. Earlier, I recorded that
(his/her) basic charges from a previous billing period were paid by
Medicaid, and in this billing period, Medicaid is no longer a payment
source.
Is Medicaid indeed no longer paying for
(her/his) care?
IF
YES, PRESS '1' TO CONTINUE.
IF NO, BACK UP TO MAKE
APPROPRIATE CORRECTIONS.
Field 1: EX25S1C
Field 1 Routing
Value |
Label |
Route |
1 |
CONTINUE |
BOX EX12S1 |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
EXBPCAID |
IF EX25S1 - EX25S1C = 1/Continue, then EXBPCAID = 1/Indicated |
Box Instructions
IF MEDICARE IS IDENTIFIED AS A PAYMENT SOURCE AND THE AMOUNT PAID BY MEDICARE REPRESENTS LESS THAN 10 PERCENT OF THE TOTAL PAYMENTS RECEIVED FOR THE BILLING PERIOD, GO TO EX26S1 - CAREPRTB.
ELSE GO TO BOX EX14S1.
Question Text
Medicare's payment for this billing period represents less than 10 percent of the total payments for basic care. Is this Medicare payment a Part B payment?
IF NECESSARY, BACK UP TO CORRECT PAYMENTS.
Field 1: CAREPRTB
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
EX27S1 - VBPETXTE |
1 |
YES |
BOX EX14S1 |
|
Don't Know |
EX27S1 - VBPETXTE |
|
Refused |
BOX EX14S1 |
Question Text
Can you tell me why the Medicare payment is so small?
RECORD VERBATIM BELOW. IF NECESSARY, BACK UP TO CORRECT PAYMENTS.
Field 1: VBPETXTE
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
BOX EX14S1 |
Box Instructions
IF PreloadBPRO.RECDANCP = 0/No or EX17S1 – ANYANCIL = 1/Yes, GO TO EX28S1 - RECDANCP.
ELSE GO TO EX33BS1 - EXSBKCT.
Question Text
Have you received all the payments you expect to receive for (SP)'s ancillary services during the [READ BILLING PERIOD ABOVE] billing period?
Field 1: RECDANCP
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
EX33BS1 - EXSBKCT |
1 |
YES |
EX29AAS1 - ADDSOP2 |
Other Programming Instructions
Design Notes
Store on BPRO.
Question Text
Do you need to add any Source(s) of Payment for (SP)'s ancillary services for [READ BILLING PERIOD ABOVE]?
Field 1: ADDSOP2
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
EX29ACS1 - ANCRATE |
1 |
YES |
EX29ABS1 - PAYMPLN2 |
Other Programming Instructions
Report Display
Display
report above question text:
# OF BILLED DAYS:
(PreloadBPER.BILLDAYS)
TOTAL BILLED: $(TOTAL BILLED
ANCILLARY)
AMOUNT REMAINING: $(AMOUNT REMAINING
ANCILLARY)
Display Sources of Payment in the following
order:
(1 = MEDICAID)
2 = PRIVATE PAY OR SP/FAMILY
INCOME
(3 = SOCIAL SECURITY)
(5 = PRIVATE INSURANCE)
(6
= PENSION)
7 = MEDICARE
(8 = VA CONTRACT)
(9 = HMO
CONTRACT (SPECIFY))
(10 = SUPPLEMENTAL SECURITY INCOME
(SSI))
(91 = OTHER)
Display 1/MEDICAID if there is a
current or previous round Medicaid payment or PERS.INCAID = 1/Yes or
PERS.HCAIDNM <> DK, RF, EMPTY, NULL or a PAYM exists for this
BPER.
If PERS.GAPCOV = 1/Yes or PERS.LTCCOV = 1/Yes or there is
a current or previous round PRIVATE INSURANCE payment or a PAYM
exists for this BPER, then display 5/PRIVATE INSURANCE.
Display
3/SOCIAL SECURITY if there is a current or previous round SOCIAL
SECURITY payment or a PAYM exists for this BPER.
Display
6/PENSION if there is a current or previous round PENSION payment or
a PAYM exists for this BPER.
If PERS.AFHIST = 1/Yes or there
is a current or previous round VA payment or a PAYM exists for this
BPER, then display 8/VA CONTRACT.
Display PAYM.PAYMTEXT for
9/HMO CONTRACT if there is a current or previous round HMO CONTRACT
payment or a PAYM exists for this BPER.
Display 10/SUPPLEMENTAL
SECURITY INCOME (SSI) if there is a current or previous round SSI
payment or a PAYM exists for this BPER.
Display PAYM.PAYMTEXT
for each 91/Other SOP with a current or previous round PAYM record or
a PAYM exists for this BPER.
Question Text
What Source(s) of Payment do you need to add for (SP)'s ancillary services for [READ BILLING PERIOD ABOVE]?
SELECT
ALL THAT APPLY.
SEPARATE RESPONSES BY USING THE SPACEBAR.
IF
NO RESPONSES ARE AVAILABLE, BACK UP AND CORRECT YOUR RESPONSE.
Field 1: PAYMPLN2
Field 1 Routing
Value |
Label |
Route |
1 |
MEDICAID |
EX29ACS1 - ANCRATE |
2 |
PRIVATE PAY OR SP/FAMILY INCOME |
EX29ACS1 - ANCRATE |
3 |
SOCIAL SECURITY |
EX29ACS1 - ANCRATE |
4 |
SP/FAMILY INCOME |
EX29ACS1 - ANCRATE |
5 |
PRIVATE INSURANCE |
EX29ACS1 - ANCRATE |
6 |
PENSION |
EX29ACS1 - ANCRATE |
7 |
MEDICARE |
EX29ACS1 - ANCRATE |
8 |
VA CONTRACT |
EX29ACS1 - ANCRATE |
9 |
HMO CONTRACT |
EX29ABS1 - HMOOS2 |
10 |
SUPPLEMENTAL SECURITY INCOME (SSI) |
EX29ACS1 - ANCRATE |
91 |
OTHER |
EX29ABS1 - SOPOS2 |
|
Don't Know |
EX29ACS1 - ANCRATE |
|
Refused |
EX29ACS1 - ANCRATE |
Field 2: HMOOS2
HMO CONTRACT (SPECIFY)
Field 2 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
EX29ACS1 - ANCRATE |
Field 3: SOPOS2
OTHER (SPECIFY)
Field 3 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
EX29ACS1 - ANCRATE |
Other Programming Instructions
Report Display
Display
report above grid:
# OF BILLED DAYS:
(PreloadBPER.BILLDAYS)
TOTAL BILLED: $(TOTAL BILLED
ANCILLARY)
AMOUNT REMAINING: $(AMOUNT REMAINING
ANCILLARY)
Display Sources of Payment in the following
order:
(1 = MEDICAID)
2 = PRIVATE PAY OR SP/FAMILY
INCOME
(3 = SOCIAL SECURITY)
(5 = PRIVATE INSURANCE)
(6
= PENSION)
7 = MEDICARE
(8 = VA CONTRACT)
(9 = HMO
CONTRACT (SPECIFY))
(10 = SUPPLEMENTAL SECURITY INCOME
(SSI))
(91 = OTHER)
Display 1/MEDICAID if there is a
current or previous round Medicaid payment or PERS.INCAID = 1/Yes or
PERS.HCAIDNM <> DK, RF, EMPTY, NULL or a PAYM exists for this
BPER.
If PERS.GAPCOV = 1/Yes or PERS.LTCCOV = 1/Yes or there is
a current or previous round PRIVATE INSURANCE payment or a PAYM
exists for this BPER, then display 5/PRIVATE INSURANCE.
Display
3/SOCIAL SECURITY if there is a current or previous round SOCIAL
SECURITY payment or a PAYM exists for this BPER.
Display
6/PENSION if there is a current or previous round PENSION payment or
a PAYM exists for this BPER.
If PERS.AFHIST = 1/Yes or there
is a current or previous round VA payment or a PAYM exists for this
BPER, then display 8/VA CONTRACT.
Display PAYM.PAYMTEXT for
9/HMO CONTRACT if there is a current or previous round HMO CONTRACT
payment or a PAYM exists for this BPER.
Display 10/SUPPLEMENTAL
SECURITY INCOME (SSI) if there is a current or previous round SSI
payment or a PAYM exists for this BPER.
Display PAYM.PAYMTEXT
for each 91/Other SOP with a current or previous round PAYM record or
a PAYM exists for this BPER.
Question Text
What is the total amount each source paid for [READ BILLING PERIOD ABOVE]?
Field 1: ANCRATE
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
BOX EX15S1 |
|
Don't Know |
BOX EX15S1 |
|
Refused |
BOX EX15S1 |
Other Programming Instructions
Roster/Grid Instructions
Display
Sources of Payment in the following order:
(1 = MEDICAID)
2
= PRIVATE PAY OR SP/FAMILY INCOME
(3 = SOCIAL SECURITY)
(5
= PRIVATE INSURANCE)
(6 = PENSION)
7 = MEDICARE
(8 =
VA CONTRACT)
(9 = HMO CONTRACT (SPECIFY))
(10 =
SUPPLEMENTAL SECURITY INCOME (SSI))
(91 = OTHER)
Display
1/MEDICAID if there is a current or previous round Medicaid payment
or PERS.INCAID = 1/Yes or PERS.HCAIDNM <> DK, RF, EMPTY, NULL
or if added at EX29ABS1 - PAYMPLN2.
If PERS.GAPCOV = 1/Yes or
PERS.LTCCOV = 1/Yes or there is a current or previous round PRIVATE
INSURANCE payment or a PAYM exists for this BPER or if added at
EX29ABS1 - PAYMPLN2, then display 5/PRIVATE INSURANCE.
Display
3/SOCIAL SECURITY if there is a current or previous round SOCIAL
SECURITY payment or a PAYM exists for this BPER or if added at
EX29ABS1 - PAYMPLN2.
Display 6/PENSION if there is a current or
previous round PENSION payment or a PAYM exists for this BPER or if
added at EX29ABS1 - PAYMPLN2.
If PERS.AFHIST = 1/Yes or there
is a current or previous round VA payment or a PAYM exists for this
BPER or if added at EX29ABS1 - PAYMPLN2, then display 8/VA
CONTRACT.
Display PAYM.PAYMTEXT for 9/HMO CONTRACT if there is a
current or previous round HMO CONTRACT payment or a PAYM exists for
this BPER or if added at EX29ABS1 - PAYMPLN2.
Display
10/SUPPLEMENTAL SECURITY INCOME (SSI) if there is a current or
previous round SSI payment or a PAYM exists for this BPER or if added
at EX29ABS1 - PAYMPLN2.
Display PAYM.PAYMTEXT for each 91/Other
SOP with a current or previous round PAYM record or a PAYM exists for
this BPER or if added at EX29ABS1 - PAYMPLN2.
Roster/Grid Display
Column # |
Header |
Instructions |
1 |
SOP Name |
Display source of payment name. Display Only. |
2 |
SOP Payment |
ANCRATE. Input field 1. |
Report Display
Display
report above grid:
# OF BILLED DAYS:
(PreloadBPER.BILLDAYS)
TOTAL BILLED: $(TOTAL BILLED
ANCILLARY)
AMOUNT REMAINING: $(AMOUNT REMAINING ANCILLARY)
Background Variable Assignments
Calculate amount remaining by subtracting SUM OF PAYMENTS FROM TOTAL CHARGE.
Variable Name |
Assignment Instructions |
ANCILPAY |
If any PAYM for
PAYMNUM = BPERNUM has |
Design Notes
We
need to calculate ANCILPAY as each SOP is collected.
Store on
EX29ACS1-ANCRATE PAYM.
Box Instructions
IF BPER.ANCILAMT = DK, RF OR BPER.ANCILPAY = DK OR ((BPER.ANCILPAY >= BPER.ANCILAMT*0.9) AND (BPER.ANCILPAY <= BPER.ANCILAMT*1.1)) OR (MEDICAID IS A SOURCE OF PAYMENT AND (BPER.ANCILPAY >= BPER.ANCILAMT*0.7) AND (BPER.ANCILPAY <= BPER.ANCILAMT*1.1)) OR (A WRITE-OFF WAS PREVIOUSLY REPORTED AND EX30S1 - ANC10PCT WAS ASKED THIS BP ROUND AND (BPER.ANCILPAY >= BPER.ANCILAMT*0.7) AND (BPER.ANCILPAY <= BPER.ANCILAMT*1.1)), GO TO BOX EX16S1.
ELSE GO TO EX30S1 - ANC10PCT.
Question Text
There seems to be a difference between what (FACILITY) billed for ancillary services between (BP START DATE) and (BP END DATE) and the payments received. The total amount billed I have entered for [READ BILLING PERIOD ABOVE] is (TOTAL AMOUNT BILLED FOR BILLING PERIOD) and the total payments for the period are (SUM OF ANCILLARY PAYMENTS). Why is that?
PRESS F1 FOR DEFINITION OF "MEDICAID WRITE-OFF".
Field 1: ANC10PCT
Field 1 Routing
Value |
Label |
Route |
1 |
MEDICAID WRITE-OFF/ADJUSTMENT |
BOX EX16S1 |
2 |
OTHER WRITE-OFF/ADJUSTMENT |
BOX EX16S1 |
91 |
OTHER |
EX30S1 - ANC10POS |
|
Don't Know |
BOX EX16S1 |
|
Refused |
BOX EX16S1 |
Field 2: ANC10POS
OTHER (SPECIFY)
Field 2 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
BOX EX16S1 |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
ANC10FLG |
PERS.ANC10FLG = BPER.BPERRNDC |
WRITEANC |
If EX30S1-ANC10PCT = 1/MedicaidWriteOff or 2/OtherWriteOff, then PERS.WRITEANC = 1/Indicated. |
Box Instructions
(IF MEDICAID IS IDENTIFIED AS A PAYMENT SOURCE AND FACILITY IS NOT MEDICAID CERTIFIED AND FACILITY HAS NEVER CONFIRMED), GO TO EX31A1S1 - EX31A1S1C.
ELSE GO TO BOX EX16AAS1.
Question Text
I
seem to have recorded some discrepant information. Earlier, I
recorded that (FACILITY) is not certified by Medicaid but I have
identified Medicaid as a payment source.
Is Medicaid
indeed paying for (SP)'s care?
IF
YES, PRESS '1' TO CONTINUE.
IF NO, BACK UP TO MAKE
APPROPRIATE CORRECTIONS.
Field 1: EX31A1S1C
Field 1 Routing
Value |
Label |
Route |
1 |
CONTINUE |
BOX EX16AAS1 |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
EXFCAID |
IF EX31A1S1 - EX31A1S1C = 1/Continue, then PERS.EXFCAID = current round |
Design Notes
Store on bEX.
Box Instructions
IF (MEDICARE IS IDENTIFIED AS A PAYMENT SOURCE AND FACILITY IS NOT MEDICARE CERTIFED AND FACILITY HAS NEVER CONFIRMED), GO TO EX31A2S1 - EX31A2S1C.
ELSE GO TO BOX EX16AS1.
Question Text
I
seem to have recorded some discrepant information. Earlier, I
recorded that (FACILITY) is not certified by Medicare but I have
identified Medicare as a payment source.
Is Medicare
indeed paying for (SP)'s care?
IF
YES, PRESS '1' TO CONTINUE.
IF NO, BACK UP TO MAKE
APPROPRIATE CORRECTIONS.
Field 1: EX31A2S1C
Field 1 Routing
Value |
Label |
Route |
1 |
CONTINUE |
BOX EX16AS1 |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
EXFCARE |
IF EX31A2S1 - EX31A2S1C = 1/Continue, then PERS.EXFCARE = current round |
Design Notes
Store on bEX.
Box Instructions
IF (THIS IS THE FIRST TIME MEDICAID IS IDENTIFIED AS A PAYMENT SOURCE FOR AN SP WHOSE MEDICAID STATUS IN THIS ROUND IS "PENDING" OR WHOSE MEDICAID NUMBER IS UNKNOWN), GO TO EX31AS1 - ECAIDNM3.
ELSE GO TO BOX EX18S1.
Question Text
Please tell me (SP)'s [(PREFERRED NAME(S) FOR MEDICAID)/MEDICAID] ID number.
Field 1: ECAIDNM3
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
EX31BS1 - ECAIDVR2 |
|
Don't Know |
BOX EX17S1 |
|
Refused |
BOX EX17S1 |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
ECAIDNM |
PERS.ECAIDNM = EX31AS1 - ECAIDNM3 |
Design Notes
Store on bEX.
Question Text
I'd like to verify the [(PREFERRED NAME(S) FOR MEDICAID)/MEDICAID] ID number that I have recorded. I have entered (MEDICAID ID NUMBER). Is this correct?
Field 1: ECAIDVR2
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
EX31AS1 - ECAIDNM3 |
1 |
YES |
BOX EX17S1 |
|
Don't Know |
BOX EX17S1 |
|
Refused |
BOX EX17S1 |
Other Programming Instructions
Design Notes
Store on bEX.
Box Instructions
IF EX31AS1 - ECAIDNM3 = DK, RF OR EX31BS1-ECAIDVR2 = DK, RF, GO TO EX32AS1 - EX32AS1C.
ELSE GO TO BOX EX18S1.
Variable Name |
Assignment Instructions |
EXSPCAID |
PERS.EXSPCAID = current round |
MCAIDFLG |
If PERS.ECAIDNM =
RF, then PERS.MCAIDFLG = 1/RForNWK |
Question Text
Earlier,
I recorded that (SP) was not a Medicaid recipient but I have
identified Medicaid as a source of payment.
Is Medicaid
indeed paying for (SP)'s ancillaries?
IF
YES, PRESS '1' TO CONTINUE.
IF NO, BACK UP TO MAKE
APPROPRIATE CORRECTIONS.
Field 1: EX32AS1C
Field 1 Routing
Value |
Label |
Route |
1 |
CONTINUE |
BOX EX18S1 |
Other Programming Instructions
Design Notes
Store on bEX.
Box Instructions
IF
MEDICAID IS NOT IDENTIFIED AS PAYMENT SOURCE FOR
ANCILLARIES FOR
THE CURRENT BILLING PERIOD BUT APPEARS IN THE PRECEDING PERIOD, GO TO
EX33S1 - EX33S1C.
ELSE GO TO EX33BS1 - EXSBKCT.
Question Text
It
seems that I might have made a mistake in identifying the various
sources of payment for (SP)'s care. Earlier, I recorded that
(his/her) charges for ancillaries in a previous billing period were
paid by Medicaid, and in this billing period, Medicaid is no longer a
payment source.
Is Medicaid indeed no longer paying for
(his/her) ancillary services?
IF
YES, PRESS '1' TO CONTINUE.
IF NO, BACK UP TO MAKE
APPROPRIATE CORRECTIONS..
Field 1: EX33S1C
Field 1 Routing
Value |
Label |
Route |
1 |
CONTINUE |
EX33BS1 - EXSBKCT |
Question Text
THIS IS THE LAST SCREEN FOR THIS BILLING PERIOD WHERE YOU CAN BACK UP TO MAKE CORRECTIONS.
PRESS "1" TO CONTINUE.
Field 1: EXSBKCT
Field 1 Routing
Value |
Label |
Route |
1 |
CONTINUE |
BOX EX20S1 |
Box Instructions
IF THERE IS ADDITIONAL PREVIOUS ROUND DATA THAT HAS NOT BEEN ANOTHER BPER IN PreloadBPER COLLECTED, GO TO BOX EXS1A.
ELSE IF THERE IS CURRENT ROUND BILLING TO COLLECT, GO TO BOX EXSEND.
ELSE GO TO BOX EX21S1.
Box Instructions
IF PRIVATE PAY HAS NEVER BEEN REPORTED AS A SOURCE OF PAYMENT AND SP WAS COVERED BY A LONG-TERM CARE POLICY, GO TO EX34S1 - USENOLTC.
ELSE GO TO BOX EX21AS1.
Question Text
Earlier I was told that (SP) had long-term care insurance from (NAME OF FIRST LTC INSURANCE COMPANY REPORTED). Is it correct that this policy paid for none of (his/her) care?
Field 1: USENOLTC
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
EX35S1 - VEXPTXTG |
1 |
YES |
BOX EX21AS1 |
|
Don't Know |
BOX EX21AS1 |
|
Refused |
BOX EX21AS1 |
Question Text
Can you explain this to me?
RECORD VERBATIM BELOW.
Field 1: VEXPTXTG
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
BOX EX21AS1 |
Other Programming Instructions
Design Notes
Store on bEX.
Box Instructions
IF IT IS PENDING WHETHER SP HAS BEEN COVERED BY MEDICAID FROM CRIN-1 AND MEDICAID HAS NEVER BEEN REPORTED AS A SOURCE OF PAYMENT, GO TO EX35AS1 - ECAIDECO.
ELSE TO TO BOX EXSEND.
Question Text
The last time I was here, I collected information that (SP)'s [(PREFERRED NAME(S) FOR MEDICAID)/MEDICAID] eligibility status was pending. Is it still pending or has [(PREFERRED NAME(S) FOR MEDICAID)/MEDICAID] been denied?
Field 1: ECAIDECO
Field 1 Routing
Value |
Label |
Route |
1 |
STILL PENDING |
BOX EXSEND |
2 |
DENIED |
BOX EXSEND |
|
Don't Know |
BOX EXSEND |
|
Refused |
BOX EXSEND |
Box Instructions
IF THERE IS CURRENT ROUND BILLING TO COLLECT, GO TO BOX EXBEG.
ELSE GO TO BOX EXEND.
Box Instructions
GO TO EX1PRE - EX1PRECT.
Other Programming Instructions
Variable Name |
Assignment Instructions |
BPLENGTH |
If PreloadFQ.BPLENGTH <> EMPTY, NULL, then FQ.BPLENGTH = PreloadFQ.BPLENGTH |
FRSTBPER |
If PERS.FRSTBPER = EMPTY, NULL and Preload SP.FRSTBPER = EMPTY, NULL, then PERS.FRSTBPER = 001. Else if PERS.FRSTBPER <> EMPTY, NULL, then PERS.FRSTBPER = PreloadSP.FRSTBPER |
ANCNVSEP |
If FQ.ANCNVSEP = EMPTY, NULL and PreloadFQ.ANCNVSEP = 1/Indicated, then FQ.ANCNVSEP = 1/Indicated |
BPLENGOS |
If PreloadFQ.BPLENGOS <> EMPTY, NULL, then FQ.BPLENGOS = PreloadFQ.BPLENGOS |
Design Notes
Data storage for EX1PRE - FEX2 on bEX unless otherwise noted.
Question Text
This
series of questions asks about (SP)'s expenditures for room and board
and ancillary charges while a resident of (FACILITY).
[The
first few questions are about billing and sources of payment when
(he/she) first became a resident here on (FAD/RAD).]
PRESS "1" TO CONTINUE.
Field 1: EX1PRECT
Field 1 Routing
Value |
Label |
Route |
1 |
CONTINUE |
EX2 - ANYBASIC |
Question Text
The
following questions are about (SP)'s basic care between (EX REFERENCE
START DATE) and (EX REFERENCE END DATE).
Was there a
charge for (her/his) room and board and basic care between (EX
REFERENCE START DATE) and (EX REFERENCE END DATE)? Please include
any charges to (SP), (her/his) family, or a third party, such as
Medicaid, Medicare, or a legal guardian.
Field 1: ANYBASIC
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
EX3 - VEXPTXTA |
1 |
YES |
BOX EX1A |
|
Don't Know |
EX2A - EX2ANAME |
|
Refused |
EXEND - EXENDCNT |
Question Text
Please tell me the name of someone in (FACILITY) who could give me that information.
SELECT A RESPONSE BELOW OR ADD TO THE PERSON ROSTER.
Field 1: EX2ANAME
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
EXEND - EXENDCNT |
Other Programming Instructions
Report Display
.
Background Variable Assignments
Variable Name |
Assignment Instructions |
FACRNAME |
FACR.FACRNAME = EX2A-EX2ANAME |
Question Text
Why were there no charges?
IF
ANSWER IS "MEDICAID PAID", BACK UP TO EX2 AND ENTER
"1".
RECORD VERBATIM.
Field 1: VEXPTXTA
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
EXEND - EXENDCNT |
Other Programming Instructions
Design Notes
Store on bEX.
Box Instructions
If FQ.ANCNVSEP = 1/Indicated, GO TO EX5 - COMRECMM.
ELSE GO TO EX4 - ANCILSEP.
Question Text
Between (EX REFERENCE START DATE) and (EX REFERENCE END DATE), was (SP) billed separately for health-related ancillary services? (That is, were there charges for ancillary services that were not included in the basic rate?)
IF
FACILITY NEVER BILLS SEPARATELY FOR ANCILLARIES, ENTER 96.
PRESS
F1 FOR DEFINITION OF ANCILLARY SERVICES.
Field 1: ANCILSEP
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
EX5 - COMRECMM |
1 |
YES |
EX5 - COMRECMM |
96 |
NEVER BILLS SEPARATELY |
EX5 - COMRECMM |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
ANCNVSEP |
If EX4 - ANCILSEP = 96/NeverBillsSeparately, then FQ.ANCNVSEP = 1/Indicated |
Question Text
Through what date do you have complete billing records for the services provided to (SP)?
Field 1: COMRECMM
MONTH
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
EX5 - COMRECDD |
Field 2: COMRECDD
DAY
Field 2 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
EX5 - COMRECYY |
Field 3: COMRECYY
YEAR
Field 3 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
BOX EX2AA |
Box Instructions
IF BILLING PERIOD LENGTH IS UNKNOWN, GO TO EX6 - BPLENCUR.
ELSE GO TO BOX EX2AA1.
Question Text
What is the length of the (facility/home)'s billing period? Is it…
Field 1: BPLENCUR
Field 1 Routing
Value |
Label |
Route |
1 |
monthly, |
BOX EX2AA1 |
2 |
every two weeks, |
BOX EX2AA1 |
3 |
every week, or |
BOX EX2AA1 |
4 |
quarterly? |
BOX EX2AA1 |
91 |
OTHER |
EX6 - BPLNCROS |
Field 2: BPLNCROS
OTHER (SPECIFY)
Field 2 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
BOX EX2AA1 |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
BPLENGTH |
FQ.BPLENGTH = EX6-BPLENCUR |
BPLENGOS |
FQ.BPLENGOS = EX6-BPLNCROS |
Box Instructions
GO TO BOX EX2A.
Other Programming Instructions
Variable Name |
Assignment Instructions |
COMREC |
If
FQ.BPLENGTH = 1/Monthly and EX5-COMRECDD <> last day of the
month represented by EX5-COMRECMM and EX5-COMRECYY, then
PERS.COMREC = last day of month preceding EX5-COMRECMM. |
Design Notes
If bill monthly, COMREC date must cover only full calendar months.
Box Instructions
IF EX REFERENCE START DATE IS LATER THAN THE DATE FOR WHICH THE FACILITY HAS COMPLETE BILLING RECORDS FOR THE SERVICES PROVIDED TO RESIDENTS, GO TO EXEND - EXENDCNT.
ELSE GO TO EX7PRE - EX7PCNT.
Other Programming Instructions
Variable Name |
Assignment Instructions |
EXREFEND |
If PERS.EXREFEND > PERS.COMREC, then PERS.EXREFEND = PERS.COMREC |
TOTEXDAYS |
TOTEXDAYS = (PERS.EXREFEND - PERS.EXREFBEG) + 1 |
SUMDAYS |
SUMDAYS = 0 |
Design Notes
Update global display for EX REFERENCE END DATE if necessary.
Question Text
FACILITY
HAS UP-TO-DATE RECORDS THROUGH (COMPLETED RECORDS DATE)
LENGTH
OF BILLING PERIOD: (LENGTH OF BILLING PERIOD.)
START WITH
EARLIEST BILLING PERIOD.
COLLECT BILLING INFORMATION FROM
(EX REFERENCE START DATE) THROUGH (EX REFERENCE END DATE).
PRESS "1" TO CONTINUE.
Field 1: EX7PCNT
Field 1 Routing
Value |
Label |
Route |
1 |
CONTINUE |
FEX2 - BILLINFO |
Question Text
Do you prefer to report billing information for all billing periods before reporting any payment information or do you prefer to report billing and then payment information for a billing period, then billing and payment information for each remaining billing period?
Field 1: BILLINFO
Field 1 Routing
Value |
Label |
Route |
1 |
ALL BILLING AND THEN ALL PAYMENT INFORMATION |
BOX EX3AB2 |
2 |
BILLING AND PAYMENT INFORMATION BY BILLING PERIOD |
BOX EX3A |
|
Don't Know |
BOX EX3A |
|
Refused |
EXEND - EXENDCNT |
Box Instructions
GO TO EX8 - BPBEGDATE.
Other Programming Instructions
Background Variable Assignments
Create next sequential BPER and a current round BPRO.
Variable Name |
Assignment Instructions |
BPERNUM |
BPER.BPERNUM = PERS.FRSTBPER |
BPERRNDC |
BPER.BPERRNDC = current round |
BILLSTARTMM |
If FQ.BPLENGTH = 1/Monthly, then BILLSTARTMM = first/next month between EXREFBEG and EXREFEND to be collected |
BILLSTARTDD |
If FQ.BPLENGTH = 1/Monthly and BILLSTARTMM = month portion of EXREFBEG, then BILLSTARTDD = day portion of EXREFBEG. Else if FQ.BPLENGTH = 1/Monthly, then BILLSTARTDD = 01 |
BILLSTARTYY |
If FQ.BPLENGTH = 1/Monthly, then BILLSTARTYY = year of first/next month between EXREFBEG and EXREFEND to be collected |
BILLENDMM |
If FQ.BPLENGTH = 1/Monthly, then BILLENDMM = BPSTARTMM |
BILLENDDD |
If FQ.BPLENGTH =
1/Monthly and BILLENDMM = month portion of EXREFEND, then
BILLENDDD = day portion of EXREFEND. |
BILLENDYY |
If FQ.BPLENGTH = 1/Monthly, then BILLENDYY = BILLSTARTYY |
FRSTBPER |
PERS.FRSTBPER = PERS.FRSTBPER + 1 |
BPROBPER |
BPRO.BPROBPER = BPERNUM |
BPRORNDC |
BPRO.BPRORNDC = current round |
BILLSTARTDATE |
BILLSTARTDATE = BILLSTARTYY + BILLSTARTMM + BILLSTARTDD |
BILLENDDATE |
BILLENDDATE = BILLENDYY + BILLENDMM + BILLENDDD |
Design Notes
BEGIN COLLECTION OF FIRST/NEXT BILLING PERIOD DETAIL. MOST DATA STORAGE FROM EX8-EX33 WILL BE ON BPER, UNLESS OTHERWISE NOTED.
Question Text
ENTER THE START AND END DATES FOR THE (NEXT) BILLING PERIOD.
ENTER DATES IN "MM DD YY" FORMAT.
Field 1: BPBEGDATE
BP START DATE[: (BILLSTARTDATE)]
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
EX8 - BPENDDATE |
Field 2: BPENDDATE
BP END DATE[: (BILLENDDATE)]
Field 2 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
BOX EX3A2 |
Other Programming Instructions
Background Variable Assignments
RHDAYS:
If
BP begin date and BP end date fall on or between STAY begin date and
STAY end date for a STAY in the target facility and there are no DK,
RF in the STAY dates covered by the BP begin or BP end dates, then
RHDAYS = number of days the SP was in the target facility during the
billing period. Else RHDAYS = DK
Variable Name |
Assignment Instructions |
ONEBPDONE |
PERS.ONEBPDONE = 1/Indicated |
Box Instructions
GO TO EX9 - BILLDAYS.
Variable Name |
Assignment Instructions |
BPDAYS |
BPDAYS = (BPENDDATE – BPBEGDATE) + 1 |
Question Text
Between (BP START DATE) and (BP END DATE), how many days was (SP) billed for care?
PRESS F1 FOR HELP ENTERING FLAT-RATE BILLING.
Field 1: BILLDAYS
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
BOX EX3 |
Other Programming Instructions
Report Display
Column
1 Header: Days in Reference Period
Column 1: Display
RHDAYS
Column 2 Header: Billing Period Begin Date
Column
2: Display EX8 - BPBEGDATE in month, day, year format.
Column
3 Header: Billing Period End Date
Column 3: Display EX8 -
BPENDDATE in month, day, year format.
Column 4 Header:
Days in Billing Period
Column 4: Display BPDAYS.
Background Variable Assignments
Variable Name |
Assignment Instructions |
TOTBRATDAYS |
TOTBRATDAYS = 0 |
Box Instructions
IF EX9 - BILLDAYS = 0, GO TO EX33B - EXABKCT.
ELSE IF (RHDAYS = DK) OR (EX9 - BILLDAYS = RHDAYS AND (BPDAYS = EX9 - BILLDAYS OR (RHDAYS < BPDAYS))), GO TO EX11 - BRATRATE.
ELSE IF BPDAYS = RHDAYS AND RHDAYS > EX9 - BILLDAYS, GO TO EX10 - EX10CODE.
ELSE IF (BPDAYS > EX9 - BILLDAYS AND EX9 - BILLDAYS > RHDAYS) OR (BPDAYS > RHDAYS AND RHDAYS > EX9 - BILLDAYS) OR (BPDAYS = EX9 - BILLDAYS AND EX9 - BILLDAYS > RHDAYS), GO TO EX10A - EX10ACOD.
ELSE GO TO EX10 - EX10CODE.
Variable Name |
Assignment Instructions |
SUMDAYS |
If RHDAYS <>
0, DK, then SUMDAYS = SUMDAYS + RHDAYS. |
Question Text
Can you tell me why I have a discrepancy between the number of days in this billing period, that is, (DAYS IN BILLING PERIOD) and the number of days for which (SP) was billed, that is, (DAYS BILLED)?
SELECT
ALL THAT APPLY.
SEPARATE RESPONSES BY USING THE SPACEBAR.
Field 1: EX10CODE
Field 1 Routing
Value |
Label |
Route |
1 |
SP DISCHARGED TO COMMUNITY |
BOX EX3B |
2 |
SP SENT TO HOSPITAL |
BOX EX3B |
3 |
SP DECEASED |
BOX EX3B |
4 |
SP ADMITTED AFTER BP START DATE |
BOX EX3B |
5 |
SP DISCHARGED TO ANOTHER NH |
BOX EX3B |
91 |
OTHER |
EX10 - EX10OS |
|
Don't Know |
BOX EX3B |
|
Refused |
BOX EX3B |
Field 2: EX10OS
OTHER (SPECIFY)
Field 2 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
BOX EX3B |
Question Text
Earlier,
I collected information that (SP) was a resident of this
(facility/home) for (NUMBER OF DAYS SP IN ELIGIBLE FACILITY) days
during this billing period. Yet, (he/she) was billed for (DAYS
BILLED) days.
Can you tell me why I have this
discrepancy?
SELECT
ALL THAT APPLY.
SEPARATE RESPONSES BY USING THE SPACEBAR.
Field 1: EX10ACOD
Field 1 Routing
Value |
Label |
Route |
1 |
SP SENT TO HOSPITAL, BED HELD |
BOX EX3B |
2 |
SP NOT BILLED ON ADMISSION DAY |
BOX EX3B |
3 |
SP NOT BILLED ON DISCHARGE DAY |
BOX EX3B |
4 |
SP NOT BILLED ON DATE OF DEATH |
BOX EX3B |
5 |
FACILITY CHARGES FLAT-RATE BILLING |
BOX EX3B |
91 |
OTHER |
EX10A - EX10AOS |
|
Don't Know |
BOX EX3B |
|
Refused |
BOX EX3B |
Field 2: EX10AOS
OTHER (SPECIFY)
Field 2 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
BOX EX3B |
Box Instructions
GO TO EX11 - BRATRATE.
Other Programming Instructions
Background Variable Assignments
CREATE A NEW BRAT:
Variable Name |
Assignment Instructions |
BRATBPER |
BRATBPER = BPERNUM |
BRATNUM |
If no BRAT exists for this BPER then BRATNUM = 01. Else BRATNUM = next sequential number |
BRATRNDC |
BRATRNDC = current round |
Question Text
Between
(BP START DATE) and (BP END DATE), what rates were billed for (SP)'s
care? (I'll ask about billing for ancillary services
later.)
[PROBE: If more than one rate was billed, let's
start with the first rate within the billing period.]
Field 1: BRATRATE
What is the amount?
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
EX11 - BRATUNIT |
|
Don't Know |
EX11 - BRATUNIT |
|
Refused |
EX11 - BRATUNIT |
Field 2: BRATUNIT
Is that per day, per month, per quarter, or some other amount of time?
Field 2 Routing
Value |
Label |
Route |
1 |
DAY |
EX11 - BRATDAYS |
2 |
MONTH |
EX11 - BRATDAYS |
3 |
QUARTER |
EX11 - BRATDAYS |
91 |
OTHER |
EX11 - BRATUNOS |
|
Don't Know |
EX11 - BRATDAYS |
|
Refused |
EX11 - BRATDAYS |
Field 3: BRATUNOS
OTHER (SPECIFY)
Field 3 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
EX11 - BRATDAYS |
Field 4: BRATDAYS
How many days were billed at that rate?
Field 4 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
BOX EX4 |
Other Programming Instructions
Report Display
Display
report above question text.
(BP START DATE) - (BP END
DATE)
# OF BILLED DAYS: (DAYS BILLED)
DAYS YET TO BE
ACCOUNTED FOR: (DAYS YET TO BE ACCOUNTED FOR)
[TOTAL AMOUNT
BILLED: (TOTAL AMOUNT BILLED)]
Report display
instructions:
DAYS BILLED:
Display EX9 - BILLDAYS.
If
BPER.SHOTOTAM = 1, display "TOTAL AMOUNT BILLED: (TOTAL AMOUNT
BILLED)".
Else do not display.
DAYS YET TO BE
ACCOUNTED FOR:
Display (EX9 - BILLDAYS - TOTBRATDAYS).
Background Variable Assignments
Variable Name |
Assignment Instructions |
TOTBRATDAYS |
TOTBRATDAYS = TOTBRATDAYS + EX11 - BRATDAYS |
SHOTOTAM |
BPER.SHOTOTAM = 1 |
Design Notes
Implement
as an array.
Store on BRAT.
Box Instructions
IF ALL BILLED DAYS IN THE BILLING PERIOD HAVE BEEN ACCOUNTED FOR, GO TO BOX EX5.
ELSE GO TO BOX EX3B.
Box Instructions
IF SP BILLED SEPARATELY FOR ANCILLARIES, GO TO EX15PRE - EX15PRCT.
ELSE GO TO BOX EX7B.
Other Programming Instructions
Background Variable Assignments
BASICAMT:
If
any BRAT with BRATBPER = BPERNUM has BRATRATE = DK,RF or BRATUNIT =
91/Other, DK,RF, then BPER.BASICAMT = DK
Else set BPER.BASICAMT
= 0, then loop through all BRATs with BRATBPER = BPERNUM performing
the following calculations:
If BRATUNIT = 1/Days, then
BPER.BASICAMT = BPER.BASICAMT + (BRATRATE * BRATDAYS), rounded to 2
decimal places
If BRATUNIT = 2/Month, then set temp variables
calcdays = 0, nummonths = 0
nummonths = number of months
between year and month of EX8-BPBEGDATE and EX8-BPENDDATE (inclusive)
calcdays = number of calendar days in each month between year
and month of EX8-BPBEGDATE and EX8-BPENDDATE (inclusive)
If
calcdays = BRATDAYS, then BPER.BASICAMT = BPER.BASICAMT + (nummonths
* BRATRATE), rounded to 2 decimal places
Else BPER.BASICAMT =
BPER.BASICAMT + (((nummonths * BRATRATE)/calcdays) * BRATDAYS),
rounded to 2 decimal places
If BRATUNIT = 3/Quarter, then
BPER.BASICAMT = BPER.BASICAMT + ((BRATRATE/91) * BRATDAYS), rounded
to 2 decimal places.
If BRATUNIT = 91/Other, then BASICAMT =
DK.
If BPER.BASICAMT > 99999.99, then BPER.BASICAMT =
99999.99
Question Text
The
next questions are about health-related services received by (SP) for
which there was a separate charge, that is, your (facility/home)'s
ancillary services.
(Please do not include
non-health-related services such as hairdressing, television, or
telephone).
PRESS
F1 FOR EXAMPLES OF NON-HEALTH-RELATED ANCILLARIES.
PRESS
"1" TO CONTINUE.
Field 1: EX15PRCT
Field 1 Routing
Value |
Label |
Route |
1 |
CONTINUE |
EX16 - ANCLPOST |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
EX15LONG |
FACR.EX15LONG = current round |
Question Text
Have all charges for ancillaries been posted for the period from (BP START DATE) to (BP END DATE)?
Field 1: ANCLPOST
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
BOX EX7B |
1 |
YES |
EX17 - ANYANCIL |
|
Don't Know |
BOX EX7B |
|
Refused |
BOX EX7B |
Other Programming Instructions
Design Notes
Store on BPRO.
Question Text
Does (SP) have any ancillary charges between (BP START DATE) and (BP END DATE)?
Field 1: ANYANCIL
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
BOX EX7B |
1 |
YES |
EX18 - ANCILAMT |
|
Don't Know |
BOX EX7B |
|
Refused |
BOX EX7B |
Other Programming Instructions
Design Notes
Store on BPRO.
Question Text
Altogether, what was the total charge for those health-related ancillary services?
Field 1: ANCILAMT
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
BOX EX7B |
|
Don't Know |
BOX EX7B |
|
Refused |
BOX EX7B |
Box Instructions
GO TO EX20 - RECDBASP.
Question Text
Have you received all of the payments for basic care you expect to receive for (SP) during the [READ BILLING PERIOD ABOVE] billing period?
Field 1: RECDBASP
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
BOX EX14 |
1 |
YES |
EX21AA - ADDSOP1 |
Other Programming Instructions
Design Notes
Store on BPRO.
Question Text
Do you need to add any Source(s) of Payment for (SP)'s basic care for [READ BILLING PERIOD ABOVE]?
Field 1: ADDSOP1
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
EX21AC - BASRATE |
1 |
YES |
EX21AB - PAYMPLN1 |
Other Programming Instructions
Report Display
Display
report above question text:
# OF BILLED DAYS: (EX9 -
BILLDAYS)
TOTAL BILLED: $(TOTAL BILLED)
AMOUNT REMAINING:
$(AMOUNT REMAINING)
Display Sources of Payment in the
following order:
(1 = MEDICAID)
2 = PRIVATE PAY OR
SP/FAMILY INCOME
(3 = SOCIAL SECURITY)
(5 = PRIVATE
INSURANCE)
(6 = PENSION)
7 = MEDICARE
(8 = VA
CONTRACT)
(9 = HMO CONTRACT (SPECIFY))
(10 = SUPPLEMENTAL
SECURITY INCOME (SSI))
(91 = OTHER)
Display
1/MEDICAID if there is a current or previous round Medicaid payment
or PERS.INCAID = 1/Yes or PERS.HCAIDNM <> DK, RF, EMPTY,
NULL.
If PERS.GAPCOV = 1/Yes or PERS.LTCCOV = 1/Yes or there is
a current or previous round PRIVATE INSURANCE payment, then display
5/PRIVATE INSURANCE.
Display 3/SOCIAL SECURITY if there is a
current or previous round SOCIAL SECURITY payment.
Display
6/PENSION if there is a current or previous round PENSION payment.
If PERS.AFHIST = 1/Yes or there is a current or previous round
VA payment, then display 8/VA CONTRACT.
Display PAYM.PAYMTEXT
for 9/HMO CONTRACT if there is a current or previous round HMO
CONTRACT payment.
Display 10/SUPPLEMENTAL SECURITY INCOME (SSI)
if there is a current or previous round SSI payment.
Display
PAYM.PAYMTEXT for each 91/Other SOP with a current or previous round
PAYM record.
Background Variable Assignments
Variable Name |
Assignment Instructions |
PAYMBPER |
PAYM.PAYMBPER = BPER.BPERNUM |
PAYMNUM |
PAYM.PAYMNUM = number portion of each SOP displayed in EX21AA - ADDSOP1 report |
PAYMRNDC |
PAYM.PAYMRNDC = current round |
PAYMTEXT |
If PAYM.PAYMNUM = 9/HMOContract or 91/Other, then PAYM.PAYMTEXT = PAYMTEXT from most recent current or previous round PAYM |
Design Notes
"VA CONTRACT" will be displayed in the report if the respondent ever said the SP was in the Armed Forces in BQ12.
Question Text
What Source(s) of Payment do you need to add for (SP)'s basic care for [READ BILLING PERIOD ABOVE]?
SELECT
ALL THAT APPLY.
SEPARATE RESPONSES BY USING THE SPACEBAR.
IF
NO RESPONSES ARE AVAILABLE, BACK UP AND CORRECT YOUR RESPONSE.
Field 1: PAYMPLN1
Field 1 Routing
Value |
Label |
Route |
1 |
MEDICAID |
EX21AC - BASRATE |
2 |
PRIVATE PAY OR SP/FAMILY INCOME |
EX21AC - BASRATE |
3 |
SOCIAL SECURITY |
EX21AC - BASRATE |
4 |
SP/FAMILY INCOME |
EX21AC - BASRATE |
5 |
PRIVATE INSURANCE |
EX21AC - BASRATE |
6 |
PENSION |
EX21AC - BASRATE |
7 |
MEDICARE |
EX21AC - BASRATE |
8 |
VA CONTRACT |
EX21AC - BASRATE |
9 |
HMO CONTRACT |
EX21AB - HMOOS1 |
10 |
SUPPLEMENTAL SECURITY INCOME (SSI) |
EX21AC - BASRATE |
91 |
OTHER |
EX21AB - SOPOS1 |
|
Don't Know |
EX21AC - BASRATE |
|
Refused |
EX21AC - BASRATE |
Field 2: HMOOS1
HMO CONTRACT (SPECIFY)
Field 2 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
EX21AC - BASRATE |
Field 3: SOPOS1
OTHER (SPECIFY)
Field 3 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
EX21AC - BASRATE |
Other Programming Instructions
Report Display
Display
report above grid:
# OF BILLED DAYS: (EX9 - BILLDAYS)
TOTAL
BILLED: $(TOTAL BILLED)
AMOUNT REMAINING: $(AMOUNT
REMAINING)
Display Sources of Payment in the following
order:
(1 = MEDICAID)
2 = PRIVATE PAY OR SP/FAMILY
INCOME
(3 = SOCIAL SECURITY)
(5 = PRIVATE INSURANCE)
(6
= PENSION)
7 = MEDICARE
(8 = VA CONTRACT)
(9 = HMO
CONTRACT (SPECIFY))
(10 = SUPPLEMENTAL SECURITY INCOME
(SSI))
(91 = OTHER)
Display 1/MEDICAID if there is a
current or previous round Medicaid payment or PERS.INCAID = 1/Yes or
PERS.HCAIDNM <> DK, RF, EMPTY, NULL.
If PERS.GAPCOV =
1/Yes or PERS.LTCCOV = 1/Yes or there is a current or previous round
PRIVATE INSURANCE payment, then display 5/PRIVATE INSURANCE.
Display
3/SOCIAL SECURITY if there is a current or previous round SOCIAL
SECURITY payment.
Display 6/PENSION if there is a current or
previous round PENSION payment.
If PERS.AFHIST = 1/Yes or
there is a current or previous round VA payment, then display 8/VA
CONTRACT.
Display PAYM.PAYMTEXT for 9/HMO CONTRACT if there is a
current or previous round HMO CONTRACT payment.
Display
10/SUPPLEMENTAL SECURITY INCOME (SSI) if there is a current or
previous round SSI payment.
Display PAYM.PAYMTEXT for each
91/Other SOP with a current or previous round PAYM record.
Background Variable Assignments
Variable Name |
Assignment Instructions |
PAYMBPER |
PAYM.PAYMBPER = BPER.BPERNUM |
PAYMNUM |
PAYM.PAYMNUM = EX21AB - PAYMPLN1 |
PAYMRNDC |
PAYM.PAYMRNDC = current round |
PAYMTEXT |
If EX21AB-PAYMPLN1 = 9/HMOContract and PAYM.PAYMNUM = 9/HMOContract, then PAYM.PAYMTEXT = EX21AB-HMOOS1. Else if EX21AB - PAYMPLN1 = 91/Other and PAYM.PAYMNUM = 91/Other, then PAYM. PAYMTEXT = EX21AB-SOPOS1. |
Question Text
What is the total amount each source paid for [READ BILLING PERIOD ABOVE]?
Field 1: BASRATE
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
BOX EX7C |
|
Don't Know |
BOX EX7C |
|
Refused |
BOX EX7C |
Other Programming Instructions
Roster/Grid Instructions
Display
Sources of Payment in the following order:
(1 = MEDICAID)
2
= PRIVATE PAY OR SP/FAMILY INCOME
(3 = SOCIAL SECURITY)
(5
= PRIVATE INSURANCE)
(6 = PENSION)
7 = MEDICARE
(8 =
VA CONTRACT)
(9 = HMO CONTRACT (SPECIFY))
(10 =
SUPPLEMENTAL SECURITY INCOME (SSI))
(91 = OTHER)
Display
1/MEDICAID if there is a current or previous round Medicaid payment
or PERS.INCAID = 1/Yes or PERS.HCAIDNM <> DK, RF, EMPTY, NULL
or if added at EX21AB - PAYMPLN1.
If PERS.GAPCOV = 1/Yes or
PERS.LTCCOV = 1/Yes or there is a current or previous round PRIVATE
INSURANCE payment, or if added at EX21AB - PAYMPLN1, then display
5/PRIVATE INSURANCE.
Display 3/SOCIAL SECURITY if there is a
current or previous round SOCIAL SECURITY payment or if added at
EX21AB - PAYMPLN1.
Display 6/PENSION if there is a current or
previous round PENSION payment or if added at EX21AB - PAYMPLN1.
If
PERS.AFHIST = 1/Yes or there is a current or previous round VA
payment or if added at EX21AB - PAYMPLN1, then display 8/VA
CONTRACT.
Display PAYM.PAYMTEXT for 9/HMO CONTRACT if there is a
current or previous round HMO CONTRACT payment or if added at EX21AB
- PAYMPLN1.
Display 10/SUPPLEMENTAL SECURITY INCOME (SSI) if
there is a current or previous round SSI payment or if added at
EX21AB - PAYMPLN1.
Display PAYM.PAYMTEXT for each 91/Other SOP
with a current or previous round PAYM record or if added at EX21AB -
PAYMPLN1.
Roster/Grid Display
Column # |
Header |
Instructions |
1 |
SOP Name |
Display source of payment name. Display Only. |
2 |
SOP Payment |
BASRATE. Input field 1. |
Report Display
Display
report above grid:
# OF BILLED DAYS: (EX9 - BILLDAYS)
TOTAL
BILLED: $(TOTAL BILLED)
AMOUNT REMAINING: $(AMOUNT REMAINING)
Background Variable Assignments
Variable Name |
Assignment Instructions |
BASICPAY |
If any PAYM for PAYMNUM = BPERNUM has BASRATE = DK, RF, then BPER.BASICPAY = DK. Else BPER.BASICPAY = sum of all PAYM.BASRATE for PAYMNUM = BPERNUM |
Design Notes
We
need to calculate BASICPAY as each SOP is collected.
Store on
EX21AC-BASRATE PAYM.
Box Instructions
IF MEDICARE IS IDENTIFIED AS A SOURCE OF PAYMENT FOR BASIC CARE AND THERE IS NO STAY IN A HOSPITAL BETWEEN (BP START DATE - 60 DAYS) AND (BP END DATE + 60 DAYS) AND THIS WAS NOT EXPLAINED THIS ROUND, GO TO EX21B - VEXPTXTB.
ELSE GO TO BOX EX8.
Question Text
Medicare
has been reported as a payment source for basic care for (SP) for
[READ BILLING PERIOD ABOVE], but I have not recorded any preceding
hospital stays for (him/her).
Please tell me why Medicare
paid for (SP) during this billing period.
RECORD
VERBATIM BELOW. IF NECESSARY, BACK UP TO CORRECT.
IF
HOSPITAL STAY IS REPORTED, RECORD DATES OF STAY BELOW.
Field 1: VEXPTXTB
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
BOX EX8 |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
EX21BFLG |
PERS.EX21BFLG = current round |
Design Notes
Store on bEX.
Box Instructions
IF BPER.BASICAMT = DK, RF OR BPER.BASICPAY = DK OR ((BASICPAY >= BASICAMT*0.9) AND (BASICPAY <= BASICAMT*1.1)) OR (MEDICAID IS A SOURCE OF PAYMENT AND (BASICPAY >= BASICAMT*0.7) AND (BASICPAY <= BASICAMT*1.1)) OR (A WRITE-OFF WAS PREVIOUSLY REPORTED AND EX22 - BAS10PCT WAS ASKED THIS ROUND AND (BASICPAY >= BASICAMT*0.7) AND (BASICPAY <= BASICAMT*1.1)), GO TO BOX EX9.
ELSE GO TO EX22 - BAS10PCT.
Question Text
There seems to be a difference between what (FACILITY) billed between (BP START DATE) and (BP END DATE) and the payments received. The total amount billed I have entered for this billing period is (TOTAL AMOUNT BILLED FOR THIS BILLING PERIOD) and the total payments for the period are (SUM OF EX21 PAYMENTS). Why is that?
PRESS F1 FOR DEFINITION OF "MEDICAID WRITE-OFF".
Field 1: BAS10PCT
Field 1 Routing
Value |
Label |
Route |
1 |
MEDICAID WRITE-OFF/ADJUSTMENT |
BOX EX9 |
2 |
OTHER WRITE-OFF/ADJUSTMENT |
BOX EX9 |
91 |
OTHER |
EX22 - BAS10POS |
|
Don't Know |
BOX EX9 |
|
Refused |
BOX EX9 |
Field 2: BAS10POS
OTHER (SPECIFY)
Field 2 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
BOX EX9 |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
BAS10FLG |
PERS.BAS10FLG = BPER.BPERRNDC |
WRITEBAS |
If EX22-BAS10PCT = 1/MedicaidWriteOff or 2/OtherWriteOff, then PERS.WRITEBAS = 1/Indicated. |
Box Instructions
IF (MEDICAID IS IDENTIFIED AS A PAYMENT SOURCE AND FACILITY IS NOT MEDICAID CERTIFIED AND FACILITY HAS NEVER CONFIRMED), GO TO EX23A1 - EX23A1C.
ELSE GO TO BOX EX9AA.
Question Text
I
seem to have recorded some discrepant information. Earlier, I
recorded that (FACILITY) is not certified by Medicaid but I have
identified Medicaid as a payment source.
Is Medicaid
indeed paying for (SP)'s care?
IF
YES, PRESS '1' TO CONTINUE.
IF NO, BACK UP TO MAKE
APPROPRIATE CORRECTIONS.
Field 1: EX23A1C
Field 1 Routing
Value |
Label |
Route |
1 |
CONTINUE |
BOX EX9AA |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
EXFCAID |
IF EX23A1 - EX23A1C = 1/Continue, then PERS.EXFCAID = current round |
Design Notes
Store on bEX.
Box Instructions
IF (MEDICARE IS IDENTIFIED AS A PAYMENT SOURCE AND FACILITY IS NOT MEDICARE CERTIFED AND FACILITY HAS NEVER CONFIRMED), GO TO EX23A2 - EX23A2C.
ELSE GO TO BOX EX9A.
Question Text
I
seem to have recorded some discrepant information. Earlier, I
recorded that (FACILITY) is not certified by Medicare but I have
identified Medicare as a payment source.
Is Medicare
indeed paying for (SP)'s care?
IF
YES, PRESS '1' TO CONTINUE.
IF NO, BACK UP TO MAKE
APPROPRIATE CORRECTIONS.
Field 1: EX23A2C
Field 1 Routing
Value |
Label |
Route |
1 |
CONTINUE |
BOX EX9A |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
EXFCARE |
IF EX23A2 - EX23A2C = 1/Continue, then PERS.EXFCARE = current round |
Design Notes
Store on bEX.
Box Instructions
IF (THIS IS THE FIRST TIME MEDICAID IS IDENTIFIED AS A PAYMENT SOURCE FOR AN SP WHOSE MEDICAID STATUS IN THIS ROUND IS "PENDING" OR WHOSE MEDICAID NUMBER IS UNKNOWN), GO TO EX23A - ECAIDNUM.
ELSE GO TO BOX EX11.
Question Text
Please tell me (SP)'s [(PREFERRED NAME(S) FOR MEDICAID)/MEDICAID] ID number.
Field 1: ECAIDNUM
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
EX23B - ECAIDVR1 |
|
Don't Know |
BOX EX10 |
|
Refused |
BOX EX10 |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
ECAIDNM |
PERS.ECAIDNM = EX23A-ECAIDNUM |
Design Notes
Store on bEX.
Question Text
I'd like to verify the [(PREFERRED NAME(S) FOR MEDICAID)/MEDICAID] ID number that I have recorded. I have entered (MEDICAID ID NUMBER). Is this correct?
Field 1: ECAIDVR1
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
BOX EX10 |
1 |
YES |
BOX EX10 |
|
Don't Know |
BOX EX10 |
|
Refused |
BOX EX10 |
Other Programming Instructions
Design Notes
Store on bEX.
Box Instructions
IF EX23A - ECAIDNUM = DK, RF OR EX23B - ECAIDVR1 = DK, RF, GO TO EX24A - EX24AC.
ELSE GO TO BOX EX11.
Variable Name |
Assignment Instructions |
EXSPCAID |
PERS.EXSPCAID = current round |
MCAIDFLG |
If PERS.ECAIDNM =
RF, then PERS.MCAIDFLG = 1/RForNWK |
Question Text
Earlier,
I recorded that (SP) was not a Medicaid recipient, but I have
identified Medicaid as a source of payment.
Is Medicaid
indeed paying for (SP)'s care?
IF
YES, PRESS '1' TO CONTINUE.
IF NO, BACK UP TO MAKE
APPROPRIATE CORRECTIONS.
Field 1: EX24AC
Field 1 Routing
Value |
Label |
Route |
1 |
CONTINUE |
BOX EX11 |
Other Programming Instructions
Design Notes
Store on bEX.
Box Instructions
IF MEDICAID IS NOT IDENTIFIED AS A PAYMENT SOURCE FOR THE CURRENT BILLING PERIOD BUT APPEARS IN THE PRECEDING BILLING PERIOD, GO TO EX25 - EX25C.
ELSE GO TO BOX EX12.
Question Text
It
seems that I might have made a mistake in identifying the various
sources of payment for (SP)'s care. Earlier, I recorded that
(his/her) basic charges from a previous billing period were paid by
Medicaid, and in this billing period, Medicaid is no longer a payment
source.
Is Medicaid indeed no longer paying for
(her/his) care?
IF
YES, PRESS '1' TO CONTINUE.
IF NO, BACK UP TO MAKE
APPROPRIATE CORRECTIONS.
Field 1: EX25C
Field 1 Routing
Value |
Label |
Route |
1 |
CONTINUE |
BOX EX12 |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
EXBPCAID |
IF EX25 - EX25C = 1/Continue, then EXBPCAID = 1/Indicated |
Box Instructions
IF MEDICARE IS IDENTIFIED AS A PAYMENT SOURCE AND THE AMOUNT PAID BY MEDICARE REPRESENTS LESS THAN 10 PERCENT OF THE TOTAL PAYMENTS RECEIVED FOR THE BILLING PERIOD, GO TO EX26 - CAREPRTB.
ELSE GO TO BOX EX14.
Question Text
Medicare's payment for this billing period represents less than 10 percent of the total payments for basic care. Is this Medicare payment a Part B payment?
IF NECESSARY, BACK UP TO CORRECT PAYMENTS.
Field 1: CAREPRTB
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
EX27 - VBPETXTE |
1 |
YES |
BOX EX14 |
|
Don't Know |
EX27 - VBPETXTE |
|
Refused |
BOX EX14 |
Question Text
Can you tell me why the Medicare payment is so small?
RECORD VERBATIM BELOW. IF NECESSARY, BACK UP TO CORRECT PAYMENTS.
Field 1: VBPETXTE
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
BOX EX14 |
Box Instructions
IF SP HAS ANY ANCILLARY CHARGES BETWEEN THE BILLING PERIOD START DATE AND THE BILLING PERIOD END DATE, GO TO EX28 - RECDANCP.
ELSE GO TO EX33B - EXABKCT.
Question Text
Have you received all the payments you expect to receive for (SP)'s ancillary services during the [READ BILLING PERIOD ABOVE] billing period?
Field 1: RECDANCP
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
EX33B - EXABKCT |
1 |
YES |
EX29AA - ADDSOP2 |
Other Programming Instructions
Design Notes
Store on BPRO.
Question Text
Do you need to add any Source(s) of Payment for (SP)'s ancillary services for [READ BILLING PERIOD ABOVE]?
Field 1: ADDSOP2
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
EX29AC - ANCRATE |
1 |
YES |
EX29AB - PAYMPLN2 |
Other Programming Instructions
Report Display
Display
report above question text:
# OF BILLED DAYS: (EX9 -
BILLDAYS)
TOTAL BILLED: $(TOTAL BILLED ANCILLARY)
AMOUNT
REMAINING: $(AMOUNT REMAINING ANCILLARY)
Display Sources
of Payment in the following order:
(1 = MEDICAID)
2 =
PRIVATE PAY OR SP/FAMILY INCOME
(3 = SOCIAL SECURITY)
(5 =
PRIVATE INSURANCE)
(6 = PENSION)
7 = MEDICARE
(8 = VA
CONTRACT)
(9 = HMO CONTRACT (SPECIFY))
(10 = SUPPLEMENTAL
SECURITY INCOME (SSI))
(91 = OTHER)
Display
1/MEDICAID if there is a current or previous round Medicaid payment
or PERS.INCAID = 1/Yes or PERS.HCAIDNM <> DK, RF, EMPTY, NULL
or a PAYM exists for this BPER.
If PERS.GAPCOV = 1/Yes or
PERS.LTCCOV = 1/Yes or there is a current or previous round PRIVATE
INSURANCE payment or a PAYM exists for this BPER, then display
5/PRIVATE INSURANCE.
Display 3/SOCIAL SECURITY if there is a
current or previous round SOCIAL SECURITY payment or a PAYM exists
for this BPER.
Display 6/PENSION if there is a current or
previous round PENSION payment or a PAYM exists for this BPER.
If
PERS.AFHIST = 1/Yes or there is a current or previous round VA
payment or a PAYM exists for this BPER, then display 8/VA
CONTRACT.
Display PAYM.PAYMTEXT for 9/HMO CONTRACT if there is a
current or previous round HMO CONTRACT payment or a PAYM exists for
this BPER.
Display 10/SUPPLEMENTAL SECURITY INCOME (SSI) if
there is a current or previous round SSI payment or a PAYM exists for
this BPER.
Display PAYM.PAYMTEXT for each 91/Other SOP with a
current or previous round PAYM record or a PAYM exists for this BPER.
Question Text
What Source(s) of Payment do you need to add for (SP)'s ancillary services for [READ BILLING PERIOD ABOVE]?
SELECT
ALL THAT APPLY.
SEPARATE RESPONSES BY USING THE SPACEBAR.
IF
NO RESPONSES ARE AVAILABLE, BACK UP AND CORRECT YOUR RESPONSE.
Field 1: PAYMPLN2
Field 1 Routing
Value |
Label |
Route |
1 |
MEDICAID |
EX29AC - ANCRATE |
2 |
PRIVATE PAY OR SP/FAMILY INCOME |
EX29AC - ANCRATE |
3 |
SOCIAL SECURITY |
EX29AC - ANCRATE |
4 |
SP/FAMILY INCOME |
EX29AC - ANCRATE |
5 |
PRIVATE INSURANCE |
EX29AC - ANCRATE |
6 |
PENSION |
EX29AC - ANCRATE |
7 |
MEDICARE |
EX29AC - ANCRATE |
8 |
VA CONTRACT |
EX29AC - ANCRATE |
9 |
HMO CONTRACT |
EX29AB - HMOOS2 |
10 |
SUPPLEMENTAL SECURITY INCOME (SSI) |
EX29AC - ANCRATE |
91 |
OTHER |
EX29AB - SOPOS2 |
|
Don't Know |
EX29AC - ANCRATE |
|
Refused |
EX29AC - ANCRATE |
Field 2: HMOOS2
HMO CONTRACT (SPECIFY)
Field 2 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
EX29AC - ANCRATE |
Field 3: SOPOS2
OTHER (SPECIFY)
Field 3 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
EX29AC - ANCRATE |
Other Programming Instructions
Report Display
Display
report above grid:
# OF BILLED DAYS: (EX9 - BILLDAYS)
TOTAL
BILLED: $(TOTAL BILLED ANCILLARY)
AMOUNT REMAINING: $(AMOUNT
REMAINING ANCILLARY)
Display Sources of Payment in the
following order:
(1 = MEDICAID)
2 = PRIVATE PAY OR
SP/FAMILY INCOME
(3 = SOCIAL SECURITY)
(5 = PRIVATE
INSURANCE)
(6 = PENSION)
7 = MEDICARE
(8 = VA
CONTRACT)
(9 = HMO CONTRACT (SPECIFY))
(10 = SUPPLEMENTAL
SECURITY INCOME (SSI))
(91 = OTHER)
Display
1/MEDICAID if there is a current or previous round Medicaid payment
or PERS.INCAID = 1/Yes or PERS.HCAIDNM <> DK, RF, EMPTY, NULL
or a PAYM exists for this BPER.
If PERS.GAPCOV = 1/Yes or
PERS.LTCCOV = 1/Yes or there is a current or previous round PRIVATE
INSURANCE payment or a PAYM exists for this BPER, then display
5/PRIVATE INSURANCE.
Display 3/SOCIAL SECURITY if there is a
current or previous round SOCIAL SECURITY payment or a PAYM exists
for this BPER.
Display 6/PENSION if there is a current or
previous round PENSION payment or a PAYM exists for this BPER.
If
PERS.AFHIST = 1/Yes or there is a current or previous round VA
payment or a PAYM exists for this BPER, then display 8/VA
CONTRACT.
Display PAYM.PAYMTEXT for 9/HMO CONTRACT if there is a
current or previous round HMO CONTRACT payment or a PAYM exists for
this BPER.
Display 10/SUPPLEMENTAL SECURITY INCOME (SSI) if
there is a current or previous round SSI payment or a PAYM exists for
this BPER.
Display PAYM.PAYMTEXT for each 91/Other SOP with a
current or previous round PAYM record or a PAYM exists for this BPER.
Question Text
What is the total amount each source paid for [READ BILLING PERIOD ABOVE]?
Field 1: ANCRATE
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
BOX EX15 |
|
Don't Know |
BOX EX15 |
|
Refused |
BOX EX15 |
Other Programming Instructions
Roster/Grid Instructions
Display
Sources of Payment in the following order:
(1 = MEDICAID)
2
= PRIVATE PAY OR SP/FAMILY INCOME
(3 = SOCIAL SECURITY)
(5
= PRIVATE INSURANCE)
(6 = PENSION)
7 = MEDICARE
(8 =
VA CONTRACT)
(9 = HMO CONTRACT (SPECIFY))
(10 =
SUPPLEMENTAL SECURITY INCOME (SSI))
(91 = OTHER)
Display
1/MEDICAID if there is a current or previous round Medicaid payment
or PERS.INCAID = 1/Yes or PERS.HCAIDNM <> DK, RF, EMPTY, NULL
or if added at EX29AB - PAYMPLN2.
If PERS.GAPCOV = 1/Yes or
PERS.LTCCOV = 1/Yes or there is a current or previous round PRIVATE
INSURANCE payment or a PAYM exists for this BPER or if added at
EX29AB - PAYMPLN2, then display 5/PRIVATE INSURANCE.
Display
3/SOCIAL SECURITY if there is a current or previous round SOCIAL
SECURITY payment or a PAYM exists for this BPER or if added at EX29AB
- PAYMPLN2.
Display 6/PENSION if there is a current or previous
round PENSION payment or a PAYM exists for this BPER or if added at
EX29AB - PAYMPLN2.
If PERS.AFHIST = 1/Yes or there is a
current or previous round VA payment or a PAYM exists for this BPER
or if added at EX29AB - PAYMPLN2, then display 8/VA CONTRACT.
Display
PAYM.PAYMTEXT for 9/HMO CONTRACT if there is a current or previous
round HMO CONTRACT payment or a PAYM exists for this BPER or if added
at EX29AB - PAYMPLN2.
Display 10/SUPPLEMENTAL SECURITY INCOME
(SSI) if there is a current or previous round SSI payment or a PAYM
exists for this BPER or if added at EX29AB - PAYMPLN2.
Display
PAYM.PAYMTEXT for each 91/Other SOP with a current or previous round
PAYM record or a PAYM exists for this BPER or if added at EX29AB -
PAYMPLN2.
Roster/Grid Display
Column # |
Header |
Instructions |
1 |
SOP Name |
Display source of payment name. Display Only. |
2 |
SOP Payment |
ANCRATE. Input field 1. |
Report Display
Display
report above grid:
# OF BILLED DAYS: (EX9 - BILLDAYS)
TOTAL
BILLED: $(TOTAL BILLED ANCILLARY)
AMOUNT REMAINING: $(AMOUNT
REMAINING ANCILLARY)
Background Variable Assignments
Calculate amount remaining by subtracting SUM OF PAYMENTS FROM TOTAL CHARGE.
Variable Name |
Assignment Instructions |
ANCILPAY |
If any PAYM for
PAYMNUM = BPERNUM has |
Design Notes
We
need to calculate ANCILPAY as each SOP is collected.
Store on
EX29AC-ANCRATE PAYM.
Box Instructions
IF EX18 - ANCILAMT = DK, RF OR BPER.ANCILPAY = DK OR ((BPER.ANCILPAY >= EX18 - ANCILAMT*0.9) AND (BPER.ANCILPAY <= EX18 - ANCILAMT*1.1)) OR (MEDICAID IS A SOURCE OF PAYMENT AND (BPER.ANCILPAY >= EX18 - ANCILAMT*0.7) AND (BPER.ANCILPAY <= EX18 - ANCILAMT*1.1)) OR (A WRITE-OFF WAS PREVIOUSLY REPORTED AND EX30 - ANC10PCT WAS ASKED THIS BP ROUND AND (BPER.ANCILPAY >= EX18 - ANCILAMT*0.7) AND (BPER.ANCILPAY <= EX18 - ANCILAMT*1.1)), GO TO BOX EX16.
ELSE GO TO EX30 - ANC10PCT.
Question Text
There seems to be a difference between what (FACILITY) billed for ancillary services between (BP START DATE) and (BP END DATE) and the payments received. The total amount billed I have entered for [READ BILLING PERIOD ABOVE] is (TOTAL AMOUNT BILLED FOR BILLING PERIOD) and the total payments for the period are (SUM OF ANCILLARY PAYMENTS). Why is that?
PRESS F1 FOR DEFINITION OF "MEDICAID WRITE-OFF".
Field 1: ANC10PCT
Field 1 Routing
Value |
Label |
Route |
1 |
MEDICAID WRITE-OFF/ADJUSTMENT |
BOX EX16 |
2 |
OTHER WRITE-OFF/ADJUSTMENT |
BOX EX16 |
91 |
OTHER |
EX30 - ANC10POS |
|
Don't Know |
BOX EX16 |
|
Refused |
BOX EX16 |
Field 2: ANC10POS
OTHER (SPECIFY)
Field 2 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
BOX EX16 |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
ANC10FLG |
PERS.ANC10FLG = current round |
WRITEANC |
If EX30-ANC10PCT = 1/MedicaidWriteOff or 2/OtherWriteOff, then PERS.WRITEANC = 1/Indicated. |
Box Instructions
IF (MEDICAID IS IDENTIFIED AS A PAYMENT SOURCE AND FACILITY IS NOT MEDICAID CERTIFIED AND FACILITY HAS NEVER CONFIRMED), GO TO EX31A1 - EX31A1C.
ELSE GO TO BOX EX16AA.
Question Text
I
seem to have recorded some discrepant information. Earlier, I
recorded that (FACILITY) is not certified by Medicaid but I have
identified Medicaid as a payment source.
Is Medicaid
indeed paying for (SP)'s care?
IF
YES, PRESS '1' TO CONTINUE.
IF NO, BACK UP TO MAKE
APPROPRIATE CORRECTIONS.
Field 1: EX31A1C
Field 1 Routing
Value |
Label |
Route |
1 |
CONTINUE |
BOX EX16AA |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
EXFCAID |
IF EX31A1 - EX31A1C = 1/Continue, then PERS.EXFCAID = current round |
Design Notes
Store on bEX.
Box Instructions
IF (MEDICARE IS IDENTIFIED AS A PAYMENT SOURCE AND FACILITY IS NOT MEDICARE CERTIFED AND FACILITY HAS NEVER CONFIRMED), GO TO EX31A2 - EX31A2C.
ELSE GO TO BOX EX16A.
Question Text
I
seem to have recorded some discrepant information. Earlier, I
recorded that (FACILITY) is not certified by Medicare but I have
identified Medicare as a payment source.
Is Medicare
indeed paying for (SP)'s care?
IF
YES, PRESS '1' TO CONTINUE.
IF NO, BACK UP TO MAKE
APPROPRIATE CORRECTIONS.
Field 1: EX31A2C
Field 1 Routing
Value |
Label |
Route |
1 |
CONTINUE |
BOX EX16A |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
EXFCARE |
IF EX31A2 - EX31A2C = 1/Continue, then PERS.EXFCARE = current round |
Design Notes
Store on bEX.
Box Instructions
IF (THIS IS THE FIRST TIME MEDICAID IS IDENTIFIED AS A PAYMENT SOURCE FOR AN SP WHOSE MEDICAID STATUS IN THIS ROUND IS "PENDING" OR WHOSE MEDICAID NUMBER IS UNKNOWN), GO TO EX31A - ECAIDNM3.
ELSE GO TO BOX EX18.
Question Text
Please tell me (SP)'s [(PREFERRED NAME(S) FOR MEDICAID)/MEDICAID] ID number.
Field 1: ECAIDNM3
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
EX31B - ECAIDVR2 |
|
Don't Know |
BOX EX17 |
|
Refused |
BOX EX17 |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
ECAIDNM |
PERS.ECAIDNM = EX31A - ECAIDNM3 |
Design Notes
Store on bEX.
Question Text
I'd like to verify the [(PREFERRED NAME(S) FOR MEDICAID)/MEDICAID] ID number that I have recorded. I have entered (MEDICAID ID NUMBER). Is this correct?
Field 1: ECAIDVR2
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
BOX EX17 |
1 |
YES |
BOX EX17 |
|
Don't Know |
BOX EX17 |
|
Refused |
BOX EX17 |
Other Programming Instructions
Design Notes
Store on bEX.
Box Instructions
IF EX31A - ECAIDNM3 = DK, RF OR EX31B - ECAIDVR2 = DK, RF, GO TO EX32A - EX32AC.
ELSE GO TO BOX EX18.
Variable Name |
Assignment Instructions |
MCAIDFLG |
If PERS.ECAIDNM =
RF, then PERS.MCAIDFLG = 1/RForNWK |
EXSPCAID |
PERS.EXSPCAID = current round |
Question Text
Earlier,
I recorded that (SP) was not a Medicaid recipient but I have
identified Medicaid as a source of payment.
Is Medicaid
indeed paying for (SP)'s ancillaries?
IF
YES, PRESS '1' TO CONTINUE.
IF NO, BACK UP TO MAKE
APPROPRIATE CORRECTIONS.
Field 1: EX32AC
Field 1 Routing
Value |
Label |
Route |
1 |
CONTINUE |
BOX EX18 |
Other Programming Instructions
Design Notes
Store on bEX.
Box Instructions
IF MEDICAID IS NOT IDENTIFIED AS PAYMENT SOURCE FOR ANCILLARIES FOR THE CURRENT BILLING PERIOD BUT APPEARS IN THE PRECEDING PERIOD (INCLUDING IF THE BILLING PERIOD OCCURRED IN THE PREVIOUS ROUND), GO TO EX33 - EX33C.
ELSE GO TO EX33B - EXABKCT.
Question Text
It
seems that I might have made a mistake in identifying the various
sources of payment for (SP)'s care. Earlier, I recorded that
(his/her) charges for ancillaries in a previous billing period were
paid by Medicaid, and in this billing period, Medicaid is no longer a
payment source.
Is Medicaid indeed no longer paying for
(his/her) ancillary services?
IF
YES, PRESS '1' TO CONTINUE.
IF NO, BACK UP TO MAKE
APPROPRIATE CORRECTIONS.
Field 1: EX33C
Field 1 Routing
Value |
Label |
Route |
1 |
CONTINUE |
EX33B - EXABKCT |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
EXBPCAID |
IF EX33 - EX33C = 1/Continue, then EXBPCAID = 1/Indicated |
Question Text
THIS IS THE LAST SCREEN FOR THIS BILLING PERIOD WHERE YOU CAN BACK UP TO MAKE CORRECTIONS.
PRESS "1" TO CONTINUE.
Field 1: EXABKCT
Field 1 Routing
Value |
Label |
Route |
1 |
CONTINUE |
BOX EX20 |
Box Instructions
IF AMOUNTS BILLED FOR ALL BILLING PERIODS HAVE NOT BEEN COLLECTED, GO TO BOX EX3A.
ELSE GO TO BOX EX21.
Box Instructions
IF PRIVATE PAY HAS NEVER BEEN REPORTED AS A SOURCE OF PAYMENT AND SP WAS COVERED BY A LONG-TERM CARE POLICY, GO TO EX34 - USENOLTC.
ELSE GO TO BOX EX21A.
Question Text
Earlier I was told that (SP) had long-term care insurance from (NAME OF FIRST LTC INSURANCE COMPANY REPORTED). Is it correct that this policy paid for none of (his/her) care?
Field 1: USENOLTC
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
EX35 - VEXPTXTG |
1 |
YES |
BOX EX21A |
|
Don't Know |
BOX EX21A |
|
Refused |
BOX EX21A |
Question Text
Can you explain this to me?
RECORD VERBATIM BELOW.
Field 1: VEXPTXTG
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
BOX EX21A |
Other Programming Instructions
Design Notes
Store on bEX.
Box Instructions
IF IT IS PENDING WHETHER SP HAS BEEN COVERED BY MEDICAID FROM CRIN-1 AND MEDICAID HAS NEVER BEEN REPORTED AS A SOURCE OF PAYMENT, GO TO EX35A - ECAIDECO.
ELSE GO TO EXEND - EXENDCNT.
Question Text
The last time I was here, I collected information that (SP)'s [(PREFERRED NAME(S) FOR MEDICAID)/MEDICAID] eligibility status was pending. Is it still pending or has [(PREFERRED NAME(S) FOR MEDICAID)/MEDICAID] been denied?
Field 1: ECAIDECO
Field 1 Routing
Value |
Label |
Route |
1 |
STILL PENDING |
EXEND - EXENDCNT |
2 |
DENIED |
EXEND - EXENDCNT |
|
Don't Know |
EXEND - EXENDCNT |
|
Refused |
EXEND - EXENDCNT |
Box Instructions
GO TO EX8B2 - BPBEGDATE.
Other Programming Instructions
Background Variable Assignments
Create next sequential BPER and a current round BPRO.
Variable Name |
Assignment Instructions |
BPERNUM |
BPER.BPERNUM = PERS.FRSTBPER |
BPERRNDC |
BPER.BPERRNDC = current round |
BILLSTARTMM |
If FQ.BPLENGTH = 1/Monthly, then BILLSTARTMM = first/next month between EXREFBEG and EXREFEND to be collected. |
BILLSTARTDD |
If FQ.BPLENGTH = 1/Monthly and BILLSTARTMM = month portion of EXREFBEG, then BILLSTARTDD = day portion of EXREFBEG. Else if FQ.BPLENGTH = 1/Monthly, then BILLSTARTDD = 01 |
BILLSTARTYY |
If FQ.BPLENGTH = 1/Monthly, then BILLSTARTYY = year of first/next month between EXREFBEG and EXREFEND to be collected. |
BILLENDMM |
If FQ.BPLENGTH = 1/Monthly, then BILLENDMM = BPSTARTMM. |
BILLENDDD |
If FQ.BPLENGTH =
1/Monthly and BILLENDMM = month portion of EXREFEND, then
BILLENDDD = day portion of EXREFEND. |
BILLENDYY |
If FQ.BPLENGTH = 1/Monthly, then BILLENDYY = BILLSTARTYY. |
FRSTBPER |
PERS.FRSTBPER = PERS.FRSTBPER + 1. |
BPROBPER |
BPRO.BPROBPER = BPERNUM |
BPRORNDC |
BPRO.BPRORNDC = current round |
BILLSTARTDATE |
BILLSTARTDATE = BILLSTARTYY + BILLSTARTMM + BILLSTARTDD |
BILLENDDATE |
BILLENDDATE = BILLENDYY + BILLENDMM + BILLENDDD |
Design Notes
BEGIN COLLECTION OF FIRST/NEXT BILLING PERIOD DETAIL. MOST DATA STORAGE FROM EX8 - EX33 WILL BE ON BPER, UNLESS OTHERWISE NOTED.
Question Text
ENTER THE START AND END DATES FOR THE (NEXT) BILLING PERIOD.
Field 1: BPBEGDATE
BP START DATE[: (BILLSTARTDATE)]
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
EX8B2 - BPENDDATE |
Field 2: BPENDDATE
BP END DATE[: (BILLENDDATE)]
Field 2 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
BOX EX3A2B2 |
Other Programming Instructions
Background Variable Assignments
RHDAYS:
If
BP begin date and BP end date fall on or between STAY begin date and
STAY end date for a STAY in the target facility and there are no DK,
RF in the STAY dates covered by the BP begin or BP end dates, then
RHDAYS = number of days the SP was in the target facility during the
billing period. Else RHDAYS = DK
Variable Name |
Assignment Instructions |
ONEBPDONE |
PERS.ONEBPDONE = 1/Indicated |
Box Instructions
GO TO EX9B2 - BILLDAYS.
Variable Name |
Assignment Instructions |
BPDAYS |
BPDAYS = (BPENDDATE – BPBEGDATE) + 1 |
Question Text
Between (BP START DATE) and (BP END DATE), how many days was (SP) billed for care?
PRESS F1 FOR HELP ENTERING FLAT-RATE BILLING.
Field 1: BILLDAYS
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
BOX EX3B2 |
Other Programming Instructions
Report Display
Column
1 Header: Days in Reference Period
Column 1: Display
RHDAYS
Column 2 Header: Billing Period Begin Date
Column
2: Display EX8B2 - BPBEGDATE in month, day, year format.
Column
3 Header: Billing Period End Date
Column 3: Display EX8B2 -
BPENDDATE in month, day, year format.
Column 4 Header:
Days in Billing Period
Column 4: Display BPDAYS.
Background Variable Assignments
Variable Name |
Assignment Instructions |
TOTBRATDAYS |
TOTBRATDAYS = 0 |
Box Instructions
IF EX9B2 - BILLDAYS = 0, THEN GO TO BOX EX6B2.
ELSE IF (RHDAYS = DK) OR (EX9B2 - BILLDAYS = RHDAYS AND (BPDAYS = EX9B2 - BILLDAYS OR (RHDAYS < BPDAYS))), GO TO EX11B2 - BRATRATE.
ELSE IF BPDAYS = RHDAYS AND RHDAYS > EX9B2 - BILLDAYS, GO TO EX10B2 - EX10CODE.
ELSE IF (BPDAYS > EX9B2 - BILLDAYS AND EX9B2 - BILLDAYS > RHDAYS) OR (BPDAYS > RHDAYS AND RHDAYS > EX9B2 - BILLDAYS) OR (BPDAYS = EX9B2 - BILLDAYS AND EX9B2 - BILLDAYS > RHDAYS), GO TO EX10AB2 - EX10ACOD.
ELSE GO TO EX10B2 - EX10CODE.
Variable Name |
Assignment Instructions |
SUMDAYS |
If RHDAYS <>
0, DK, then SUMDAYS = SUMDAYS + RHDAYS. |
Question Text
Can you tell me why I have a discrepancy between the number of days in this billing period, that is, (DAYS IN BILLING PERIOD) and the number of days for which (SP) was billed, that is, (DAYS BILLED)?
SELECT
ALL THAT APPLY.
SEPARATE RESPONSES BY USING THE SPACEBAR.
Field 1: EX10CODE
Field 1 Routing
Value |
Label |
Route |
1 |
SP DISCHARGED TO COMMUNITY |
BOX EX3BB2 |
2 |
SP SENT TO HOSPITAL |
BOX EX3BB2 |
3 |
SP DECEASED |
BOX EX3BB2 |
4 |
SP ADMITTED AFTER BP START DATE |
BOX EX3BB2 |
5 |
SP DISCHARGED TO ANOTHER NH |
BOX EX3BB2 |
91 |
OTHER |
EX10B2 - EX10OS |
|
Don't Know |
BOX EX3BB2 |
|
Refused |
BOX EX3BB2 |
Field 2: EX10OS
OTHER (SPECIFY)
Field 2 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
BOX EX3BB2 |
Question Text
Earlier,
I collected information that (SP) was a resident of this
(facility/home) for (NUMBER OF DAYS SP IN ELIGIBLE FACILITY) days
during this billing period. Yet, (he/she) was billed for (DAYS
BILLED) days.
Can you tell me why I have this
discrepancy?
SELECT
ALL THAT APPLY.
SEPARATE RESPONSES BY USING THE SPACEBAR.
Field 1: EX10ACOD
Field 1 Routing
Value |
Label |
Route |
1 |
SP SENT TO HOSPITAL, BED HELD |
BOX EX3BB2 |
2 |
SP NOT BILLED ON ADMISSION DAY |
BOX EX3BB2 |
3 |
SP NOT BILLED ON DISCHARGE DAY |
BOX EX3BB2 |
4 |
SP NOT BILLED ON DATE OF DEATH |
BOX EX3BB2 |
5 |
FACILITY CHARGES FLAT-RATE BILLING |
BOX EX3BB2 |
91 |
OTHER |
EX10AB2 - EX10AOS |
|
Don't Know |
BOX EX3BB2 |
|
Refused |
BOX EX3BB2 |
Field 2: EX10AOS
OTHER (SPECIFY)
Field 2 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
BOX EX3BB2 |
Box Instructions
GO TO EX11B2 - BRATRATE.
Variable Name |
Assignment Instructions |
BRATBPER |
BRATBPER = BPERNUM |
BRATNUM |
If no BRAT exists for this BPER then BRATNUM = 01. Else BRATNUM = next sequential number |
BRATRNDC |
BRATRNDC = current round |
Question Text
Between
(BP START DATE) and (BP END DATE), what rates were billed for (SP)'s
care? (I'll ask about billing for ancillary services
later.)
[PROBE: If more than one rate was billed, let's
start with the first rate within the billing period.]
Field 1: BRATRATE
What is the amount?
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
EX11B2 - BRATUNIT |
|
Don't Know |
EX11B2 - BRATUNIT |
|
Refused |
EX11B2 - BRATUNIT |
Field 2: BRATUNIT
Is that per day, per month, per quarter, or some other amount of time?
Field 2 Routing
Value |
Label |
Route |
1 |
DAY |
EX11B2 - BRATDAYS |
2 |
MONTH |
EX11B2 - BRATDAYS |
3 |
QUARTER |
EX11B2 - BRATDAYS |
91 |
OTHER |
EX11B2 - BRATUNOS |
|
Don't Know |
EX11B2 - BRATDAYS |
|
Refused |
EX11B2 - BRATDAYS |
Field 3: BRATUNOS
OTHER (SPECIFY)
Field 3 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
EX11B2 - BRATDAYS |
Field 4: BRATDAYS
How many days were billed at that rate?
Field 4 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
BOX EX4B2 |
Other Programming Instructions
Report Display
Display
report above question text.
(BP START DATE) - (BP END
DATE)
# OF BILLED DAYS: (DAYS BILLED)
DAYS YET TO BE
ACCOUNTED FOR: (DAYS YET TO BE ACCOUNTED FOR)
[TOTAL AMOUNT
BILLED: (TOTAL AMOUNT BILLED)]
Report display
instructions:
DAYS BILLED:
Display EX9B2 - BILLDAYS.
If
BPER.SHOTOTAM = 1, display "TOTAL AMOUNT BILLED: (TOTAL AMOUNT
BILLED)".
Else do not display.
DAYS YET TO BE
ACCOUNTED FOR:
Display (EX9B2 - BILLDAYS - TOTBRATDAYS).
Background Variable Assignments
Variable Name |
Assignment Instructions |
TOTBRATDAYS |
TOTBRATDAYS = TOTBRATDAYS + EX11B2 - BRATDAYS |
SHOTOTAM |
BPER.SHOTOTAM = 1 |
Design Notes
Implement
as an array.
Store on BRAT.
Box Instructions
IF ALL BILLED DAYS IN THE BILLING PERIOD HAVE BEEN ACCOUNTED FOR, GO TO BOX EX5B2.
ELSE GO TO BOX EX3BB2.
Box Instructions
IF SP BILLED SEPARATELY FOR ANCILLARIES, GO TO EX15PREB2 - EX15PRCT.
ELSE GO TO BOX EX6B2.
Other Programming Instructions
Background Variable Assignments
BASICAMT:
If
any BRAT with BRATBPER = BPERNUM has BRATRATE = DK,RF or BRATUNIT =
91/Other, DK,RF, then BPER.BASICAMT = DK
Else set BPER.BASICAMT
= 0, then loop through all BRATs with BRATBPER = BPERNUM performing
the following calculations:
If BRATUNIT = 1/Days, then
BPER.BASICAMT = BPER.BASICAMT + (BRATRATE * BRATDAYS), rounded to 2
decimal places
If BRATUNIT = 2/Month, then set temp variables
calcdays = 0, nummonths = 0
nummonths = number of months
between year and month of EX8B2-BPBEGDATE and EX8B2-BPENDDATE
(inclusive)
calcdays = number of calendar days in each month
between year and month of EX8B2-BPBEGDATE and EX8B2- BPENDDATE
(inclusive)
If calcdays = BRATDAYS, then BPER.BASICAMT =
BPER.BASICAMT + (nummonths * BRATRATE), rounded to 2 decimal places
Else BPER.BASICAMT = BPER.BASICAMT + (((nummonths *
BRATRATE)/calcdays) * BRATDAYS), rounded to 2 decimal places
If
BRATUNIT = 3/Quarter, then BPER.BASICAMT = BPER.BASICAMT + ((BRATRATE
= 91/Other) * BRATDAYS), rounded to 2 decimal places
If
BRATUNIT = 91/Other, then BASICAMT = DK.
If BPER.BASICAMT
> 99999.99, then BPER.BASICAMT = 99999.99
Question Text
The
next questions are about health-related services received by (SP) for
which there was a separate charge, that is, your (facility/home)'s
ancillary services.
(Please do not include
non-health-related services such as hairdressing, television, or
telephone).
PRESS
F1 FOR EXAMPLES OF NON-HEALTH-RELATED ANCILLARIES.
PRESS
"1" TO CONTINUE.
Field 1: EX15PRCT
Field 1 Routing
Value |
Label |
Route |
1 |
CONTINUE |
EX16B2 - ANCLPOST |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
EX15LONG |
FACR.EX15LONG = current round |
Question Text
Have all charges for ancillaries been posted for the period from (BP START DATE) to (BP END DATE)?
Field 1: ANCLPOST
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
BOX EX6B2 |
1 |
YES |
EX17B2 - ANYANCIL |
|
Don't Know |
BOX EX6B2 |
|
Refused |
BOX EX6B2 |
Other Programming Instructions
Design Notes
Store on BPRO.
Question Text
Does (SP) have any ancillary charges between (BP START DATE) and (BP END DATE)?
Field 1: ANYANCIL
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
BOX EX6B2 |
1 |
YES |
EX18B2 - ANCILAMT |
|
Don't Know |
BOX EX6B2 |
|
Refused |
BOX EX6B2 |
Other Programming Instructions
Design Notes
Store on BPRO.
Question Text
Altogether, what was the total charge for those health-related ancillary services?
Field 1: ANCILAMT
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
BOX EX6B2 |
|
Don't Know |
BOX EX6B2 |
|
Refused |
BOX EX6B2 |
Box Instructions
IF AMOUNTS BILLED FOR ALL BILLING PERIODS HAVE NOT BEEN COLLECTED, GO TO BOX EX3AB2.
ELSE GO TO BOX EX6BB2.
Box Instructions
IF THERE ARE ANY BILLING PERIODS FOR WHICH BILLED DAYS > 0 AND FOR WHICH PAYMENT DATA HAS NOT ALREADY BEEN COLLECTED, GO TO BOX EX7BB2.
ELSE GO TO BOX EX21B2.
Other Programming Instructions
Background Variable Assignments
IF THERE ARE ANY BILLING PERIODS FOR WHICH BILLED DAYS > 0 AND FOR WHICH PAYMENT DATA HAS NOT ALREADY BEEN COLLECTED, POSITION TO FIRST CURRENT ROUND BPER WITH EX9B2 - BILLDAYS > 0.
Box Instructions
GO TO EX20B2 - RECDBASP.
Question Text
Have you received all of the payments for basic care you expect to receive for (SP) during the [READ BILLING PERIOD ABOVE] billing period?
Field 1: RECDBASP
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
BOX EX14B2 |
1 |
YES |
EX21AAB2 - ADDSOP1 |
Other Programming Instructions
Design Notes
Store on BPRO.
Question Text
Do you need to add any Source(s) of Payment for (SP)'s basic care for [READ BILLING PERIOD ABOVE]?
Field 1: ADDSOP1
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
EX21ACB2 - BASRATE |
1 |
YES |
EX21ABB2 - PAYMPLN1 |
Other Programming Instructions
Report Display
Display
report above question text:
# OF BILLED DAYS: (EX9B2-
BILLDAYS)
TOTAL BILLED: $(TOTAL BILLED)
AMOUNT REMAINING:
$(AMOUNT REMAINING)
Display Sources of Payment in the
following order:
(1 = MEDICAID)
2 = PRIVATE PAY OR
SP/FAMILY INCOME
(3 = SOCIAL SECURITY)
(5 = PRIVATE
INSURANCE)
(6 = PENSION)
7 = MEDICARE
(8 = VA
CONTRACT)
(9 = HMO CONTRACT (SPECIFY))
(10 = SUPPLEMENTAL
SECURITY INCOME (SSI))
(91 = OTHER)
Display
1/MEDICAID if there is a current or previous round Medicaid payment
or PERS.INCAID = 1/Yes or PERS.HCAIDNM <> DK, RF, EMPTY,
NULL.
If PERS.GAPCOV = 1/Yes or PERS.LTCCOV = 1/Yes or there is
a current or previous round PRIVATE INSURANCE payment, then display
5/PRIVATE INSURANCE.
Display 3/SOCIAL SECURITY if there is a
current or previous round SOCIAL SECURITY payment.
Display
6/PENSION if there is a current or previous round PENSION payment.
If PERS.AFHIST = 1/Yes or there is a current or previous round
VA payment, then display 8/VA CONTRACT.
Display PAYM.PAYMTEXT
for 9/HMO CONTRACT if there is a current or previous round HMO
CONTRACT payment.
Display 10/SUPPLEMENTAL SECURITY INCOME (SSI)
if there is a current or previous round SSI payment.
Display
PAYM.PAYMTEXT for each 91/Other SOP with a current or previous round
PAYM record.
Background Variable Assignments
Variable Name |
Assignment Instructions |
PAYMBPER |
PAYM.PAYMBPER = BPER.BPERNUM |
PAYMNUM |
PAYM.PAYMNUM = number portion of each SOP displayed in EX21AAB2 - ADDSOP1 report |
PAYMRNDC |
PAYM.PAYMRNDC = current round |
PAYMTEXT |
If PAYM.PAYMNUM = 9/HMOContract or 91/Other, then PAYM.PAYMTEXT = PAYMTEXT from most recent current or previous round PAYM |
Design Notes
"VA CONTRACT" will be displayed in the report if the respondent ever said the SP was in the Armed Forces in BQ12.
Question Text
What Source(s) of Payment do you need to add for (SP)'s basic care for [READ BILLING PERIOD ABOVE]?
SELECT
ALL THAT APPLY.
SEPARATE RESPONSES BY USING THE SPACEBAR.
IF
NO RESPONSES ARE AVAILABLE, BACK UP AND CORRECT YOUR RESPONSE.
Field 1: PAYMPLN1
Field 1 Routing
Value |
Label |
Route |
1 |
MEDICAID |
EX21ACB2 - BASRATE |
2 |
PRIVATE PAY OR SP/FAMILY INCOME |
EX21ACB2 - BASRATE |
3 |
SOCIAL SECURITY |
EX21ACB2 - BASRATE |
4 |
SP/FAMILY INCOME |
EX21ACB2 - BASRATE |
5 |
PRIVATE INSURANCE |
EX21ACB2 - BASRATE |
6 |
PENSION |
EX21ACB2 - BASRATE |
7 |
MEDICARE |
EX21ACB2 - BASRATE |
8 |
VA CONTRACT |
EX21ACB2 - BASRATE |
9 |
HMO CONTRACT |
EX21ABB2 - HMOOS1 |
10 |
SUPPLEMENTAL SECURITY INCOME (SSI) |
EX21ACB2 - BASRATE |
91 |
OTHER |
EX21ABB2 - SOPOS1 |
|
Don't Know |
EX21ACB2 - BASRATE |
|
Refused |
EX21ACB2 - BASRATE |
Field 2: HMOOS1
HMO CONTRACT (SPECIFY)
Field 2 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
EX21ACB2 - BASRATE |
Field 3: SOPOS1
OTHER (SPECIFY)
Field 3 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
EX21ACB2 - BASRATE |
Other Programming Instructions
Report Display
Display
report above grid:
# OF BILLED DAYS: (EX9B2 - BILLDAYS)
TOTAL
BILLED: $(TOTAL BILLED)
AMOUNT REMAINING: $(AMOUNT
REMAINING)
Display Sources of Payment in the following
order:
(1 = MEDICAID)
2 = PRIVATE PAY OR SP/FAMILY
INCOME
(3 = SOCIAL SECURITY)
(5 = PRIVATE INSURANCE)
(6
= PENSION)
7 = MEDICARE
(8 = VA CONTRACT)
(9 = HMO
CONTRACT (SPECIFY))
(10 = SUPPLEMENTAL SECURITY INCOME
(SSI))
(91 = OTHER)
Display 1/MEDICAID if there is a
current or previous round Medicaid payment or PERS.INCAID = 1/Yes or
PERS.HCAIDNM <> DK, RF, EMPTY, NULL.
If PERS.GAPCOV =
1/Yes or PERS.LTCCOV = 1/Yes or there is a current or previous round
PRIVATE INSURANCE payment, then display 5/PRIVATE INSURANCE.
Display
3/SOCIAL SECURITY if there is a current or previous round SOCIAL
SECURITY payment.
Display 6/PENSION if there is a current or
previous round PENSION payment.
If PERS.AFHIST = 1/Yes or
there is a current or previous round VA payment, then display 8/VA
CONTRACT.
Display PAYM.PAYMTEXT for 9/HMO CONTRACT if there is a
current or previous round HMO CONTRACT payment.
Display
10/SUPPLEMENTAL SECURITY INCOME (SSI) if there is a current or
previous round SSI payment.
Display PAYM.PAYMTEXT for each
91/Other SOP with a current or previous round PAYM record.
Background Variable Assignments
Variable Name |
Assignment Instructions |
PAYMBPER |
PAYM.PAYMBPER = BPER.BPERNUM |
PAYMNUM |
PAYM.PAYMNUM = EX21ABB2 - PAYMPLN1 |
PAYMRNDC |
PAYM.PAYMRNDC = current round |
PAYMTEXT |
If EX21AB-PAYMPLN1 = 9/HMOContract and PAYM.PAYMNUM = 9/HMOContract, then PAYM.PAYMTEXT = EX21ABB2-HMOOS1. Else if EX21ABB2 - PAYMPLN1 = 91/Other and PAYM.PAYMNUM = 91/Other, then PAYM. PAYMTEXT = EX21ABB2-SOPOS1. |
Question Text
What is the total amount each source paid for [READ BILLING PERIOD ABOVE]?
Field 1: BASRATE
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
BOX EX7CB2 |
|
Don't Know |
BOX EX7CB2 |
|
Refused |
BOX EX7CB2 |
Other Programming Instructions
Roster/Grid Instructions
Display
Sources of Payment in the following order:
(1 = MEDICAID)
2
= PRIVATE PAY OR SP/FAMILY INCOME
(3 = SOCIAL SECURITY)
(5
= PRIVATE INSURANCE)
(6 = PENSION)
7 = MEDICARE
(8 =
VA CONTRACT)
(9 = HMO CONTRACT (SPECIFY))
(10 =
SUPPLEMENTAL SECURITY INCOME (SSI))
(91 = OTHER)
Display
1/MEDICAID if there is a current or previous round Medicaid payment
or PERS.INCAID = 1/Yes or PERS.HCAIDNM <> DK, RF, EMPTY, NULL
or if added at EX21ABB2 - PAYMPLN1.
If PERS.GAPCOV = 1/Yes or
PERS.LTCCOV = 1/Yes or there is a current or previous round PRIVATE
INSURANCE payment, or if added at EX21ABB2 - PAYMPLN1, then display
5/PRIVATE INSURANCE.
Display 3/SOCIAL SECURITY if there is a
current or previous round SOCIAL SECURITY payment or if added at
EX21ABB2 - PAYMPLN1.
Display 6/PENSION if there is a current or
previous round PENSION payment or if added at EX21ABB2 - PAYMPLN1.
If PERS.AFHIST = 1/Yes or there is a current or previous round
VA payment or if added at EX21ABB2 - PAYMPLN1, then display 8/VA
CONTRACT.
Display PAYM.PAYMTEXT for 9/HMO CONTRACT if there is a
current or previous round HMO CONTRACT payment or if added at
EX21ABB2 - PAYMPLN1.
Display 10/SUPPLEMENTAL SECURITY INCOME
(SSI) if there is a current or previous round SSI payment or if added
at EX21ABB2 - PAYMPLN1.
Display PAYM.PAYMTEXT for each 91/Other
SOP with a current or previous round PAYM record or if added at
EX21ABB2 - PAYMPLN1.
Roster/Grid Display
Column # |
Header |
Instructions |
1 |
SOP Name |
Display source of payment name. Display Only. |
2 |
SOP Payment |
BASRATE. Input field 1. |
Report Display
Display
report above grid:
# OF BILLED DAYS: (EX9B2 - BILLDAYS)
TOTAL
BILLED: $(TOTAL BILLED)
AMOUNT REMAINING: $(AMOUNT REMAINING)
Background Variable Assignments
Variable Name |
Assignment Instructions |
BASICPAY |
If any PAYM for PAYMNUM = BPERNUM has BASRATE = DK, RF, then BPER.BASICPAY = DK. Else BPER.BASICPAY = sum of all PAYM.BASRATE for PAYMNUM = BPERNUM |
Design Notes
We
need to calculate BASICPAY as each SOP is collected.
Store on
EX21ACB2-BASRATE PAYM.
Box Instructions
IF MEDICARE IS IDENTIFIED AS A SOURCE OF PAYMENT FOR BASIC CARE AND THERE IS NO STAY IN A HOSPITAL BETWEEN (BP START DATE - 60 DAYS) AND (BP END DATE + 60 DAYS) DATE AND THIS WAS NOT EXPLAINED THIS ROUND, GO TO EX21BB2 - VEXPTXTB.
ELSE GO TO BOX EX8B2.
Question Text
Medicare
has been reported as a payment source for basic care for (SP) for
[READ BILLING PERIOD ABOVE], but I have not recorded any preceding
hospital stays for (him/her).
Please tell me why Medicare
paid for (SP) during this billing period.
RECORD
VERBATIM BELOW. IF NECESSARY, BACK UP TO CORRECT.
IF
HOSPITAL STAY IS REPORTED, RECORD DATES OF STAY BELOW.
Field 1: VEXPTXTB
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
BOX EX8B2 |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
EX21BFLG |
PERS.EX21BFLG = current round |
Design Notes
Store on bEX.
Box Instructions
IF BPER.BASICAMT = DK, RF OR BPER.BASICPAY = DK OR ((BASICPAY >= BASICAMT*0.9) AND (BASICPAY <= BASICAMT*1.1)) OR (MEDICAID IS A SOURCE OF PAYMENT AND (BASICPAY >= BASICAMT*0.7) AND (BASICPAY <= BASICAMT*1.1)) OR (A WRITE-OFF WAS PREVIOUSLY REPORTED AND EX22B2 - BAS10PCT WAS ASKED THIS ROUND AND (BASICPAY >= BASICAMT*0.7) AND (BASICPAY <= BASICAMT*1.1)), GO TO BOX EX9B2.
ELSE GO TO EX22B2 - BAS10PCT.
Question Text
There seems to be a difference between what (FACILITY) billed between (BP START DATE) and (BP END DATE) and the payments received. The total amount billed I have entered for this billing period is (TOTAL AMOUNT BILLED FOR THIS BILLING PERIOD) and the total payments for the period are (SUM OF EX21 PAYMENTS). Why is that?
PRESS F1 FOR DEFINITION OF "MEDICAID WRITE-OFF".
Field 1: BAS10PCT
Field 1 Routing
Value |
Label |
Route |
1 |
MEDICAID WRITE-OFF/ADJUSTMENT |
BOX EX9B2 |
2 |
OTHER WRITE-OFF/ADJUSTMENT |
BOX EX9B2 |
91 |
OTHER |
EX22B2 - BAS10POS |
|
Don't Know |
BOX EX9B2 |
|
Refused |
BOX EX9B2 |
Field 2: BAS10POS
OTHER (SPECIFY)
Field 2 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
BOX EX9B2 |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
BAS10FLG |
PERS.BAS10FLG = BPER.BPERRNDC |
WRITEBAS |
If EX22B2-BAS10PCT = 1/MedicaidWriteOff or 2/OtherWriteOff, then PERS.WRITEBAS = 1/Indicated. |
Box Instructions
IF (MEDICAID IS IDENTIFIED AS A PAYMENT SOURCE AND FACILITY IS NOT MEDICAID CERTIFIED AND FACILITY HAS NEVER CONFIRMED), GO TO EX23A1B2 - EX23A1B2C.
ELSE GO TO BOX EX9AAB2.
Question Text
I
seem to have recorded some discrepant information. Earlier, I
recorded that (FACILITY) is not certified by Medicaid but I have
identified Medicaid as a payment source.
Is Medicaid
indeed paying for (SP)'s care?
IF
YES, PRESS '1' TO CONTINUE.
IF NO, BACK UP TO MAKE
APPROPRIATE CORRECTIONS.
Field 1: EX23A1B2C
Field 1 Routing
Value |
Label |
Route |
1 |
CONTINUE |
BOX EX9AAB2 |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
EXFCAID |
IF EX23A1B2 - EX23A1B2C = 1/Continue, then PERS.EXFCAID = current round |
Design Notes
Store on bEX.
Box Instructions
IF (MEDICARE IS IDENTIFIED AS A PAYMENT SOURCE AND FACILITY IS NOT MEDICARE CERTIFED AND FACILITY HAS NEVER CONFIRMED), GO TO EX23A2B2 - EX23A2B2C.
ELSE GO TO BOX EX9AB2.
Question Text
I
seem to have recorded some discrepant information. Earlier, I
recorded that (FACILITY) is not certified by Medicare but I have
identified Medicare as a payment source.
Is Medicare
indeed paying for (SP)'s care?
IF
YES, PRESS '1' TO CONTINUE.
IF NO, BACK UP TO MAKE
APPROPRIATE CORRECTIONS.
Field 1: EX23A2B2C
Field 1 Routing
Value |
Label |
Route |
1 |
CONTINUE |
BOX EX9AB2 |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
EXFCARE |
IF EX23A2B2 - EX23A2B2C = 1/Continue, then PERS.EXFCARE = current round |
Design Notes
Store on bEX.
Box Instructions
IF (THIS IS THE FIRST TIME MEDICAID IS IDENTIFIED AS A PAYMENT SOURCE FOR AN SP WHOSE MEDICAID STATUS IN THIS ROUND IS "PENDING" OR WHOSE MEDICAID NUMBER IS UNKNOWN), GO TO EX23AB2 - ECAIDNUM.
ELSE GO TO BOX EX11B2.
Question Text
Please tell me (SP)'s [(PREFERRED NAME(S) FOR MEDICAID)/MEDICAID] ID number.
Field 1: ECAIDNUM
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
EX23BB2 - ECAIDVR1 |
|
Don't Know |
BOX EX10B2 |
|
Refused |
BOX EX10B2 |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
ECAIDNM |
PERS.ECAIDNM = EX23AB2-ECAIDNUM |
Design Notes
Store on bEX.
Question Text
I'd like to verify the [(PREFERRED NAME(S) FOR MEDICAID)/MEDICAID] ID number that I have recorded. I have entered (MEDICAID ID NUMBER). Is this correct?
Field 1: ECAIDVR1
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
BOX EX10B2 |
1 |
YES |
BOX EX10B2 |
|
Don't Know |
BOX EX10B2 |
|
Refused |
BOX EX10B2 |
Other Programming Instructions
Design Notes
Store on bEX.
Box Instructions
IF EX23AB2 - ECAIDNUM = DK, RF OR EX23BB2 - ECAIDVR1 = DK, RF, GO TO EX24AB2 - EX24AB2C.
ELSE GO TO BOX EX11B2.
Variable Name |
Assignment Instructions |
EXSPCAID |
PERS.EXSPCAID = current round |
MCAIDFLG |
If PERS.ECAIDNM =
RF, then PERS.MCAIDFLG = 1/RForNWK |
Question Text
Earlier,
I recorded that (SP) was not a Medicaid recipient, but I have
identified Medicaid as a source of payment.
Is Medicaid
indeed paying for (SP)'s care?
IF
YES, PRESS '1' TO CONTINUE.
IF NO, BACK UP TO MAKE
APPROPRIATE CORRECTIONS.
Field 1: EX24AB2C
Field 1 Routing
Value |
Label |
Route |
1 |
CONTINUE |
BOX EX11B2 |
Other Programming Instructions
Design Notes
Store on bEX.
Box Instructions
IF MEDICAID IS NOT IDENTIFIED AS A PAYMENT SOURCE FOR THE CURRENT BILLING PERIOD BUT APPEARS IN THE PRECEDING BILLING PERIOD, GO TO EX25B2 - EX25B2C.
ELSE GO TO BOX EX12B2.
Question Text
It
seems that I might have made a mistake in identifying the various
sources of payment for (SP)'s care. Earlier, I recorded that
(his/her) basic charges from a previous billing period were paid by
Medicaid, and in this billing period, Medicaid is no longer a payment
source.
Is Medicaid indeed no longer paying for
(her/his) care?
IF
YES, PRESS '1' TO CONTINUE.
IF NO, BACK UP TO MAKE
APPROPRIATE CORRECTIONS.
Field 1: EX25B2C
Field 1 Routing
Value |
Label |
Route |
1 |
CONTINUE |
BOX EX12B2 |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
EXBPCAID |
IF EX25B2 - EX25B2C = 1/Continue, then EXBPCAID = 1/Indicated |
Box Instructions
IF MEDICARE IS IDENTIFIED AS A PAYMENT SOURCE AND THE AMOUNT PAID BY MEDICARE REPRESENTS LESS THAN 10 PERCENT OF THE TOTAL PAYMENTS RECEIVED FOR THE BILLING PERIOD, GO TO EX26B2 - CAREPRTB.
ELSE GO TO BOX EX14B2.
Question Text
Medicare's payment for this billing period represents less than 10 percent of the total payments for basic care. Is this Medicare payment a Part B payment?
IF NECESSARY, BACK UP TO CORRECT PAYMENTS.
Field 1: CAREPRTB
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
EX27B2 - VBPETXTE |
1 |
YES |
BOX EX14B2 |
|
Don't Know |
EX27B2 - VBPETXTE |
|
Refused |
BOX EX14B2 |
Question Text
Can you tell me why the Medicare payment is so small?
RECORD VERBATIM BELOW. IF NECESSARY, BACK UP TO CORRECT PAYMENTS.
Field 1: VBPETXTE
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
BOX EX14B2 |
Box Instructions
IF SP HAS ANY ANCILLARY CHARGES BETWEEN THE BILLING PERIOD START DATE AND THE BILLING PERIOD END DATE, GO TO EX28B2 - RECDANCP.
ELSE GO TO EX33BB2 - EXBBKCT.
Question Text
Have you received all the payments you expect to receive for (SP)'s ancillary services during the [READ BILLING PERIOD ABOVE] billing period?
Field 1: RECDANCP
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
EX33BB2 - EXBBKCT |
1 |
YES |
EX29AAB2 - ADDSOP2 |
Other Programming Instructions
Design Notes
Store on BPRO.
Question Text
Do you need to add any Source(s) of Payment for (SP)'s ancillary services for [READ BILLING PERIOD ABOVE]?
Field 1: ADDSOP2
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
EX29ACB2 - ANCRATE |
1 |
YES |
EX29ABB2 - PAYMPLN2 |
Other Programming Instructions
Report Display
Display
report above question text:
# OF BILLED DAYS: (EX9B2 -
BILLDAYS)
TOTAL BILLED: $(TOTAL BILLED ANCILLARY)
AMOUNT
REMAINING: $(AMOUNT REMAINING ANCILLARY)
Display Sources
of Payment in the following order:
(1 = MEDICAID)
2 =
PRIVATE PAY OR SP/FAMILY INCOME
(3 = SOCIAL SECURITY)
(5 =
PRIVATE INSURANCE)
(6 = PENSION)
7 = MEDICARE
(8 = VA
CONTRACT)
(9 = HMO CONTRACT (SPECIFY))
(10 = SUPPLEMENTAL
SECURITY INCOME (SSI))
(91 = OTHER)
Display
1/MEDICAID if there is a current or previous round Medicaid payment
or PERS.INCAID = 1/Yes or PERS.HCAIDNM <> DK, RF, EMPTY, NULL
or a PAYM exists for this BPER.
If PERS.GAPCOV = 1/Yes or
PERS.LTCCOV = 1/Yes or there is a current or previous round PRIVATE
INSURANCE payment or a PAYM exists for this BPER, then display
5/PRIVATE INSURANCE.
Display 3/SOCIAL SECURITY if there is a
current or previous round SOCIAL SECURITY payment or a PAYM exists
for this BPER.
Display 6/PENSION if there is a current or
previous round PENSION payment or a PAYM exists for this BPER.
If
PERS.AFHIST = 1/Yes or there is a current or previous round VA
payment or a PAYM exists for this BPER, then display 8/VA
CONTRACT.
Display PAYM.PAYMTEXT for 9/HMO CONTRACT if there is a
current or previous round HMO CONTRACT payment or a PAYM exists for
this BPER.
Display 10/SUPPLEMENTAL SECURITY INCOME (SSI) if
there is a current or previous round SSI payment or a PAYM exists for
this BPER.
Display PAYM.PAYMTEXT for each 91/Other SOP with a
current or previous round PAYM record or a PAYM exists for this BPER.
Question Text
What Source(s) of Payment do you need to add for (SP)'s ancillary services for [READ BILLING PERIOD ABOVE]?
SELECT
ALL THAT APPLY.
SEPARATE RESPONSES BY USING THE SPACEBAR.
IF
NO RESPONSES ARE AVAILABLE, BACK UP AND CORRECT YOUR RESPONSE.
Field 1: PAYMPLN2
Field 1 Routing
Value |
Label |
Route |
1 |
MEDICAID |
EX29ACB2 - ANCRATE |
2 |
PRIVATE PAY OR SP/FAMILY INCOME |
EX29ACB2 - ANCRATE |
3 |
SOCIAL SECURITY |
EX29ACB2 - ANCRATE |
4 |
SP/FAMILY INCOME |
EX29ACB2 - ANCRATE |
5 |
PRIVATE INSURANCE |
EX29ACB2 - ANCRATE |
6 |
PENSION |
EX29ACB2 - ANCRATE |
7 |
MEDICARE |
EX29ACB2 - ANCRATE |
8 |
VA CONTRACT |
EX29ACB2 - ANCRATE |
9 |
HMO CONTRACT |
EX29ABB2 - HMOOS2 |
10 |
SUPPLEMENTAL SECURITY INCOME (SSI) |
EX29ACB2 - ANCRATE |
91 |
OTHER |
EX29ABB2 - SOPOS2 |
|
Don't Know |
EX29ACB2 - ANCRATE |
|
Refused |
EX29ACB2 - ANCRATE |
Field 2: HMOOS2
HMO CONTRACT (SPECIFY)
Field 2 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
EX29ACB2 - ANCRATE |
Field 3: SOPOS2
OTHER (SPECIFY)
Field 3 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
EX29ACB2 - ANCRATE |
Other Programming Instructions
Report Display
Display
report above grid:
# OF BILLED DAYS: (EX9B2 - BILLDAYS)
TOTAL
BILLED: $(TOTAL BILLED ANCILLARY)
AMOUNT REMAINING: $(AMOUNT
REMAINING ANCILLARY)
Display Sources of Payment in the
following order:
(1 = MEDICAID)
2 = PRIVATE PAY OR
SP/FAMILY INCOME
(3 = SOCIAL SECURITY)
(5 = PRIVATE
INSURANCE)
(6 = PENSION)
7 = MEDICARE
(8 = VA
CONTRACT)
(9 = HMO CONTRACT (SPECIFY))
(10 = SUPPLEMENTAL
SECURITY INCOME (SSI))
(91 = OTHER)
Display
1/MEDICAID if there is a current or previous round Medicaid payment
or PERS.INCAID = 1/Yes or PERS.HCAIDNM <> DK, RF, EMPTY, NULL
or a PAYM exists for this BPER.
If PERS.GAPCOV = 1/Yes or
PERS.LTCCOV = 1/Yes or there is a current or previous round PRIVATE
INSURANCE payment or a PAYM exists for this BPER, then display
5/PRIVATE INSURANCE.
Display 3/SOCIAL SECURITY if there is a
current or previous round SOCIAL SECURITY payment or a PAYM exists
for this BPER.
Display 6/PENSION if there is a current or
previous round PENSION payment or a PAYM exists for this BPER.
If
PERS.AFHIST = 1/Yes or there is a current or previous round VA
payment or a PAYM exists for this BPER, then display 8/VA
CONTRACT.
Display PAYM.PAYMTEXT for 9/HMO CONTRACT if there is a
current or previous round HMO CONTRACT payment or a PAYM exists for
this BPER.
Display 10/SUPPLEMENTAL SECURITY INCOME (SSI) if
there is a current or previous round SSI payment or a PAYM exists for
this BPER.
Display PAYM.PAYMTEXT for each 91/Other SOP with a
current or previous round PAYM record or a PAYM exists for this BPER.
Question Text
What is the total amount each source paid for [READ BILLING PERIOD ABOVE]?
Field 1: ANCRATE
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
BOX EX15B2 |
|
Don't Know |
BOX EX15B2 |
|
Refused |
BOX EX15B2 |
Other Programming Instructions
Roster/Grid Instructions
Display
Sources of Payment in the following order:
(1 = MEDICAID)
2
= PRIVATE PAY OR SP/FAMILY INCOME
(3 = SOCIAL SECURITY)
(5
= PRIVATE INSURANCE)
(6 = PENSION)
7 = MEDICARE
(8 =
VA CONTRACT)
(9 = HMO CONTRACT (SPECIFY))
(10 =
SUPPLEMENTAL SECURITY INCOME (SSI))
(91 = OTHER)
Display
1/MEDICAID if there is a current or previous round Medicaid payment
or PERS.INCAID = 1/Yes or PERS.HCAIDNM <> DK, RF, EMPTY, NULL
or if added at EX29ABB2 - PAYMPLN2.
If PERS.GAPCOV = 1/Yes or
PERS.LTCCOV = 1/Yes or there is a current or previous round PRIVATE
INSURANCE payment or a PAYM exists for this BPER or if added at
EX29ABB2 - PAYMPLN2, then display 5/PRIVATE INSURANCE.
Display
3/SOCIAL SECURITY if there is a current or previous round SOCIAL
SECURITY payment or a PAYM exists for this BPER or if added at
EX29ABB2 - PAYMPLN2.
Display 6/PENSION if there is a current or
previous round PENSION payment or a PAYM exists for this BPER or if
added at EX29ABB2 - PAYMPLN2.
If PERS.AFHIST = 1/Yes or there
is a current or previous round VA payment or a PAYM exists for this
BPER or if added at EX29ABB2 - PAYMPLN2, then display 8/VA
CONTRACT.
Display PAYM.PAYMTEXT for 9/HMO CONTRACT if there is a
current or previous round HMO CONTRACT payment or a PAYM exists for
this BPER or if added at EX29ABB2 - PAYMPLN2.
Display
10/SUPPLEMENTAL SECURITY INCOME (SSI) if there is a current or
previous round SSI payment or a PAYM exists for this BPER or if added
at EX29ABB2 - PAYMPLN2.
Display PAYM.PAYMTEXT for each 91/Other
SOP with a current or previous round PAYM record or a PAYM exists for
this BPER or if added at EX29ABB2 - PAYMPLN2.
Roster/Grid Display
Column # |
Header |
Instructions |
1 |
SOP Name |
Display source of payment name. Display Only. |
2 |
SOP Payment |
ANCRATE. Input field 1. |
Report Display
Display
report above grid:
# OF BILLED DAYS: (EX9B2 - BILLDAYS)
TOTAL
BILLED: $(TOTAL BILLED ANCILLARY)
AMOUNT REMAINING: $(AMOUNT
REMAINING ANCILLARY)
Background Variable Assignments
Calculate amount remaining by subtracting SUM OF PAYMENTS FROM TOTAL CHARGE.
Variable Name |
Assignment Instructions |
ANCILPAY |
If any PAYM for
PAYMNUM = BPERNUM has |
Design Notes
We
need to calculate ANCILPAY as each SOP is collected.
Store on
EX29ACB2-ANCRATE PAYM.
Box Instructions
IF EX18B2 - .ANCILAMT = DK, RF OR BPER.ANCILPAY = DK OR ((BPER.ANCILPAY >= EX18B2 - ANCILAMT*0.9) AND (BPER.ANCILPAY <= EX18B2 - ANCILAMT*1.1)) OR (MEDICAID IS A SOURCE OF PAYMENT AND (BPER.ANCILPAY >= EX18B2 - ANCILAMT*0.7) AND (BPER.ANCILPAY <= EX18B2 - ANCILAMT*1.1)) OR (A WRITE-OFF WAS PREVIOUSLY REPORTED AND EX30B2 - ANC10PCT WAS ASKED THIS BP ROUND AND (BPER.ANCILPAY >= EX18B2 - ANCILAMT*0.7) AND (BPER.ANCILPAY <= EX18B2 - ANCILAMT*1.1)), GO TO BOX EX16B2.
ELSE GO TO EX30B2 - ANC10PCT.
Question Text
There seems to be a difference between what (FACILITY) billed for ancillary services between (BP START DATE) and (BP END DATE) and the payments received. The total amount billed I have entered for [READ BILLING PERIOD ABOVE] is (TOTAL AMOUNT BILLED FOR BILLING PERIOD) and the total payments for the period are (SUM OF ANCILLARY PAYMENTS). Why is that?
PRESS F1 FOR DEFINITION OF "MEDICAID WRITE-OFF".
Field 1: ANC10PCT
Field 1 Routing
Value |
Label |
Route |
1 |
MEDICAID WRITE-OFF/ADJUSTMENT |
BOX EX16B2 |
2 |
OTHER WRITE-OFF/ADJUSTMENT |
BOX EX16B2 |
91 |
OTHER |
EX30B2 - ANC10POS |
|
Don't Know |
BOX EX16B2 |
|
Refused |
BOX EX16B2 |
Field 2: ANC10POS
OTHER (SPECIFY)
Field 2 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
BOX EX16B2 |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
ANC10FLG |
PERS.ANC10FLG = current round |
WRITEANC |
If EX30B2-ANC10PCT = 1/MedicaidWriteOff or 2/OtherWriteOff, then PERS.WRITEANC = 1/Indicated. |
Box Instructions
IF (MEDICAID IS IDENTIFIED AS A PAYMENT SOURCE AND FACILITY IS NOT MEDICAID CERTIFIED AND FACILITY HAS NEVER CONFIRMED), GO TO EX31A1B2 - EX31A1B2C.
ELSE GO TO BOX EX16AAB2.
Question Text
I
seem to have recorded some discrepant information. Earlier, I
recorded that (FACILITY) is not certified by Medicaid but I have
identified Medicaid as a payment source.
Is Medicaid
indeed paying for (SP)'s care?
IF
YES, PRESS '1' TO CONTINUE.
IF NO, BACK UP TO MAKE
APPROPRIATE CORRECTIONS.
Field 1: EX31A1B2C
Field 1 Routing
Value |
Label |
Route |
1 |
CONTINUE |
BOX EX16AAB2 |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
EXFCAID |
IF EX31A1B2 - EX31A1B2C = 1/Continue, then PERS.EXFCAID = current round |
Design Notes
Store on bEX.
Box Instructions
IF (MEDICARE IS IDENTIFIED AS A PAYMENT SOURCE AND FACILITY IS NOT MEDICARE CERTIFED AND FACILITY HAS NEVER CONFIRMED), GO TO EX31A2B2 - EX31A2B2C.
ELSE GO TO BOX EX16AB2.
Question Text
I
seem to have recorded some discrepant information. Earlier, I
recorded that (FACILITY) is not certified by Medicare but I have
identified Medicare as a payment source.
Is Medicare
indeed paying for (SP)'s care?
IF
YES, PRESS '1' TO CONTINUE.
IF NO, BACK UP TO MAKE
APPROPRIATE CORRECTIONS.
Field 1: EX31A2B2C
Field 1 Routing
Value |
Label |
Route |
1 |
CONTINUE |
BOX EX16AB2 |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
EXFCARE |
IF EX31A2B2 - EX31A2B2C = 1/Continue, then PERS.EXFCARE = current round |
Design Notes
Store on bEX.
Box Instructions
IF (THIS IS THE FIRST TIME MEDICAID IS IDENTIFIED AS A PAYMENT SOURCE FOR AN SP WHOSE MEDICAID STATUS IN THIS ROUND IS "PENDING" OR WHOSE MEDICAID NUMBER IS UNKNOWN), GO TO EX31AB2 - ECAIDNM3.
ELSE GO TO BOX EX18B2.
Question Text
Please tell me (SP)'s [(PREFERRED NAME(S) FOR MEDICAID)/MEDICAID] ID number.
Field 1: ECAIDNM3
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
EX31BB2 - ECAIDVR2 |
|
Don't Know |
BOX EX17B2 |
|
Refused |
BOX EX17B2 |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
ECAIDNM |
PERS.ECAIDNM = EX31AB2 - ECAIDNM3 |
Design Notes
Store on bEX.
Question Text
I'd like to verify the [(PREFERRED NAME(S) FOR MEDICAID)/MEDICAID] ID number that I have recorded. I have entered (MEDICAID ID NUMBER). Is this correct?
Field 1: ECAIDVR2
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
BOX EX17B2 |
1 |
YES |
BOX EX17B2 |
|
Don't Know |
BOX EX17B2 |
|
Refused |
BOX EX17B2 |
Other Programming Instructions
Design Notes
Store on bEX.
Box Instructions
IF EX31AB2 - ECAIDNM3 = DK, RF OR EX31BB2 - ECAIDVR2 = DK, RF, GO TO EX32AB2 - EX32AB2C.
ELSE GO TO BOX EX18B2.
Variable Name |
Assignment Instructions |
MCAIDFLG |
If PERS.ECAIDNM =
RF, then PERS.MCAIDFLG = 1/RForNWK |
EXSPCAID |
PERS.EXSPCAID = current round |
Question Text
Earlier,
I recorded that (SP) was not a Medicaid recipient but I have
identified Medicaid as a source of payment.
Is Medicaid
indeed paying for (SP)'s ancillaries?
IF
YES, PRESS '1' TO CONTINUE.
IF NO, BACK UP TO MAKE
APPROPRIATE CORRECTIONS.
Field 1: EX32AB2C
Field 1 Routing
Value |
Label |
Route |
1 |
CONTINUE |
BOX EX18B2 |
Other Programming Instructions
Design Notes
Store on bEX.
Box Instructions
IF MEDICAID IS NOT IDENTIFIED AS PAYMENT SOURCE FOR ANCILLARIES FOR THE CURRENT BILLING PERIOD BUT APPEARS IN THE PRECEDING PERIOD (INCLUDING IF THE BILLING PERIOD OCCURRED IN THE PREVIOUS ROUND), GO TO EX33B2 - EX33B2C.
ELSE GO TO EX33BB2 - EXBBKCT.
Question Text
It
seems that I might have made a mistake in identifying the various
sources of payment for (SP)'s care. Earlier, I recorded that
(his/her) charges for ancillaries in a previous billing period were
paid by Medicaid, and in this billing period, Medicaid is no longer a
payment source.
Is Medicaid indeed no longer paying for
(his/her) ancillary services?
IF
YES, PRESS '1' TO CONTINUE.
IF NO, BACK UP TO MAKE
APPROPRIATE CORRECTIONS.
Field 1: EX33B2C
Field 1 Routing
Value |
Label |
Route |
1 |
CONTINUE |
EX33BB2 - EXBBKCT |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
EXBPCAID |
IF EX33B2 - EX33B2C = 1/Continue, then EXBPCAID = 1/Indicated |
Question Text
THIS IS THE LAST SCREEN FOR THIS BILLING PERIOD .
PRESS "1" TO CONTINUE.
Field 1: EXBBKCT
Field 1 Routing
Value |
Label |
Route |
1 |
CONTINUE |
BOX EX20B2 |
Box Instructions
IF THERE ARE ANY ADDITIONAL BILLING PERIODS FOR WHICH BILLED DAYS > 0 AND FOR WHICH PAYMENT DATA HAS NOT ALREADY BEEN COLLECTED, GO TO BOX EX7BB2.
ELSE GO TO BOX EX21B2.
Other Programming Instructions
Background Variable Assignments
IF THERE IS ANOTHER BILLING PERIOD FOR WHICH BILLED DAYS > 0 AND FOR WHICH PAYMENT DATA HAS NOT ALREADY BEEN COLLECTED, POSITION TO THE NEXT CURRENT ROUND BPER WITH EX9B2 - BILLDAYS > 0.
Box Instructions
IF PRIVATE PAY HAS NEVER BEEN REPORTED AS A SOURCE OF PAYMENT AND SP WAS COVERED BY A LONG-TERM CARE POLICY, GO TO EX34B2 - USENOLTC.
ELSE GO TO BOX EX21AB2.
Question Text
Earlier I was told that (SP) had long-term care insurance from (NAME OF FIRST LTC INSURANCE COMPANY REPORTED). Is it correct that this policy paid for none of (his/her) care?
Field 1: USENOLTC
Field 1 Routing
Value |
Label |
Route |
0 |
NO |
EX35B2 - VEXPTXTG |
1 |
YES |
BOX EX21AB2 |
|
Don't Know |
BOX EX21AB2 |
|
Refused |
BOX EX21AB2 |
Question Text
Can you explain this to me?
RECORD VERBATIM BELOW.
Field 1: VEXPTXTG
Field 1 Routing
Value |
Label |
Route |
1 |
[Continuous answer.] |
BOX EX21AB2 |
Other Programming Instructions
Design Notes
Store on bEX.
Box Instructions
IF IT IS PENDING WHETHER SP HAS BEEN COVERED BY MEDICAID FROM CRIN-1 AND MEDICAID HAS NEVER BEEN REPORTED AS A SOURCE OF PAYMENT, GO TO EX35AB2 - ECAIDECO.
ELSE GO TO EXEND - EXENDCNT.
Question Text
The last time I was here, I collected information that (SP)'s [(PREFERRED NAME(S) FOR MEDICAID)/MEDICAID] eligibility status was pending. Is it still pending or has [(PREFERRED NAME(S) FOR MEDICAID)/MEDICAID] been denied?
Field 1: ECAIDECO
Field 1 Routing
Value |
Label |
Route |
1 |
STILL PENDING |
EXEND - EXENDCNT |
2 |
DENIED |
EXEND - EXENDCNT |
|
Don't Know |
EXEND - EXENDCNT |
|
Refused |
EXEND - EXENDCNT |
Question Text
(Thank you for your time, I will need to talk to this person to complete these questions.)
(YOU
HAVE COMPLETED THE EXPENDITURES SECTION FOR THIS SP.)
PRESS
"1" TO RETURN TO NAVIGATION SCREEN.
Field 1: EXENDCNT
Field 1 Routing
Value |
Label |
Route |
1 |
CONTINUE |
BOX EXEND |
Other Programming Instructions
Background Variable Assignments
Variable Name |
Assignment Instructions |
EXDISP |
If EX2 – ANYBASIC <> DK, then EXDISP = 96/Complete |
Box Instructions
GO TO NAVIGATOR
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | Ryan Hubbard |
| File Modified | 0000-00-00 |
| File Created | 2021-01-21 |