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Language:
English
WESSQL6.MEPS_V2
Spec Label:
This is the cover page. Additional contents currently project specific.
CP - Page 1 of 43
MEPS_V2
Charge/Payment (CP) Section
(Rout
Full Detail Spec
BOX_00
Route Details:
(CP1000)
Item Type: Route
Type Class: If Then
01 Box = BOX_00, BOX_10, BOX_20, BOX_30, BOX_40, BOX_50, BOX_60, BOX_
70, BOX_80, BOX_90, BOX_100,BOX_110, BOX_120, BOX_130, BOX_140, BOX_
150
04 Single Select = CP20, CP40, CP60, CP70, CP100, CP110, CP160, CP170, CP180,
CP190, CP210, CP240
06 Single Select with Fill in Answer Text = CP10, CP80, CP120, CP130, CP140
11 Multiple Select with Add/Edit/Delete = CP220
18 Dollar Items Not Allowing Cents = CP30, CP150, CP200, CP230
23 Text Field = CP90
24 Information Screen = CP50
Grid 2 = CP230
CP - Page 2 of 43
MEPS_V2
Charge/Payment (CP) Section
(Rout
Full Detail Spec
BOX_10
Route Details:
(CP1001)
Item Type: Route
Type Class: If Then
Context header display instructions:
Display PROV.PROVNAME, EVPV.EVNTTYPE, EVPV.EVNTBEGM,
EVPV.EVNTBEGD, EVPV.EVNTBEGY, EVPV.EVNTENDM, EVPV.EVNTENDD,
EVPV.EVNTENDY, PRND.BEGREFMM, PRND.BEGREFDD, PRND.BEGREFYY,
PRND.ENDREFMM, PRND.ENDREFDD, PRND.ENDREFYY, EVPV.RVNAME
Display {NAME OF MEDICAL CARE PROVIDER} in the context header if the event
type is not 'OM' (Other Medical Expenses). Otherwise, use null value.
Display {EVN-DT} in the context header if event type is not ‘OM’ (Other Medical
Expenses).
Display {REF-DT} in the context header if event type is ‘OM’ (Other Medical Expenses).
Display ‘repeat visit: {NAME OF REPEAT VISIT GROUP}’ in the context header if this
event is a repeat visit stem.
For ‘{REF- DT}’, displayed in the context header, display the start date of the current
round.
Display {OME ITEM GROUP NAME} in the context header if the event type is OM. For
{OME ITEM GROUP NAME} display the name of the other medical expenses item group
being asked about for this event.
Display ‘Glasses or Contact Lenses’ if this is an OM event for 'GLASSES OR CONTACT
LENSES' (EE40='1' YES, EE50='1' YES, or OM10 = '1' YES).
Display ‘Ambulance Services’ if this is an OM event for 'AMBULANCE SERVICES'
(OM30='1' YES).
Display 'Disposable Supplies’ if this is an OM event for 'DISPOSABLE SUPPLIES'
(OM40='1' YES).
Display ‘Long-term Medical Equipment’ if this is an OM event for 'LONG-TERM
MEDICAL EQUIPMENT' (OM50='1' YES).
CP - Page 3 of 43
MEPS_V2
Charge/Payment (CP) Section
(Rout
Full Detail Spec
BOX_20
Route Details:
(CP1005)
Item Type: Route
Type Class: If Then
Throughout the Charge/Payment (CP) section, entry of all dollar amounts will include
only whole dollars. Entry of cents will be disallowed.
S ome items (CP220) in this section allow the addition of a source of payment for the
RU. When the interviewer presses CTRL-A, CAPI displays a pop-up with a blank entry
field and a selectable pick list of some common sources as follows:
What is the source of payment?
Government S ources
- 'Medicare'
- 'Medicaid{/S TATE NAME FOR MEDICAID}'
- 'S CHIP/{S TATE NAME FOR CHIP}'
- 'VA (VETERAN'S ADMINIS TRATION)/CHAMPVA'
- 'Tricare'
- 'Military Facility'
- 'Indian Health S ervice'
- 'Worker's Compensation'
Private S ources
- 'AARP'
- 'Aetna'
- 'Blue Cross/Blue S hield'
- 'Cigna'
- 'Delta Dental'
- 'Kaiser/Kaiser Permanente'
- 'United Healthcare'
- Other S ource not listed
- When 'Other S ource not listed' is selected, CAPI should display a text box for entry
Display '/S TATE NAME FOR MEDICAID' (substituting the real state name for program)
if the state in which interview being conducted does not use the name 'Medicaid'.
Otherwise, use a null display. For the specific name to use by state, see the plan fill file.
Display 'S TATE NAME FOR CHIP' under all conditions (substituting the real state
name for program). For the specific name to use by state, see the plan fill file.
The pick list expedites the entry of one of these common sources. Once the interviewer
selects from the pick list (or types an entry) and returns to the main screen, the added
source of payment appears in the roster as selected. If a source already listed in the
roster is added at the pick list pop-up for a second time, CAPI should display the
following error message: "S OURCE ALREADY ADDED. VERIFY. IF S AME
S OURCE, CANCEL POP-UP AND S ELECT S OURCE AT MAIN QUES TION."
If event type is HH
and
HH provider associated with the event being asked about is coded 'AGENCY' (EV60 =
1‘WORKED FOR AGENCY, HOS PITAL, OR NURS ING HOME), 'INFORMAL' (EV50=
1 ‘FRIEND/NEIGHBOR’, 2 ‘RELATIVE’, 3 ‘VOLUNTEER’) or 'VOLUNTEERED: MEAL
DELIVERY S ERVICE' (EV50=5 VOLUNTEERED MEAL DELIVERY S ERVICE) go to
BOX_150.
CP - Page 4 of 43
MEPS_V2
Charge/Payment (CP) Section
(Rout
Full Detail Spec
BOX_30
Route Details:
(CP1050)
Item Type: Route
Type Class: If Then
If event type is ER, OP, MV, or DN, and is first time through charge payment for this
person-provider pair and pair was flagged as
'COPAYMENT SITUATION' during the previous round (Provdier.PersonProvider
(CoPaySituation)) (OM events can’t be flagged as a copayment situation), continue with
BOX_40.
Otherwise, go to CP50.
NOTE: Copayment data at a person-provider level needs to come forward from the
previous round (Provdier.PersonProvider (CoPaySituation)).
BOX_40
Route Details:
(CP1051)
Item Type: Route
Type Class: If Then
If copay amount from previous round is greater than $0, go to CP10
(Provider.Person[I].CPayAmt).
If copay amount from previous round is equal to $0, go to CP40
(Provider.Person[I].CPayAmt).
CP - Page 5 of 43
MEPS_V2
Charge/Payment (CP) Section
(Que
Full Detail Spec
CP10
Item Type:
Type Class:
Answer Type:
(CP1055)
Question
Enumerated
TCPAYSAME
Help Available (CPayHelp)
Context Header:
BLAISE NAME: CPaySameLRnd
Field kind: Datafield
ArrayMin:
Min value:
Field Size:
Answers allowed: 1
ArrayMax:
Max value:
Show Card (
)
Look Up File (
)
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER} {EV} {EVN-DT/REF-DT}
{REPEAT VISIT: {NAME OF REPEAT VISIT GROUP}}
Question Text:
My records indicate that at the last interview, {you/{PERSON}} (or someone in the family) usually pay{s} a {$ AMT
COPAY} copayment to {PROVIDER}. Is this still correct?
HELP: F1
Responses:
YES, STILL PAY {$ AMT COPAY}
NO
REFUSED
DON'T KNOW
1
2
RF
DK
CP50
CP20
CP50
CP50
(CP1065)
(CP1056)
(CP1065)
(CP1065)
Programmer
Instructions:
If coded ‘1’ (YES, STILL PAY {$ AMT COPAY}), ‘RF’ (REFUSED), OR ‘DK’ (DON’T
KNOW), flag this person-provider as ‘copayment situation’ for the current round and set
copayment amount from the previous round (Provider.PersonProvider[I].CpayAmt) as this
person-provider pair's copayment amount for the current round.
Display
Instructions:
For '$ AMT COPAY' in the question text and response option ‘1’ (YES, STILL PAY {$ AMT
COPAY}), display the CP200 amount flagged as 'copayment situation' during the previous round
(Provider.PersonProvider[I].CpayAmt) for this person-provider pair.
Testing/Editing
Notes:
Variable collected at MEPSSpring2018.CP_Main
Variable collected at MEPSSpring2018.OM_Main.OM_LOOP10[1..4].CP_Main
Variable stored at MEPSSpring2018_Event.CP_Main
Variable stored at MEPSSpring2018_PersSect.OM_Main.OM_LOOP10[1..4].CP_Main
CP - Page 6 of 43
MEPS_V2
Charge/Payment (CP) Section
(Que
Full Detail Spec
CP20
Item Type:
Type Class:
Answer Type:
(CP1056)
Question
Enumerated
Field kind: Datafield
Field Size:
TCCOPYMTCHNGD Answers allowed: 1
Help Available (CPayHelp)
Context Header:
BLAISE NAME: CPayChng
ArrayMin:
Min value:
ArrayMax:
Max value:
Show Card (
)
Look Up File (
)
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER} {EV} {EVN-DT/REF-DT}
{REPEAT VISIT: {NAME OF REPEAT VISIT GROUP}}
Question Text:
Has your copayment amount changed, or do you no longer have a copayment?
HELP: F1
Responses:
Programmer
Instructions:
PAY A DIFFERENT COPAYMENT
AMOUNT
NOT A COPAYMENT SITUATION
ANYMORE
REFUSED
DON'T KNOW
1
CP30
(CP1060)
2
CP50
(CP1065)
RF
DK
CP50
CP50
(CP1065)
(CP1065)
If coded 2 ‘NOT A COPAYMENT SITUATION ANYMORE’, DK ‘DON’T KNOW’, or RF
‘REFUSED’, do not flag this person-provider as ‘copayment situation’ for the current round.
Display
Instructions:
Testing/Editing
Notes:
Variable collected at MEPSSpring2018.CP_Main
Variable collected at MEPSSpring2018.OM_Main.OM_LOOP10[1..4].CP_Main
Variable stored at MEPSSpring2018_Event.CP_Main
Variable stored at MEPSSpring2018_PersSect.OM_Main.OM_LOOP10[1..4].CP_Main
CP - Page 7 of 43
MEPS_V2
Charge/Payment (CP) Section
(Que
Full Detail Spec
CP30
Item Type:
Type Class:
Answer Type:
(CP1060)
Question
Integer
Field kind: Datafield
Field Size: 2
{Continuous Answer.} Answers allowed: 1
Help Available (CPayHelp)
Context Header:
BLAISE NAME: CPayAmt
ArrayMin:
Min value: 0
ArrayMax:
Max value: 99
Show Card (
)
Look Up File (
)
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL
CARE PROVIDER} {EV} {EVN-DT/REF-DT}
{REPEAT VISIT: {NAME OF REPEAT VISIT GROUP}}
Question Text:
What is the correct copayment amount?
ENTER AMOUNT
HELP: F1
Responses:
REFUSED
DON'T KNOW
Programmer
Instructions:
RF
DK
CP50
CP50
CP50
(CP1065)
(CP1065)
(CP1065)
If amount entered, flag this person-provider as ‘copayment situation’ for the current round.
Set dollar amount entered at CP30 as the new copayment amount for this person-provider pair
for the current round.
If coded ‘RF’ (REFUSED), or ‘DK’ (DON’T KNOW), flag this person-provider pair as
‘copayment situation’ for the current round and set copayment amount from previous round
(Provider.PersonProvider[I].CPayAmt) as copayment amount for the current round.
Soft check:
If amount entered is > or = $75, display the following message: "ENTER A DOLLAR
AMOUNT < OR = $75, RF, OR DK."
Display
Instructions:
Testing/Editing
Notes:
Variable collected at MEPSSpring2018.CP_Main
Variable collected at MEPSSpring2018.OM_Main.OM_LOOP10[1..4].CP_Main
Variable stored at MEPSSpring2018_Event.CP_Main
Variable stored at MEPSSpring2018_PersSect.OM_Main.OM_LOOP10[1..4].CP_Main
CP - Page 8 of 43
MEPS_V2
Charge/Payment (CP) Section
(Que
Full Detail Spec
CP40
Item Type:
Type Class:
Answer Type:
(CP1061)
Question
Enumerated
TYESNO
Help Available (CPayHelp)
Context Header:
BLAISE NAME: ProvNoPay
Field kind: Datafield
ArrayMin:
Min value:
Field Size:
Answers allowed: 1
ArrayMax:
Max value:
Show Card (
)
Look Up File (
)
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER} {EV} {EVN-DT/REF-DT}
{REPEAT VISIT: {NAME OF REPEAT VISIT GROUP}}
Question Text:
My records indicate that at the last interview, {you/{PERSON}} (or someone in the family) do not usually have to make any
payments for visits to {PROVIDER}. Is this still correct?
HELP: F1
Responses:
YES
NO
REFUSED
DON'T KNOW
1
2
RF
DK
CP50
CP50
CP50
CP50
(CP1065)
(CP1065)
(CP1065)
(CP1065)
Programmer
Instructions:
If coded ‘1’ (YES), DK ‘DON’T KNOW’, or RF ‘REFUSED’, flag this person-provider pair
as ‘copayment situation’ for the current round and set copayment amount from the previous
round (Provider.PersonProvider[I].CPayAmt) as the person's copayment amount for the
current round ($0).
If coded ‘2’ (NO), do not flag this person-provider as ‘copayment situation’ for the current
round.
Display
Instructions:
Testing/Editing
Notes:
Variable collected at MEPSSpring2018.CP_Main
Variable collected at MEPSSpring2018.OM_Main.OM_LOOP10[1..4].CP_Main
Variable stored at MEPSSpring2018_Event.CP_Main
Variable stored at MEPSSpring2018_PersSect.OM_Main.OM_LOOP10[1..4].CP_Main
CP - Page 9 of 43
MEPS_V2
Charge/Payment (CP) Section
(Instr
Full Detail Spec
CP50
Item Type:
Type Class:
Answer Type:
(CP1065)
Instruction
Enumerated
BLAISE NAME: CPayIntro
TContinue
Answers allowed: 1
Help Available (CPayIntroHelp)
Context Header:
Field kind: Datafield
Show Card (
)
Look Up File (
)
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER} {EV} {EVN-DT/REF-DT}
{REPEAT VISIT: {NAME OF REPEAT VISIT GROUP}}
Question Text:
Now I'd like to ask you about the charges for { {your/{PERSON}'s} stay at {HOSPITAL} that began on {ADMIT
DATE}/{your/{PERSON}'s} visit to {PROVIDER} on {VISIT DATE}/the {OME ITEM GROUP NAME} used by
{you/{PERSON}} since {START DATE}/services received at home from {PROVIDER} during {MONTH} for
{you/{PERSON}} }.
{Let's begin with the charges from the hospital itself, not including any separate physician services or lab tests.}
PRESS 1 AND ENTER TO CONTINUE.
HELP: F1
Responses:
CONTINUE
CP - Page 10 of 43
MEPS_V2
Full Detail Spec
Programmer
Instructions:
Charge/Payment (CP) Section
(Instr
If event type is ER, OP, MV, or DN and person-provider pair is flagged as ‘COPAYMENT
SITUATION’ for the current round, go to CP60.
Otherwise, go to CP70.
Display
Instructions:
Display '{your/{PERSON}'s} stay at {HOSPITAL} that began on {ADMIT DATE}' if event type is
HS.
Display '{your/{PERSON}'s} visit to {PROVIDER} on {VISIT DATE}' if event type is ER, OP, MV,
OR DN.
Display the '{OME ITEM GROUP NAME} used by {you/{PERSON}} since {START DATE}' if
event type is OM.
Display 'services received at home from {PROVIDER} during {MONTH} for {you/{PERSON}}' if
event type is HH.
Display '{Let's begin with the charges from the hospital itself, not including any separate physician
services or lab tests.}' if event type is HS.
For {OME ITEM GROUP NAME}, display the name of the other medical expenses item group being
asked about for this event, as follows:
Display ‘glasses or contact lenses’ if this is an event for 'GLASSES OR CONTACT LENSES'
(EE40='1' YES, EE50='1' YES, or OM10='1' YES).
Display ‘ambulance services’ if This is an OM event for 'AMBULANCE SERVICES' (OM30='1'
YES)
Display ‘disposable supplies’ if this is an OM event for 'DISPOSABLE SUPPLIES' (OM40='1'
YES)
Display ‘long-term medical equipment’ if this is an OM event for 'LONG-TERM MEDICAL
EQUIPMENT' (OM50='1' YES).
Testing/Editing
Notes:
Variable collected at MEPSSpring2018.CP_Main
Variable collected at MEPSSpring2018.OM_Main.OM_LOOP10[1..4].CP_Main
Variable stored at MEPSSpring2018_Event.CP_Main
Variable stored at MEPSSpring2018_PersSect.OM_Main.OM_LOOP10[1..4].CP_Main
CP - Page 11 of 43
MEPS_V2
Charge/Payment (CP) Section
(Que
Full Detail Spec
CP60
Item Type:
Type Class:
Answer Type:
(CP1075)
Question
Enumerated
TYESNO
Help Available (CPayHelp)
Context Header:
BLAISE NAME: CPayOnlyAmt
Field kind: Datafield
ArrayMin:
Min value:
Field Size:
Answers allowed: 1
ArrayMax:
Max value:
Show Card (
)
Look Up File (
)
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER} {EV} {EVNDT/REF-DT}
{REPEAT VISIT: {NAME OF REPEAT VISIT GROUP}}
Question Text:
Is this the type of situation where {you/{PERSON}} (or someone in the family) {only paid the {$ AMT COPAY}
copayment/paid nothing} for this visit and {you/he/she} {do/does} not know the total charge?
HELP: F1
Responses:
YES
NO
REFUSED
DON'T KNOW
1
2
RF
DK
CP - Page 12 of 43
BOX_130
CP70
CP70
CP70
(CP1485)
(CP1080)
(CP1080)
(CP1080)
MEPS_V2
Full Detail Spec
Programmer
Instructions:
Charge/Payment (CP) Section
(Que
If coded ‘1’ (YES), copy all previous copayment charge payment data for the person-provider
pair to this event-provider-pair.
If coded ‘2’ (NO), 'RF' (REFUSED), or ‘DK’ (DON’T KNOW), do NOT copy the
copayment charge payment data for this person-provider pair to this event-provider pair. Full
charge payment data for this event-provider pair will be collected. The copayment flag
remains unchanged for this person-provider pair, however, it is not applied to this particular
event.
Display
Instructions:
Display 'only paid the {$ AMT COPAY} copayment' if this person-provider pair's copayment
amount for the current round does not equal zero ($0).
For '$ AMT COPAY': Display the current copayment amount for this person-provider pair for
this round (confirmed at CP10, updated at CP30, or amount entered at CP200 and set as
current copayment amount per BOX_140).
Display 'paid nothing' if this person-provider pair's copayment amount for the current round
equals zero ($0).
Testing/Editing
Notes:
Variable collected at MEPSSpring2018.CP_Main
Variable collected at MEPSSpring2018.OM_Main.OM_LOOP10[1..4].CP_Main
Variable stored at MEPSSpring2018_Event.CP_Main
Variable stored at MEPSSpring2018_PersSect.OM_Main.OM_LOOP10[1..4].CP_Main
CP - Page 13 of 43
MEPS_V2
Charge/Payment (CP) Section
(Que
Full Detail Spec
CP70
Item Type:
Type Class:
Answer Type:
(CP1080)
Question
Enumerated
TYESNO4
Help Available (RcvBillHelp)
Context Header:
BLAISE NAME: EvpvRcvBill
Field kind: Datafield
ArrayMin:
Min value:
Field Size:
Answers allowed: 1
ArrayMax:
Max value:
Show Card (
)
Look Up File (
)
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER} {EV} {EVN-DT/REFDT}
{REPEAT VISIT: {NAME OF REPEAT VISIT GROUP}}
Question Text:
{Have/Has} {you/{PERSON}} (or anyone in the family) received anything in writing, such as a bill, receipt, or statement, for
{this hospital stay/this visit/the {OME ITEM GROUP NAME}/the services received at home}?
HELP: F1
Responses:
YES, AND DOCUMENTATION
AVAILABLE
YES, BUT DOCUMENTATION NOT
AVAILABLE
NO
REFUSED
DON'T KNOW
1
BOX_50
(CP1096)
2
BOX_50
(CP1096)
CP80
CP80
CP80
(CP1085)
(CP1085)
(CP1085)
3
RF
DK
CP - Page 14 of 43
MEPS_V2
Full Detail Spec
Display
Instructions:
Charge/Payment (CP) Section
(Que
Display ‘this hospital stay’ if event type is HS.
Display ‘this visit’ if event type is ER, OP, MV, OR DN.
Display ‘the {OME ITEM GROUP NAME}’ if event type is OM.
Display ‘the services received at home’ if event type is HH.
For {OME ITEM GROUP NAME} display the name of the other medical expenses item group being
asked about for this event.
Display ‘glasses or contact lenses’ if this is an OM event for ‘GLASSES OR CONTACT
LENSES’(EE40=’1’ YES, EE50=’1’ YES, or OM10= '1' YES) .
Display ‘ambulance services’ if this is an OM event for ‘AMBULANCE SERVICES’ (OM30= ‘1’
YES) .
Display ‘disposable supplies’ if this is an OM event for ‘DISPOSABLE SUPPLIES’ (OM40= ‘1’
YES).
Display ‘long-term medical equipment’ if this is an OM event for ‘LONG-TERM MEDICAL
EQUIPMENT’ (OM50= ‘1’ YES).
Testing/Editing
Notes:
Variable collected at MEPSSpring2018.CP_Main
Variable collected at MEPSSpring2018.OM_Main.OM_LOOP10[1..4].CP_Main
Variable stored at MEPSSpring2018_Event.CP_Main
Variable stored at MEPSSpring2018_PersSect.OM_Main.OM_LOOP10[1..4].CP_Main
CP - Page 15 of 43
MEPS_V2
Charge/Payment (CP) Section
(Que
Full Detail Spec
CP80
Item Type:
Type Class:
Answer Type:
(CP1085)
Question
Enumerated
TYNOBILL
Help Available (YNoBillHelp)
Context Header:
BLAISE NAME: EvpvYNoBill
Field kind: Datafield
ArrayMin:
Min value:
Field Size:
Answers allowed: 1
ArrayMax:
Max value:
Show Card (CP-1)
Look Up File (
)
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER} {EV} {OME ITEM GROUP NAME} {EVN-DT/REF-DT}
{REPEAT VISIT: {NAME OF REPEAT VISIT GROUP}}
Question Text:
& CP-1.
Please look at card CP-1. Why {have/has} {you/{PERSON}} (or anyone in the family) not received anything in writing?
{SELECT 'INCLUDED WITH OTHER CHARGES’ IF THIS IS A FLAT FEE SITUATION.}
HELP: F1
Responses:
PAID AT TIME OF VISIT
MADE A COPAYMENT
BILL SENT DIRECTLY TO OTHER
SOURCE
BILL HAS NOT ARRIVED
NO BILL SENT: HMO PLAN
NO BILL SENT: VA (VETERANS
ADMINISTRATION)/CHAMPVA
NO BILL SENT: MILITARY FACILITY
NO BILL SENT: PUBLIC
ASSISTANCE/MEDICAID/SCHIP
NO BILL SENT: INDIAN HEALTH
SERVICE (IHS)
NO BILL SENT: WORKER'S
COMPENSATION
NO BILL SENT: PRIVATE HEALTH
CENTER/CLINIC
NO BILL SENT: PUBLIC CLINIC/HEALTH
CENTER OR PRIVATE CHARITY
NO CHARGE: TELEPHONE CALL
FREE FROM PROVIDER
GOVERNMENT-FINANCED RESEARCH
AND CLINICAL TRIALS
{INCLUDED WITH OTHER CHARGES
(E.G. FLAT FEE)}
REFUSED
DON'T KNOW
1
2
3
BOX_50
BOX_50
CP90
(CP1096)
(CP1096)
(CP1090)
4
5
6
BOX_50
BOX_50
BOX_50
(CP1096)
(CP1096)
(CP1096)
7
8
BOX_50
BOX_50
(CP1096)
(CP1096)
9
BOX_50
(CP1096)
10
BOX_50
(CP1096)
11
BOX_50
(CP1096)
12
BOX_50
(CP1096)
13
14
15
BOX_130
BOX_130
BOX_130
(CP1485)
(CP1485)
(CP1485)
BOX_50
BOX_50
(CP1096)
(CP1096)
95
RF
DK
CP - Page 16 of 43
MEPS_V2
Charge/Payment (CP) Section
(Que
Full Detail Spec
Programmer
Instructions:
If 'INCLUDED WITH OTHER CHARGES (E.G. FLAT FEE)' is selected, and eventprovider pair does not represent a repeat visit group or this is not an OM event, ask the Flat
Fee (FF) section immediately. Charge Payment information in the context of the single event
is no longer needed.
Display
Instructions:
Display the interviewer instruction “SELECT ‘INCLUDED WITH OTHER CHARGES’ IF
THIS IS A FLAT FEE SITUATION.” if event-provider pair does not represent repeat visit
stem or this is not an OM event. Otherwise, use a null display.
Display response option 95 ‘'INCLUDED WITH OTHER CHARGES (E.G. FLAT FEE)’ if
event provider pair does not represent a repeat visit stem or this is not an OM event.
Otherwise, use a null display.
Variable collected at MEPSSpring2018.CP_Main
Variable collected at MEPSSpring2018.OM_Main.OM_LOOP10[1..4].CP_Main
Variable stored at MEPSSpring2018_Event.CP_Main
Variable stored at MEPSSpring2018_PersSect.OM_Main.OM_LOOP10[1..4].CP_Main
Testing/Editing
Notes:
BLAISE NAME: EvpvWhereBill
CP90
Item Type:
(CP1090)
Question
Type Class:
String
Answer Type:
{Continuous Answer.} Answers allowed: 1
Help Available (
Context Header:
)
Field kind: Datafield
ArrayMin:
Min value:
ArrayMax:
Max value:
Field Size: 45
Show Card (
)
Look Up File (
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER} {EV}{OME ITEM GROUP NAME} {EVN-DT/REF-DT}
{REPEAT VISIT: {NAME OF REPEAT VISIT GROUP}}
Question Text:
To whom was the bill sent?
RECORD VERBATIM.
Responses:
REFUSED
DON'T KNOW
RF
DK
CP - Page 17 of 43
CP100
(CP1095)
CP100
CP100
(CP1095)
(CP1095)
)
MEPS_V2
Charge/Payment (CP) Section
(Que
Full Detail Spec
Display
Instructions:
Testing/Editing
Notes:
CP100
Item Type:
Type Class:
Answer Type:
Variable collected at MEPSSpring2018.CP_Main
Variable collected at MEPSSpring2018.OM_Main.OM_LOOP10[1..4].CP_Main
Variable stored at MEPSSpring2018_Event.CP_Main
Variable stored at MEPSSpring2018_PersSect.OM_Main.OM_LOOP10[1..4].CP_Main
(CP1095)
Question
Enumerated
TWHOBILLC
Help Available (WhereBillTpHelp)
Context Header:
BLAISE NAME: EvpvWhereBillTp
Field kind: Datafield
ArrayMin:
Min value:
Field Size:
Answers allowed: 1
ArrayMax:
Max value:
Show Card (
)
Look Up File (
)
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER} {EV} {OME ITEM GROUP NAME} {EVN-DT/REF-DT}
{REPEAT VISIT: {NAME OF REPEAT VISIT GROUP}}
Question Text:
INTERVIEWER: SELECT TYPE OF ORGANIZATION TO WHOM BILL WAS SENT:
HELP: F1
Responses:
HMO
VA (VETERANS
ADMINISTRATION)/CHAMPVA
TRICARE
OTHER MILITARY
PUBLIC ASSISTANCE/MEDICAID/SCHIP
WORKER'S COMPENSATION
PRIVATE INSURANCE COMPANY
INDIAN HEALTH SERVICE (IHS)
OTHER
REFUSED
DON'T KNOW
1
2
BOX_50
BOX_50
(CP1096)
(CP1096)
3
4
5
6
7
8
91
RF
DK
BOX_50
BOX_50
BOX_50
BOX_50
BOX_50
BOX_50
BOX_50
BOX_50
BOX_50
(CP1096)
(CP1096)
(CP1096)
(CP1096)
(CP1096)
(CP1096)
(CP1096)
(CP1096)
(CP1096)
CP - Page 18 of 43
MEPS_V2
Charge/Payment (CP) Section
(Que
Full Detail Spec
Display
Instructions:
Variable collected at MEPSSpring2018.CP_Main
Variable collected at MEPSSpring2018.OM_Main.OM_LOOP10[1..4].CP_Main
Variable stored at MEPSSpring2018_Event.CP_Main
Variable stored at MEPSSpring2018_PersSect.OM_Main.OM_LOOP10[1..4].CP_Main
Testing/Editing
Notes:
BOX_50
(CP1096)
Route Details:
Item Type: Route
Type Class: If Then
If event is for orthodontics (DN20=12 ‘ORTHODONTIA, BRACES , OR
RETAINERS ’) or dental restorative services (DN20=6 ‘FILLINGS , INLAYS , CROWNS
OR CAPS ’ or 7 ‘Root Canal’), go to CP110.
Otherwise, go to BOX_60.
CP110
Item Type:
(CP1097)
Question
Type Class:
Enumerated
TYESNO
Answer Type:
Help Available (
Context Header:
)
BLAISE NAME: FFeeSituation
Field kind: Datafield
ArrayMin:
Min value:
ArrayMax:
Max value:
Field Size:
Answers allowed: 1
Show Card (
)
Look Up File (
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER} {EV} {EVN-DT/REF-DT}
{REPEAT VISIT: {NAME OF REPEAT VISIT GROUP}}
Question Text:
Sometimes a person can be charged a ‘lump sum’ for orthodontia or dental restorative treatments that require a series of visits
like braces, retainers, fillings, inlays, crowns, or caps. We call this “a flat fee situation.” Is {your/{PERSON}'s} visit to
{PROVIDER} on {VISIT DATE} part of a flat fee?
Responses:
YES
NO
REFUSED
DON'T KNOW
1
2
RF
DK
CP - Page 19 of 43
BOX_60
BOX_60
BOX_60
(CP1098)
(CP1098)
(CP1098)
)
MEPS_V2
Charge/Payment (CP) Section
(Que
Full Detail Spec
Programmer
Instructions:
If coded ‘1’ YES, and event-provider pair does not represent a repeat visit group, ask the Flat
Fee (FF) section immediately. Charge Payment information in the context of the single event
is no longer needed.
Display
Instructions:
Testing/Editing
Notes:
BOX_60
Route Details:
Variable collected at MEPSSpring2018.CP_Main
Variable collected at MEPSSpring2018.OM_Main.OM_LOOP10[1..4].CP_Main
Variable stored at MEPSSpring2018_Event.CP_Main
Variable stored at MEPSSpring2018_PersSect.OM_Main.OM_LOOP10[1..4].CP_Main
(CP1098)
Item Type: Route
Type Class: If Then
If CP70 is coded ‘1’ (YES, AND DOCUMENTATION AVAILABLE) or ‘2’ (YES, BUT
DOCUMENTATION NOT AVAILABLE);
or
If CP80 is coded ‘1’ (PAID AT TIME OF VISIT), ‘2’ (MADE A COPAYMENT), ‘4’
(BILL HAS NOT ARRIVED), ‘DK’ (DON’T KNOW), or ‘RF’ (REFUSED);
or
If CP100 is coded ‘3’ (TRICARE), ‘91’ (OTHER), ‘DK’ (DON’T KNOW), or ‘RF’
(REFUSED);
Go to CP120.
Otherwise, continue with BOX_70.
BOX_70
Route Details:
(CP1100)
Item Type: Route
Type Class: If Then
If:
- Event type is OM OR HH
or
- event type is HS ,
go to CP200.
Otherwise, go to CP170.
CP - Page 20 of 43
MEPS_V2
Charge/Payment (CP) Section
(Que
Full Detail Spec
CP120
Item Type:
Type Class:
Answer Type:
(CP1105)
Question
Enumerated
TYESNO95
Help Available (EvpvChrgHelp)
Context Header:
BLAISE NAME: EvpvKnowTotal
Field kind: Datafield
ArrayMin:
Min value:
Field Size:
Answers allowed: 1
ArrayMax:
Max value:
Show Card (
)
Look Up File (
)
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER} {EV} {EVN-DT/REF-DT}
{REPEAT VISIT: {NAME OF REPEAT VISIT GROUP}}
Question Text:
Do you know the total charge for {this hospital stay/this visit/the {OME ITEM GROUP NAME}/the services received at
home}?
{ENTER 'INCLUDED WITH OTHER CHARGES' IF THIS IS A FLAT FEE SITUATION.}
HELP: F1
Responses:
YES
NO
{INCLUDED WITH OTHER CHARGES
(E.G. FLAT FEE)}
REFUSED
DON'T KNOW
1
2
95
RF
DK
CP - Page 21 of 43
BOX_80
(CP1106)
MEPS_V2
Full Detail Spec
Programmer
Instructions:
Charge/Payment (CP) Section
(Que
If:
Coded '2' (NO), 'RF' (REFUSED), or 'DK' (DON'T KNOW)
And
(event type is OM or HH or HS,
go to CP200.
If:
coded '2' (NO), 'RF' (REFUSED), or 'DK' (DON'T KNOW)
And
event type is ER, OP, MV, or DN, go to CP170.
If coded 95 'INCLUDED WITH OTHER CHARGES' (E.G. FLAT FEE)' and the eventprovider pair does not represent a repeat visit group or this is not an OM event, ask the Flat
Fee (FF) section immediately. Charge Payment information in the context of the single event
is no longer needed.
Display
Instructions:
Display 'this hospital stay' if event type is HS.
Display 'this visit' if event type is ER, OP, MV, or DN.
Display 'the {OME ITEM GROUP NAME}' if event type is OM.
Display 'the services received at home' if event type is HH.
Display the interviewer instruction "ENTER ‘INCLUDED WITH OTHER CHARGES’ IF THIS IS A
FLAT FEE SITUATION" if event-provider pair does not represent a repeat visit stem or this is not an
OM event. Otherwise, use a null display.
For '{OME ITEM GROUP NAME}' display the name of the other medical expenses item group being
asked about for this event as follows:
Display ‘glasses or contact lenses’ if this is an OM event for ‘GLASSES OR CONTACT
LENSES’(EE40=’1’ YES, EE50=’1’ YES, or OM10= '1' YES) .
Display ‘ambulance services’ if this is an OM event for ‘AMBULANCE SERVICES’ (OM30= ‘1’
YES) .
Display ‘disposable supplies’ if this is an OM event for ‘DISPOSABLE SUPPLIES’ (OM40= ‘1’
YES).
Display ‘long-term medical equipment’ if this is an OM event for ‘LONG-TERM MEDICAL
EQUIPMENT’ (OM50= ‘1’ YES).
Display response option 95 ‘'INCLUDED WITH OTHER CHARGES (E.G. FLAT FEE)’ if event
provider pair does not represent a repeat visit stem or this is not an OM event.
Otherwise, use a null display.
Testing/Editing
Notes:
Variable collected at MEPSSpring2018.CP_Main
Variable collected at MEPSSpring2018.OM_Main.OM_LOOP10[1..4].CP_Main
Variable stored at MEPSSpring2018_Event.CP_Main
Variable stored at MEPSSpring2018_PersSect.OM_Main.OM_LOOP10[1..4].CP_Main
CP - Page 22 of 43
MEPS_V2
Charge/Payment (CP) Section
(Que
Full Detail Spec
BOX_80
Route Details:
(CP1106)
If the current event type is OM = ‘3’ (DIS POS ABLE S UPPLIES ) then go to CP130.
Else go to CP140.
CP130
Item Type:
(CP1107)
Question
Type Class:
Enumerated
Answer Type:
TCTOTCHRG
Help Available (TotChrgHelp)
Context Header:
Type Class: If Then
Item Type: Route
BLAISE NAME: EvpvTotChrgRng
Field kind: Datafield
ArrayMin:
Min value:
Field Size:
Answers allowed: 1
ArrayMax:
Max value:
Show Card (CP-2)
Look Up File (
)
{PERSON'S FIRST MIDDLE AND LAST NAME} {EV} {REF-DT}
Question Text:
&CP-2
Please look at card CP-2, and tell me how much the total charge was for all of the disposable supplies purchased {since
{START DATE}/between {START DATE} and {END DATE}}? Include any amounts that may be paid by health insurance
or other sources. Was it $0, $1 to $10, $11 to $30, $31 to $100, $101 or more?
HELP: F1
Responses:
$0
$1 TO $10
$11 TO $30
$31 TO $100
$101 OR MORE
REFUSED
DON'T KNOW
1
2
3
4
5
RF
DK
BOX_130
CP180
CP180
CP180
CP180
CP190
CP190
(CP1485)
(CP1126)
(CP1126)
(CP1126)
(CP1126)
(CP1127)
(CP1127)
Display
Instructions:
Display 'Since {START DATE}' if not round 5. Display 'Between {START DATE} and
{END DATE}', if round 5.
Testing/Editing
Notes:
Variable collected at MEPSSpring2018.CP_Main
Variable collected at MEPSSpring2018.OM_Main.OM_LOOP10[1..4].CP_Main
Variable stored at MEPSSpring2018_Event.CP_Main
Variable stored at MEPSSpring2018_PersSect.OM_Main.OM_LOOP10[1..4].CP_Main
CP - Page 23 of 43
MEPS_V2
Charge/Payment (CP) Section
(Que
Full Detail Spec
CP140
Item Type:
Type Class:
Answer Type:
(CP1110)
Question
Enumerated
TTCHRG
Help Available (EvpvChrgHelp)
Context Header:
BLAISE NAME: EvpvChrgTp
Field kind: Datafield
ArrayMin:
Min value:
Field Size:
Answers allowed: 1
ArrayMax:
Max value:
Show Card (
)
Look Up File (
)
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER} {EV} {OME ITEM GROUP NAME} {EVN-DT/REF-DT}
{REPEAT VISIT: {NAME OF REPEAT VISIT GROUP}}
Question Text:
How much was the total charge, including any amounts that may be paid by health insurance or other sources?
{Do not include any services billed for separately such as physician charges or other services.} {Include charges for
procedures such as x-rays, lab tests, or diagnostic procedures that are listed separately on the {hospital} bill {or statement}.}
IF WORKING FROM DOCUMENTATION, ENTER TOTAL CHARGES. DO NOT DEDUCT DISCOUNTS OR
DISALLOWED OR DENIED CHARGES.
{SELECT 'INCLUDED WITH OTHER CHARGES' IF THIS IS A FLAT FEE SITUATION.}
HELP: F1
Responses:
AMOUNT
{INCLUDED WITH OTHER CHARGES
(E.G. FLAT FEE)}
1
95
CP - Page 24 of 43
CP150
(CP1115)
MEPS_V2
Full Detail Spec
Charge/Payment (CP) Section
(Que
Programmer
Instructions:
If coded ‘95’ 'INCLUDED WITH OTHER CHARGES (E.G. FLAT FEE)' and the eventprovider-pair does not represent a repeat visit group or this is not an OM event, ask the Flat
Fee (FF) section immediately. Charge Payment information in the context of the single event
is no longer needed.
Display
Instructions:
Display 'Do not include any services billed for separately such as physician charges or other services if
event type is HS, ER, or OP. Otherwise, use a null display.
Display 'Include charges for procedures such as x-rays, lab tests, or diagnostic procedures that are listed
separately on the {hospital} bill {or statement}.” if CP70 is coded '1' (YES, AND DOCUMENTATION
AVAILABLE). Otherwise, use a null display.
Display 'hospital' if event type is HS, ER, or OP. Otherwise, use a null display. Display 'or statement' if
event type is MV, DN, OM, or HH. Otherwise, use a null display.
Display interviewer instruction “SELECT ‘INCLUDED WITH OTHER CHARGES’ IF THIS IS A
FLAT FEE SITUATION” if event-provider pair does not
represent a repeat visit stem or this is not a OM event. Otherwise, use a null display.
Display response option 95 ‘'INCLUDED W/OTHER CHARGES (E.G. FLAT FEE)’ if event provider
pair does not represent a repeat visit stem or this is not an OM event.
Otherwise, use a null display.
Testing/Editing
Notes:
Variable collected at MEPSSpring2018.CP_Main
Variable collected at MEPSSpring2018.OM_Main.OM_LOOP10[1..4].CP_Main
Variable stored at MEPSSpring2018_Event.CP_Main
Variable stored at MEPSSpring2018_PersSect.OM_Main.OM_LOOP10[1..4].CP_Main
CP - Page 25 of 43
MEPS_V2
Charge/Payment (CP) Section
(Que
Full Detail Spec
CP150
Item Type:
Type Class:
Answer Type:
(CP1115)
Question
Integer
Field kind: Datafield
Field Size: 6
{Continuous Answer.} Answers allowed: 1
Help Available (EvpvChrgHelp)
Context Header:
BLAISE NAME: EvpvTotChrg
ArrayMin:
Min value: 0
ArrayMax:
Max value: 999999
Show Card (
)
Look Up File (
)
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER} {EV} {EVN-DT/REF-DT}
{REPEAT VISIT: {NAME OF REPEAT VISIT GROUP}}
Question Text:
[How much was the total charge, including any amounts that may be paid by health insurance or other sources?]
{[Do not include any services billed for separately such as physician charges or other services.} {Include charges for
procedures such as x-rays, lab tests, or diagnostic procedures that are listed separately on the {hospital} bill {or statement}.]}
[IF WORKING FROM DOCUMENTATION, ENTER TOTAL CHARGES. DO NOT DEDUCT DISCOUNTS OR
DISALLOWED OR DENIED CHARGES.]
ENTER AMOUNT.
HELP: F1
Responses:
REFUSED
DON'T KNOW
RF
DK
CP - Page 26 of 43
MEPS_V2
Full Detail Spec
Programmer
Instructions:
Charge/Payment (CP) Section
(Que
If the amount is $0, go to BOX_130.
If:
event type is ER, OP, MV, or DN
and
total charge is a non-zero whole number < or = $50.00 or CP150 is coded 'RF' (REFUSED)
or 'DK' (DON’T KNOW), go to CP170.
If the amount is not $0, DK, or RF and the event type is HH, continue with CP160.
Otherwise, go to CP200.
Soft check: If amount entered is > or = $100,000, display the following message: display the
following message: "VALUE IS HIGHER THAN USUAL. VERIFY AND CORRECT IF NEEDED."
Hard check:
Amount cannot be < 0.
Display
Instructions:
Display the question text "How much…other sources?" and "IF WORKING...DENIED CHARGES" in
brackets and grayed-out text.
Display 'Do not include any services billed for separately such as physician charges or other services.'
in brackets and grayed-out text, if event type is HS, ER, or OP. Otherwise, use a null display.
Display 'Include charges for procedures such as x-rays, lab tests, or diagnostic procedures that are listed
separately on the {hospital} bill {or statement}.” In brackets and grayed-out text, if CP70 is coded '1'
(YES, AND DOCUMENTATION AVAILABLE). Otherwise, use a null display.
Display 'hospital' if event type is HS, ER, or OP. Otherwise, use a null display. Display 'or statement' if
event type is MV, DN, OM, or HH. Otherwise, use a null display.
Testing/Editing
Notes:
Variable collected at MEPSSpring2018.CP_Main
Variable collected at MEPSSpring2018.OM_Main.OM_LOOP10[1..4].CP_Main
Variable stored at MEPSSpring2018_Event.CP_Main
Variable stored at MEPSSpring2018_PersSect.OM_Main.OM_LOOP10[1..4].CP_Main
CP - Page 27 of 43
MEPS_V2
Charge/Payment (CP) Section
(Que
Full Detail Spec
CP160
Item Type:
Type Class:
Answer Type:
Help Available (
Context Header:
(CP1120)
Question
Enumerated
BLAISE NAME: EvpvMonthly
Field kind: Datafield
Field Size:
TYESNO_MONTHL Answers allowed: 1
)
Show Card (
ArrayMin:
Min value:
ArrayMax:
Max value:
)
Look Up File (
)
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER} {EV} {EVN-DT/REF-DT}
{REPEAT VISIT: {NAME OF REPEAT VISIT GROUP}}
Question Text:
You said that the total charge for the services received at home was {$ AMOUNT}. Is that dollar amount a monthly amount
or not?
Responses:
Programmer
Instructions:
YES, MONTHLY AMOUNT
NO, NOT A MONTHLY AMOUNT
REFUSED
DON'T KNOW
1
2
RF
DK
CP200
(CP1130)
CP200
CP200
(CP1130)
(CP1130)
{$ AMOUNT}: Display amount entered at CP150.
Hard Check:
If coded ‘2’ (NO), display the following message: “IF {$ AMOUNT} IS NOT THE
MONTHLY AMOUNT CHARGED, CORRECT TOTAL CHARGE AT CP150
(EvpvTotChrg).” CAPI displays a selection CP150 as an option to return to. Code ‘2’ (NO)
is never allowed as a final response at CP160.
Display
Instructions:
Testing/Editing
Notes:
Variable collected at MEPSSpring2018.CP_Main
Variable collected at MEPSSpring2018.OM_Main.OM_LOOP10[1..4].CP_Main
Variable stored at MEPSSpring2018_Event.CP_Main
Variable stored at MEPSSpring2018_PersSect.OM_Main.OM_LOOP10[1..4].CP_Main
CP - Page 28 of 43
MEPS_V2
Charge/Payment (CP) Section
(Que
Full Detail Spec
CP170
Item Type:
Type Class:
Answer Type:
(CP1125)
Question
Enumerated
TYESNOFF2
Help Available (EvpySetAmtHelp)
Context Header:
BLAISE NAME: EvpvSetAmt
Field kind: Datafield
ArrayMin:
Min value:
Field Size:
Answers allowed: 1
ArrayMax:
Max value:
Show Card (
)
Look Up File (
)
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER} {EV} {EVN-DT/REF-DT}
{REPEAT VISIT: {NAME OF REPEAT VISIT GROUP}}
Question Text:
Is this the type of situation in which {you/he/she} always {make/makes} the same set dollar amount copayment regardless of
what happens during the visit?
HELP: F1
Responses:
YES
NO
USUALLY PAYS $0 (REGARDLESS OF
SERVICE)
REFUSED
DON'T KNOW
1
2
3
CP200
CP200
CP200
(CP1130)
(CP1130)
(CP1130)
RF
DK
CP200
CP200
(CP1130)
(CP1130)
Display
Instructions:
Testing/Editing
Notes:
Variable collected at MEPSSpring2018.CP_Main
Variable collected at MEPSSpring2018.OM_Main.OM_LOOP10[1..4].CP_Main
Variable stored at MEPSSpring2018_Event.CP_Main
Variable stored at MEPSSpring2018_PersSect.OM_Main.OM_LOOP10[1..4].CP_Main
CP - Page 29 of 43
MEPS_V2
Charge/Payment (CP) Section
(Que
Full Detail Spec
CP180
Item Type:
Type Class:
Answer Type:
(CP1126)
Question
Enumerated
Field kind: Datafield
Field Size:
THWTOTCHRGFAM Answers allowed: 1
Help Available (AmtUPayHelp)
Context Header:
BLAISE NAME: EvpvFamPaid
ArrayMin:
Min value:
ArrayMax:
Max value:
Show Card (
)
Look Up File (
)
{PERSON'S FIRST MIDDLE AND LAST NAME} {EV} {OME ITEM GROUP NAME}
{REF-DT}
Question Text:
How much of the total charge for the disposable supplies did anyone in the family pay ‘out-of-pocket,’ that is, before any
reimbursements? Was it all or almost all of the total charge, none of the total charge, or some of the total charge?
HELP: F1
Responses:
ALL OR ALMOST ALL OF THE TOTAL
CHARGE
NONE OF THE TOTAL CHARGE
OR SOME OF THE TOTAL CHARGE
REFUSED
DON'T KNOW
1
BOX_90
(CP1145)
2
3
RF
DK
BOX_90
CP190
CP190
CP190
(CP1145)
(CP1127)
(CP1127)
(CP1127)
Display
Instructions:
Testing/Editing
Notes:
Variable collected at MEPSSpring2018.CP_Main
Variable collected at MEPSSpring2018.OM_Main.OM_LOOP10[1..4].CP_Main
Variable stored at MEPSSpring2018_Event.CP_Main
Variable stored at MEPSSpring2018_PersSect.OM_Main.OM_LOOP10[1..4].CP_Main
CP - Page 30 of 43
MEPS_V2
Charge/Payment (CP) Section
(Que
Full Detail Spec
CP190
Item Type:
Type Class:
Answer Type:
(CP1127)
Question
Enumerated
BLAISE NAME: EvpvAmtUPayRng
Field kind: Datafield
Field Size:
TTOTCHRGOUTPKT Answers allowed: 1
Help Available (AmtUPayHelp)
ArrayMin:
Min value:
ArrayMax:
Max value:
Show Card (
)
Look Up File (
)
Question Text:
& CP-2
Please look at card CP-2, and tell me how much of the total charges for the disposable supplies did anyone in the family pay
‘out-of-pocket,’ that is, before any reimbursements? Was it $0, $1 to $10, $11 to $30, $31 to $100, $101 or more?
HELP: F1
Responses:
$0
$1 TO $10
$11 TO $30
$31 TO $100
$101 OR MORE
REFUSED
DON'T KNOW
1
2
3
4
5
RF
DK
BOX_90
BOX_90
BOX_90
BOX_90
BOX_90
BOX_90
BOX_90
(CP1145)
(CP1145)
(CP1145)
(CP1145)
(CP1145)
(CP1145)
(CP1145)
Display
Instructions:
Testing/Editing
Notes:
Variable collected at MEPSSpring2018.CP_Main
Variable collected at MEPSSpring2018.OM_Main.OM_LOOP10[1..4].CP_Main
Variable stored at MEPSSpring2018_Event.CP_Main
Variable stored at MEPSSpring2018_PersSect.OM_Main.OM_LOOP10[1..4].CP_Main
CP - Page 31 of 43
MEPS_V2
Charge/Payment (CP) Section
(Que
Full Detail Spec
CP200
Item Type:
Type Class:
Answer Type:
(CP1130)
Question
Integer
BLAISE NAME: EvpvAmtUPay
{Continuous Answer.} Answers allowed: 1
Help Available (AmtUPayHelp)
Context Header:
Field kind: Datafield
Field Size: 6
ArrayMin:
Min value: 0
ArrayMax:
Max value: 999999
Show Card (
)
Look Up File (
)
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER} {EV} {OME ITEM GROUP NAME} {EVN-DT/REF-DT}
{REPEAT VISIT: {NAME OF REPEAT VISIT GROUP}}
Question Text:
How much of the {{AMT TOT CH}/total charge} did anyone in the family pay 'out-of-pocket,' that is, before any
reimbursements?
IF AMOUNT PAID IS NOTHING, ENTER 0.
ENTER AMOUNT.
HELP:F1
Responses:
REFUSED
DON'T KNOW
Programmer
Instructions:
Display
Instructions:
RF
DK
BOX_90
(CP1145)
BOX_90
BOX_90
(CP1145)
(CP1145)
Soft check: If amount entered is > or = $10,000, display the following message: “VALUE IS
HIGHER THAN USUAL. VERIFY AND CORRECT IF NEEDED."
Display ‘{AMT TOT CH}’ if an amount is given for the total charge at CP150. Display ‘total charge’ if
CP120 is coded ‘2’ (NO), ‘RF’ (REFUSED), ‘DK’ (DON’T KNOW), if CP120 =1 but CP150 = RF or
DK, or is not asked.
For {AMT TOT CH} display the dollar amount entered at CP150.
Testing/Editing
Notes:
Variable collected at MEPSSpring2018.CP_Main
Variable collected at MEPSSpring2018.OM_Main.OM_LOOP10[1..4].CP_Main
Variable stored at MEPSSpring2018_Event.CP_Main
Variable stored at MEPSSpring2018_PersSect.OM_Main.OM_LOOP10[1..4].CP_Main
CP - Page 32 of 43
MEPS_V2
Charge/Payment (CP) Section
(Rout
Full Detail Spec
BOX_90
Route Details:
(CP1145)
Item Type: Route
Type Class: If Then
If:
CP200 is coded 'RF' (REFUS ED) or 'DK' (DON'T KNOW)
and
CP120 is coded '2' (NO), 'RF' (REFUS ED), or 'DK' (DON'T KNOW)
and
CP170 is coded '2' (NO), 'RF' (REFUS ED), or 'DK' (DON'T KNOW), go to BOX_130.
Otherwise, continue with CP210.
CP210
Item Type:
Type Class:
(CP1160)
Question
Answer Type:
TYESNO
Enumerated
Help Available (AnySrcPayHelp)
Context Header:
BLAISE NAME: EvpvAnySrcPay
Field kind: Datafield
ArrayMin:
Min value:
Field Size:
Answers allowed: 1
ArrayMax:
Show Card (
Max value:
)
Look Up File (
)
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER} {EV} {EVN-DT/REF-DT} {REPEAT VISIT: {NAME OF REPEAT VISIT
GROUP}}
Question Text:
Has any private insurance company, HMO, Medicare, Medicaid, or any other source made any payments {to {PROVIDER}}
for {this hospital stay/this visit/the {OME ITEM GROUP NAME}/the services received at home}?
HELP: F1
Responses:
YES
NO
REFUSED
DON'T KNOW
1
2
RF
DK
CP - Page 33 of 43
CP220
BOX_100
BOX_100
BOX_100
(CP1165)
(CP1295)
(CP1295)
(CP1295)
MEPS_V2
Full Detail Spec
Display
Instructions:
Charge/Payment (CP) Section
(Que
Display “to {PROVIDER}’ if event type is not OM. Otherwise, use a null display.
Display 'this hospital stay' if event type is HS. Display 'this visit' if event type is ER, OP, MV,
or DN.
Display 'the {OME ITEM GROUP NAME}' if event type is OM.
Display 'the services received at home' if event type is HH.
{OME ITEM GROUP NAME}: display the name of the other medical expenses item group being asked
about for this event.
Display ‘glasses or contact lenses’ if this is an OM event for ‘GLASSES OR CONTACT
LENSES’(EE40=’1’ YES, EE50=’1’ YES, or OM10= '1' YES) .
Display ‘ambulance services’ if this is an OM event for ‘AMBULANCE SERVICES’ (OM30= ‘1’
YES) .
Display ‘disposable supplies’ if this is an OM event for ‘DISPOSABLE SUPPLIES’ (OM40= ‘1’
YES).
Display ‘long-term medical equipment’ if this is an OM event for ‘LONG-TERM MEDICAL
EQUIPMENT’ (OM50= ‘1’ YES).
Testing/Editing
Notes:
Variable collected at MEPSSpring2018.CP_Main
Variable collected at MEPSSpring2018.OM_Main.OM_LOOP10[1..4].CP_Main
Variable stored at MEPSSpring2018_Event.CP_Main
Variable stored at MEPSSpring2018_PersSect.OM_Main.OM_LOOP10[1..4].CP_Main
CP - Page 34 of 43
MEPS_V2
Charge/Payment (CP) Section
(Que
Full Detail Spec
CP220
Item Type:
Type Class:
Answer Type:
(CP1165)
Question
Enumerated
TSOURCEPAY
Help Available (
Context Header:
)
BLAISE NAME: EvpvSOPRoster
Field kind: Datafield
ArrayMin:
Min value:
Field Size:
Answers allowed: 1
ArrayMax:
Max value:
Show Card (
)
Look Up File (
)
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER} {EV} {OME ITEM GROUP NAME} {EVN-DT/REF-DT}
{REPEAT VISIT: {NAME OF REPEAT VISIT GROUP}}
Question Text:
Who else paid?
PROBE: Anyone else?
TO ADD A NEW SOURCE OF PAYMENT, PRESS CTRL-A.
ENTER ALL THAT APPLY.
CTRL-A: ADD
CTRL-E: EDIT
CTRL-D: DELETE
Responses:
{Name of Source of Payment}
{Name of Source of Payment}
{Name of Source of Payment}
{Name of Source of Payment}
{Name of Source of Payment}
1
2
3
4
N
1
2
3
4
5
CP - Page 35 of 43
CP230
CP230
CP230
CP230
CP230
(CP1170)
(CP1170)
(CP1170)
(CP1170)
(CP1170)
MEPS_V2
Full Detail Spec
Programmer
Instructions:
Charge/Payment (CP) Section
(Que
Roster behavior:
1. Multiple select allowed.
2. Multiple add allowed.
3. Pressing CTRL-A displays a pop-up with a text entry field and a selectable list of 15
common sources of payment. (See BOX_20 for a detailed list). The interviewer can type a
new source or select one from the list. Upon return to CP220, the added source will appear on
the roster as selected.
4. Limited delete allowed. If interviewer adds a source of payment, delete is possible for that
source only, as long as the charge payment section for this person-provider pair has not been
completed.
5. Write sources selected to the Event’s-Sources-of- Payment-roster.
If at least one source is added or selected during the current round, the flag SOPFlag should
be set to YES.
Display
Instructions:
Roster 3- add/edit/delete allowed.
Roster definition:
Display the RU-Sources-Of-Payment-roster for selection.
Display payment source name (SRCS.SRCNAME)
Roster filter:
Display all sources of payment except PERSON/FAMILY
Testing/Editing
Notes:
Variable collected at MEPSSpring2018.CP_Main
Variable collected at MEPSSpring2018.OM_Main.OM_LOOP10[1..4].CP_Main
Variable stored at MEPSSpring2018_Event.CP_Main
Variable stored at MEPSSpring2018_PersSect.OM_Main.OM_LOOP10[1..4].CP_Main
CP - Page 36 of 43
MEPS_V2
Charge/Payment (CP) Section
(Que
Full Detail Spec
CP230
Item Type:
Type Class:
Answer Type:
Help Available (
Context Header:
(CP1170)
Question
Integer
BLAISE NAME: PayMAmtPaid
Field kind: Datafield
Field Size: 6
{Continuous Answer.} Answers allowed: 1
)
Show Card (
ArrayMin:
Min value: 0
ArrayMax:
Max value: 999999
)
Look Up File (
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER} {EV} {EVN-DT/REF-DT}
{REPEAT VISIT: {NAME OF REPEAT VISIT GROUP}}
Question Text:
How much did {SOURCE} pay?
ENTER AMOUNT.
TOTAL CHARGE: ${TOTAL CHARGE}
Responses:
REFUSED
DON'T KNOW
RF
DK
CP - Page 37 of 43
)
MEPS_V2
Charge/Payment (CP) Section
(Que
Full Detail Spec
Programmer
Instructions:
Preloaded Grid Type 2
Soft check: If amount entered is > $10,000, display the following message: "VALUE IS
HIGHER THAN USUAL. VERIFY AND CORRECT IF NEEDED."
Flag all sources and associated amounts as ‘payment’.
1. Interviewer enters a dollar amount for each source displayed. Amounts can be changed as
many times as necessary before the interviewer leaves the screen.
2. The PERSON/FAMILY amount paid cell is protected and prefilled with the family out-ofpocket payment amount entered at CP200; no changes are allowed to this amount.
Soft Check:
If any source coded ‘$0’, display the following message: “IF {SOURCE} DID NOT PAY
ANY PART OF THE TOTAL CHARGE, CORRECT THE SOURCES THAT MADE
DIRECT PAYMENTS TO THIS PROVIDER AT CP210 (AnySrcPay) OR CP220
(SOPRoster). IF {SOURCE} IS THE ONLY SOURCE OF DIRECT PAYMENT, GO TO
CP210 (AnySrcPay) AND CODE ‘2’ (NO). IF THERE ARE OTHER SOURCES OF
PAYMENT, GO TO CP220 (SOPRoster) AND DELETE {SOURCE} FROM THE LIST OF
SOURCES OF DIRECT PAYMENT. IF RESPONDENT DOES NOT KNOW HOW MUCH
{SOURCE} PAID, CODE “DK” AT CP230 (AmtPaid).”
Display
Instructions:
Roster 1- Report
Roster definition:
Display the Event’s-Sources-of-Payment-roster for entry of payment amount in the form pane.
Display payment source name.
Roster Filter:
Display all sources selected at CP220 for this event-provider pair and the
‘PERSON/FAMILY’ record.
For TOTAL CHARGE, display amount entered at CP130, if event is OM event type ‘3’
(DISPOSABLE SUPPLIES). Otherwise display amount entered at CP150.
Testing/Editing
Notes:
Variable collected at MEPSSpring2018.CP_Main.CP230Grid.CP230Grid[1..25]
Variable collected at
MEPSSpring2018.OM_Main.OM_LOOP10[1..4].CP_Main.CP230Grid.CP230Grid[1..25]
Variable stored at MEPSSpring2018_Event.CP_Main.CP230Grid.CP230Grid[1..25]
Variable stored at MEPSSpring2018
_PersSect.OM_Main.OM_LOOP10[1..4].CP_Main.CP230Grid.CP230Grid[1..25]
CP - Page 38 of 43
MEPS_V2
Charge/Payment (CP) Section
(Rout
Full Detail Spec
BOX_100
Route Details:
(CP1295)
Item Type: Route
Type Class: If Then
If the event type is OM event type ‘3’ (DISPOSABLE SUPPLIES), go to BOX_130
Otherwise, continue with BOX_110.
BOX_110
Route Details:
(CP1300)
Item Type: Route
Type Class: If Then
If CP150 (TOTAL CHARGE) or 'AMOUNT PAID' by any source of payment (all
payments sources, including PERS ON/FAMILY entered or displayed at CP230) is
coded 'RF' (REFUS ED) or 'DK' (DON'T KNOW), go to BOX_130.
Otherwise, continue with BOX_120.
BOX_120
Route Details:
(CP1305)
Item Type: Route
Type Class: If Then
Determine if there is an underpayment. Subtract the total payment (PERSON/FAMILY
entered at CP200 plus all payments sources entered at CP230) from the total charge entered
at CP150. If the value of the remainder is > 3% OR $5 (whichever is higher) of the total
charge, continue with CP240.
Otherwise, go to BOX_130.
NOTE: Negative values (overpayments) are not eligible for CP240.
CP - Page 39 of 43
MEPS_V2
Charge/Payment (CP) Section
(Que
Full Detail Spec
CP240
Item Type:
Type Class:
Answer Type:
Help Available (
Context Header:
(CP1310)
Question
Enumerated
TYESNO
)
BLAISE NAME: EvpvElsePay
Field kind: Datafield
ArrayMin:
Min value:
Field Size:
Answers allowed: 1
ArrayMax:
Max value:
Show Card (
)
Look Up File (
{PERSON'S FIRST MIDDLE AND LAST NAME} {NAME OF MEDICAL CARE
PROVIDER} {EV} {EVN-DT/REF-DT} {REPEAT VISIT: {NAME OF REPEAT VISIT
GROUP}}
Question Text:
Does anyone in the family or any other source expect to make additional payments for {this hospital stay/this visit/the {OME
ITEM GROUP NAME}/the services received at home}?
Responses:
Display
Instructions:
YES
NO
REFUSED
DON'T KNOW
1
2
RF
DK
BOX_130
BOX_130
BOX_130
BOX_130
(CP1485)
(CP1485)
(CP1485)
(CP1485)
Display ‘this hospital stay’ if event type is HS.
Display ‘this visit’ if event type is ER, OP, MV, OR DN.
Display ‘the {OME ITEM GROUP NAME}’ if event type is OM.
{OME ITEM GROUP NAME}: Display the name of the other medical expenses item group being
asked about for this event.
Display ‘glasses or contact lenses’ if this is an OM event for ‘GLASSES OR CONTACT
LENSES’(EE40=’1’ YES, EE50=’1’ YES, or OM10= '1' YES) .
Display ‘ambulance services’ if this is an OM event for ‘AMBULANCE SERVICES’ (OM30= ‘1’
YES) .
Display ‘long-term medical equipment’ if this is an OM event for ‘LONG-TERM MEDICAL
EQUIPMENT’ (OM50= ‘1’ YES).
Display 'the services received at home' if event type is HH.
Testing/Editing
Notes:
)
Variable collected at MEPSSpring2018.CP_Main
Variable collected at MEPSSpring2018.OM_Main.OM_LOOP10[1..4].CP_Main
Variable stored at MEPSSpring2018_Event.CP_Main
Variable stored at MEPSSpring2018_PersSect.OM_Main.OM_LOOP10[1..4].CP_Main
CP - Page 40 of 43
MEPS_V2
Charge/Payment (CP) Section
(Rout
Full Detail Spec
BOX_130
Route Details:
(CP1485)
Item Type: Route
Type Class: If Then
If:
event type is HS , OM, or HH, or
event type is ER, OP, MV, or DN and PERS ON-PROVIDER pair already flagged as
'COPAYMENT S ITUATION', go to BOX_150.
Otherwise, continue with BOX_140.
CP - Page 41 of 43
MEPS_V2
Charge/Payment (CP) Section
(Rout
Full Detail Spec
BOX_140
Route Details:
(CP1490)
Item Type: Route
Type Class: If Then
If
CP120 is coded ‘2’ (NO), ‘RF (REFUSED), or ‘DK’ (DON'T KNOW)
and
CP170 is coded ‘1’ (YES) or ‘3’ (USUALLY PAYS $0 REGARDLESS OF SERVICE)
and
CP200 is a whole dollar amount greater than or equal to (≥) $0 and less than or equal (≤)
to $50
Flag this person-provider pair as a ‘COPAYMENT SITUATION’ and continue with BOX_
150.
If
The amount entered in CP150 is equal to the amount entered in CP200
and
CP170 is coded ‘1’ (YES) or ‘3’' (USUALLY PAYS $0 REGARDLESS OF SERVICE)
and
CP200 is a whole dollar amount greater than or equal to (≥) $0 and less than or equal (≤)
to $50,
Flag this person-provider pair as a ‘COPAYMENT SITUATION’ and continue with BOX_
150.
If
CP80 is coded ‘5’ (NO BILL SENT: HMO PLAN), ‘6’ (NO BILL SENT: VA
(VETERANS ADMINISTRATION)/CHAMPVA), ‘8’ (NO BILL SENT: PUBLIC
ASSISTANCE/MEDICAID/SCHIP) or ‘9’ (NO BILL SENT: INDIAN HEALTH
SERVICE (HIS))
and
CP170 is coded ‘1’ (YES) or ‘3’ (USUALLY PAYS $0 REGARDLESS OF SERVICE)
and
CP200 is a whole dollar amount greater than or equal to (≥) $0 and less than or equal (≤)
to $50, flag this person-provider pair as a ‘COPAYMENT SITUATION’ and continue with
BOX_150.
If one of the three situations above is met, set amount entered at CP200 as this personprovider pair's copayment amount for the current round.
Otherwise, do not set any flags and then continue with BOX_150.
CP - Page 42 of 43
MEPS_V2
Charge/Payment (CP) Section
(Rout
Full Detail Spec
BOX_150
Route Details:
(CP1495)
Item Type: Route
Type Class: If Then
If event type is HS and HS 50 is coded ‘4’ (GIVE BIRTH TO A BABY) or ‘5’ (TO BE
BORN), go to the EF section.
If event type is MV and MV100 is coded ‘2’ (S OMEWHERE ELS E) go to the EF
section. Otherwise (event type = OP, ER, DN, HH, HS where HS 50 ≠ 4, 5, MV where
MV100 ≠ 2) flag CP status of event-provider pair as 'PROCES S ED'.
If event is a “S TEM” event from the OP, MV, or HH utilization sections, flag CP status of
all “LEAF” events (events selected at either OP120, MV140 or HH130) as
‘PROCES S ED’ and not editable or accessible during interview.
NOTE: All utilization and charge/payment data will be copied during MHOP to those
"LEAF" events, including condition data.
[End of CP]
CP - Page 43 of 43
| File Type | application/pdf |
| File Modified | 2018-02-21 |
| File Created | 2017-10-13 |