Form Attachment 37 Attachment 37 Attachment 37 HC Flat Fee Section

SpecWriter Data

Form Version:

9/22/2017 1:51:40 PM

Report Type:

Full Detail

Project Database:
Language:

English

WESSQL6.MEPS_V2

Spec Label:

This is the cover page. Additional contents currently project specific.

FF - Page 1 of 26

MEPS_V2

Flat Fee (FF) Section
(Rout

Full Detail Spec
BOX_00

Route Details:

(FF1000)

Item Type: Route

Type Class: If Then

01 BOX = BOX_00, BOX_10, BOX_20, BOX_30, BOX_40. BOX_50. BOX_60
04 S ingle S elect = FF40, FF60, FF90, FF100, FF120, FF130, FF160, FF190
06 S ingle S elect with Fill in Answer Text = FF10
11 Multiple S elect with Add/Edit/Delete = FF170
18 Dollar Items Not Allowing Cents = FF140, FF150, FF180
19 Numeric Field = FF50, FF70
23 Text Field = FF30, FF110
24 Information S creen = FF80
30 Multiple S elect with Fill in Answer Text and Display Roster = FF20
Roster 2 = FF10, FF20
Roster 3 = FF170
Grid 2 = FF180

BOX_10

Route Details:

(FF1001)

Item Type: Route

Type Class: If Then

Throughout the Flat Fee (FF) section, entry of all dollar amounts will include only whole
dollars. Entry of cents will be disallowed.
Context Header Display Instructions:
Display PERS .FULLNAME, PROV.PROVNAME, EVPV.EVNTTYPE,
EVPV.EVNTBEGM, EVPV.EVNTBEGD, EVPV.EVNTBEGY, EVPV.EVNTENDM,
EVPV.EVNTENDD, EVPV.EVNTENDY, FFEE.FFEENAME. Display
EVPV.EVNTENDM, EVPV.EVNTENDD, and EVPV.EVNTENDY for IC or HS events,
only.
For ‘{S TR-DT}’ display the person’s reference period start date.

BOX_20

Route Details:

(FF1005)

Item Type: Route

Type Class: If Then

If no flat fee groups already on PERS ONS -FLAT-FEE-GROUPS -ROS TER, go to
FF20.
Otherwise, continue with FF10.

FF - Page 2 of 26

MEPS_V2

Flat Fee (FF) Section
(Que

Full Detail Spec
FF10
Item Type:
Type Class:
Answer Type:

Help Available (
Context Header:

(FF1015)
Question
Enumerated
TFlatFee

BLAISE NAME: FFeeGrp
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}

Question Text:
Let me review the groups of health care events I have recorded for {you/{PERSON}}. Please tell me if any of these groups
include the charge that covered {this hospital stay/this visit}/the services received at home}.
REVIEW FLAT FEE GROUPS WITH RESPONDENT.
SELECT FLAT FEE GROUP COVERED BY SAME CHARGE AS EVENT BEING ASKED ABOUT.

Responses:

ADD GROUP
{FLAT FEE GROUP} 1
{FLAT FEE GROUP} 2
{FLAT FEE GROUP} 3
{FLAT FEE GROUP} 4
{FLAT FEE GROUP} N

0
1
2
3
4
5

FF - Page 3 of 26

FF20
BOX_60
BOX_60
BOX_60
BOX_60
BOX_60

(FF1020)
(FF1160)
(FF1160)
(FF1160)
(FF1160)
(FF1160)

)

MEPS_V2

Flat Fee (FF) Section
(Que

Full Detail Spec

Programmer
Instructions:

Since this roster will include all flat fee groups, current round single events can be added to
any flat fee group created during the current round or a previous round
(FlatFeeGroup[I].FFeeName).
Roster Behavior:
1.Only single select allowed.

Display
Instructions:

Roster 2- No Add/Edit/Delete
Roster Definition:
Display the person's-flat-fee-groups-roster (FFEE, FFEENAME) for selection.
Roster Filter:
No filter; display all.
Display 'this hospital stay' if event type is HS.
Display 'this visit' if event type is ER, OP, MV, or DN.
Display 'the services received at home' if event type is HH.

Testing/Editing
Notes:

Variable collected at MEPSSpring2018.FF_Main
Variable stored at MEPSSpring2018_Event.FF_Main

FF - Page 4 of 26

MEPS_V2

Flat Fee (FF) Section
(Que

Full Detail Spec
FF20
Item Type:
Type Class:
Answer Type:

Help Available (
Context Header:

(FF1020)
Question
Enumerated
{User Defined.}

)

BLAISE NAME: FFeeRoster
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}

Question Text:
Let me review the list of health care events I have recorded for {you/{PERSON}}. Please tell me which of these were
included in the same charge that covered {this hospital stay/this visit/the services received at home}.
REVIEW EVENTS WITH RESPONDENT.
SELECT EVENTS COVERED BY SAME CHARGE AS EVENT BEING ASKED ABOUT.
ENTER ALL THAT APPLY.

MEDICAL PROVIDER

DOCTOR OR
EVENT TYPE ADMIT DATE
DEPARTMENT NAME
EVENT OUTSIDE REFERENCE PERIOD 0
{MEDICAL PROVIDER} {DOC OR DEPT} {EVENT TYPE}{ADMIT DATE}
{MEDICAL PROVIDER} {DOC OR DEPT} {EVENT TYPE}{ADMIT DATE}
{MEDICAL PROVIDER} {DOC OR DEPT} {EVENT TYPE}{ADMIT DATE}
{MEDICAL PROVIDER} {DOC OR DEPT} {EVENT TYPE}{ADMIT DATE}
{MEDICAL PROVIDER} {DOC OR DEPT} {EVENT TYPE}{ADMIT DATE}

Responses:

FF - Page 5 of 26

DISCHARGE DATE
{DISCHARGE
{DISCHARGE
{DISCHARGE
{DISCHARGE
{DISCHARGE

DATE}1
DATE}2
DATE}3
DATE}4
DATE}N

MEPS_V2
Full Detail Spec

Programmer
Instructions:
Display
Instructions:

Flat Fee (FF) Section
(Que

RF/DK not allowed.

Display the roster in nonproportional text.
Roster 1 - Report
Roster Definition:
This item displays all medical events on person's-medical-events- roster for selection
in the info pane. The 5 columns to be displayed are: MEDICAL PROVIDER,
DOCTOR OR DEPARTMENT NAME, EVENT TYPE, ADMIT DATE,
DISCHARGE DATE. For MEDICAL PROVIDER, display the name of provider
associated with this event (EVNT.LORPNAME), if PV70 has a value, display the
doctor or department associated with this event, display the two- letter event
abbreviation (EVNT.EVNTTPYE) for EVENT TYPE, for Admit date display the
month, day, and year of medical events
(EVNT.EVNTBEGM,EVNT,EVNTBEGD,EVNT,EVNTBEGY),
and the discharge date for HS events
(EVNT.EVNTENDM,EVNT.EVNTENDD,EVNT.EVNTENDY). For MV, ER,
OP, or DN, events display the visit date for {ADMIT DATE} and use a null display
for {DISCHARGE DATE}.
For HS events display the hospital stay admit date for {ADMIT DATE} and the
hospital stay discharge date for the {DISCHARGE DATE}.
Roster Filter:
Display events that meet the following conditions:
1. Event is not the event currently looping on.
2. Event has CP status of 'PROCESSED' or 'UNPROCESSED' (display event regardless
of CP status).
3. Event is not already included in a flat fee group or a repeat visit group.
4. Event is not already coded (VERIFIED) as a copayment.
5. Event type is not IC.
6. Event is not an HS event with a discharge date coded '95' (STILL IN HOSPITAL).
7. Event is not an HH event with event date = interview month.
8. Event is not an HH event type 'INFORMAL' or 'VOLUNTEERED: MEAL DELIVERY
SERVICE.'
9. Event is not an OM event.

Testing/Editing
Notes:

Variable collected at MEPSSpring2018.FF_Main
Variable stored at MEPSSpring2018_Event.FF_Main

FF - Page 6 of 26

MEPS_V2

Flat Fee (FF) Section
(Que

Full Detail Spec
FF30
Item Type:
Type Class:
Answer Type:

Help Available (
Context Header:

(FF1035)
Question
String

BLAISE NAME: FFeeName
Field kind: Datafield
Field Size: 30

{Continuous Answer.} Answers allowed: 1

)

Show Card (

ArrayMin:

Min value:

ArrayMax:

Max value:

)

Look Up File (

{PERSON'S FIRST MIDDLE AND LAST NAME}

Question Text:
INTERVIEWER: RECORD 'NAME OF FLAT FEE GROUP' FOR EVENTS SELECTED IN PREVIOUS QUESTION:

Responses:

Programmer
Instructions:

If Round 1, continue with FF40.
If Round 5, go to FF60.
Otherwise, go toFF80.
Write flat fee group to person’s-flat-fee-groups-roster.

Display
Instructions:

Testing/Editing
Notes:

Variable collected at MEPSSpring2018.FF_Main
Variable stored at MEPSSpring2018_Event.FF_Main

FF - Page 7 of 26

)

MEPS_V2

Flat Fee (FF) Section
(Que

Full Detail Spec
FF40
Item Type:
Type Class:
Answer Type:

Help Available (
Context Header:

(FF1045)
Question
Enumerated
TYESNO

)

BLAISE NAME: FFeeVstBefStart
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} {STR-DT}
FLAT FEE GROUP: {NAME OF FLAT FEE EVENT GROUP..}

Question Text:
Did the charge which included the services for {FLAT FEE GROUP} cover any visits before {START DATE}?

Responses:

Display
Instructions:

Testing/Editing
Notes:

YES
NO
REFUSED
DON'T KNOW

1
2
RF
DK

FF50
FF80
FF80
FF80

(FF1050)
(FF1080)
(FF1080)
(FF1080)

For {FLAT FEE GROUP}, display the name of the flat fee group selected at FF10 or entered at FF30.

Variable collected at MEPSSpring2018.FF_Main
Variable stored at MEPSSpring2018_Event.FF_Main

FF - Page 8 of 26

MEPS_V2

Flat Fee (FF) Section
(Que

Full Detail Spec
FF50
Item Type:
Type Class:
Answer Type:

Help Available (
Context Header:

(FF1050)
Question
Integer

BLAISE NAME: FFeeVisBef
Field kind: Datafield
Field Size: 2

{Continuous Answer.} Answers allowed: 1

)

Show Card (

ArrayMin:

Min value: 1

ArrayMax:

Max value: 99

)

Look Up File (

{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT}
FLAT FEE GROUP: {NAME OF FLAT FEE EVENT GROUP..}

Question Text:
How many visits did {you/{PERSON}} have before {START DATE}?
ENTER NUMBER OF VISITS:

Responses:
REFUSED
DON'T KNOW

RF
DK

Display
Instructions:

Testing/Editing
Notes:

Variable collected at MEPSSpring2018.FF_Main
Variable stored at MEPSSpring2018_Event.FF_Main

FF - Page 9 of 26

FF80

(FF1080)

FF80
FF80

(FF1080)
(FF1080)

)

MEPS_V2

Flat Fee (FF) Section
(Que

Full Detail Spec
FF60
Item Type:
Type Class:
Answer Type:

Help Available (
Context Header:

(FF1070)
Question
Enumerated
TYESNO

)

BLAISE NAME: FFeeVisAft
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} {STR-DT}
FLAT FEE GROUP: {NAME OF FLAT FEE EVENT GROUP}

Question Text:
Will the charge which includes the services for {FLAT FEE GROUP} cover any visits after December 31, {YEAR}?

Responses:

Display
Instructions:

YES
NO
REFUSED
DON'T KNOW

1
2
RF
DK

FF70
FF80
FF80
FF80

(FF1075)
(FF1080)
(FF1080)
(FF1080)

For {FLAT FEE GROUP}, display the name of the flat fee group selected at FF10 or entered at FF30.
(For specifications purposes only; CAPI handles automatically): for 'YEAR' in question text, display
the second year of the panel.

Testing/Editing
Notes:

Variable collected at MEPSSpring2018.FF_Main
Variable stored at MEPSSpring2018_Event.FF_Main

FF - Page 10 of 26

MEPS_V2

Flat Fee (FF) Section
(Que

Full Detail Spec
FF70
Item Type:
Type Class:
Answer Type:

(FF1075)
Question
Integer

BLAISE NAME: FFeeNumVisAft
Field kind: Datafield
Field Size: 2

{Continuous Answer.} Answers allowed: 1

Help Available (
Context Header:

)

Show Card (

ArrayMin:

Min value: 1

ArrayMax:

Max value: 99

)

Look Up File (

)

{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT}
FLAT FEE GROUP: {NAME OF FLAT FEE EVENT GROUP..}

Question Text:
Approximately, how many visits will {you/ {PERSON}} have after December 31, {YEAR}?
NUMBER OF VISITS:

Responses:
REFUSED
DON'T KNOW
Programmer
Instructions:
Display
Instructions:

Testing/Editing
Notes:

RF
DK

FF80

(FF1080)

FF80
FF80

(FF1080)
(FF1080)

Hard Range: TBD

(For specifications purposes only; CAPI handles automatically): for 'YEAR' in question text, display
the second year of the panel.

Variable collected at MEPSSpring2018.FF_Main
Variable stored at MEPSSpring2018_Event.FF_Main

FF - Page 11 of 26

MEPS_V2

Flat Fee (FF) Section
(Que

Full Detail Spec
FF80
Item Type:
Type Class:
Answer Type:

(FF1080)
Question
Enumerated

BLAISE NAME: FFeeIntro

TContinue

Help Available (CPayIntroHelp)
Context Header:

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} {STR-DT} FLAT FEE GROUP:
{NAME OF FLAT FEE EVENT GROUP}

Question Text:
Now I'd like to ask you about the charges for the services for {FLAT FEE GROUP} for
{you/{PERSON}}.
PRESS 1 AND ENTER TO CONTINUE.
HELP:F1

Responses:

Display
Instructions:

Testing/Editing
Notes:

CONTINUE

FF90

(FF1085)

For '{FLAT FEE GROUP}' display the name of the flat fee group selected at FF10 or entered
at FF30.

Variable collected at MEPSSpring2018.FF_Main
Variable stored at MEPSSpring2018_Event.FF_Main

FF - Page 12 of 26

MEPS_V2

Flat Fee (FF) Section
(Que

Full Detail Spec
FF90
Item Type:
Type Class:
Answer Type:

(FF1085)
Question
Enumerated
TYESNO4

Help Available (RcvBillHelp)
Context Header:

BLAISE NAME: FFeeRcvBill
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} {STR-DT} FLAT FEE GROUP:
{NAME OF FLAT FEE EVENT GROUP}

Question Text:
{Have/Has} {you/{PERSON}} (or anyone in the family) received anything in writing, such as a bill, receipt, or
statement, for the services for {FLAT FEE GROUP}?
HELP:F1

Responses:

Display
Instructions:

Testing/Editing
Notes:

YES, AND DOCUMENTATION
AVAILABLE
YES, BUT DOCUMENTATION NOT
AVAILABLE
NO
REFUSED
DON'T KNOW

1

BOX_30

(FF1105)

2

BOX_30

(FF1105)

FF100
FF100
FF100

(FF1090)
(FF1090)
(FF1090)

3
RF
DK

For '{FLAT FEE GROUP}' display the name of the flat fee group selected at FF10 or entered
at FF30.

Variable collected at MEPSSpring2018.FF_Main
Variable stored at MEPSSpring2018_Event.FF_Main

FF - Page 13 of 26

MEPS_V2

Flat Fee (FF) Section
(Que

Full Detail Spec
FF100
Item Type:
Type Class:
Answer Type:

(FF1090)
Question
Enumerated

BLAISE NAME: FFeeYNoBill
Field kind: Datafield

Field Size:
TNotReceivedWriting Answers allowed: 1

Help Available (YNoBillHelp)

ArrayMin:

Min value:

ArrayMax:

Max value:

Show Card (CP-1)

Look Up File (

Context Header:
{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} FLAT FEE GROUP:
{NAME OF FLAT FEE EVENT 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?
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
REFUSED
DON'T KNOW

1
2
3

BOX_30
BOX_30
FF110

(FF1105)
(FF1105)
(FF1095)

4
5
6

BOX_30
BOX_30
BOX_30

(FF1105)
(FF1105)
(FF1105)

7
8

BOX_30
BOX_30

(FF1105)
(FF1105)

9

BOX_30

(FF1105)

10

BOX_30

(FF1105)

11

BOX_30

(FF1105)

12

BOX_30

(FF1105)

13
14
15

BOX_60
BOX_60
BOX_60

(FF1160)
(FF1160)
(FF1160)

RF
DK

BOX_30
BOX_30

(FF1105)
(FF1105)

FF - Page 14 of 26

)

MEPS_V2

Flat Fee (FF) Section
(Que

Full Detail Spec

Display
Instructions:

Testing/Editing
Notes:

Variable collected at MEPSSpring2018.FF_Main
Variable stored at MEPSSpring2018_Event.FF_Main

BLAISE NAME: FFeeWhereBill

FF110
Item Type:

(FF1095)
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} {STR-DT} FLAT FEE GROUP:
{NAME OF FLAT FEE EVENT GROUP}

Question Text:
To whom was the bill sent?
RECORD VERBATIM.

Responses:
REFUSED
DON'T KNOW

RF
DK

Display
Instructions:

Testing/Editing
Notes:

Variable collected at MEPSSpring2018.FF_Main
Variable stored at MEPSSpring2018_Event.FF_Main

FF - Page 15 of 26

FF120

(FF1100)

FF120
FF120

(FF1100)
(FF1100)

)

MEPS_V2

Flat Fee (FF) Section
(Que

Full Detail Spec
FF120
Item Type:
Type Class:
Answer Type:

(FF1100)
Question
Enumerated
TWHOBILLC

Help Available (WhereBillTpHelp)
Context Header:

BLAISE NAME: FfeeWhereBillTp
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} {STR-DT} FLAT FEE GROUP:
{NAME OF FLAT FEE EVENT 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_30
BOX_30

(FF1105)
(FF1105)

3
4
5
6
7
8
91
RF
DK

BOX_30
BOX_30
BOX_30
BOX_30
BOX_30
BOX_30
BOX_30
BOX_30
BOX_30

(FF1105)
(FF1105)
(FF1105)
(FF1105)
(FF1105)
(FF1105)
(FF1105)
(FF1105)
(FF1105)

Display
Instructions:

Testing/Editing
Notes:

Variable collected at MEPSSpring2018.FF_Main
Variable stored at MEPSSpring2018_Event.FF_Main

FF - Page 16 of 26

)

MEPS_V2

Flat Fee (FF) Section
(Rout

Full Detail Spec
BOX_30

Route Details:

(FF1105)

Item Type: Route

Type Class: If Then

If FF90 is coded ‘1’ (YES, AND DOCUMENTATION AVAILABLE) or ‘2’ (YES, BUT
DOCUMENTATION NOT AVAILABLE);
or
If FF100 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 FF120 is coded ‘3’ (TRICARE), ‘91’ (OTHER), ‘DK’ (DON’T KNOW), or ‘RF’
(REFUSED);
Go to FF130.
Otherwise, go to FF150

FF130
Item Type:

(FF1110)
Question

Type Class:

Enumerated

Answer Type:

TYESNO

Help Available (EvpvChrgHelp)
Context Header:

BLAISE NAME: FFeeKnowTotal
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} {STR-DT} FLAT FEE GROUP:
{NAME OF FLAT FEE EVENT GROUP}

Question Text:
Do you know the total charge for the services for {FLAT FEE GROUP}?
HELP: F1

Responses:

Display
Instructions:

Testing/Editing
Notes:

YES
NO
REFUSED
DON'T KNOW

1
2
RF
DK

FF140
FF150
FF150
FF150

(FF1115)
(FF1120)
(FF1120)
(FF1120)

For '{FLAT FEE GROUP}' display the name of the flat fee group selected at FF10 or entered
at FF30.

Variable collected at MEPSSpring2018.FF_Main
Variable stored at MEPSSpring2018_Event.FF_Main

FF - Page 17 of 26

MEPS_V2

Flat Fee (FF) Section
(Que

Full Detail Spec
FF140
Item Type:
Type Class:
Answer Type:

(FF1115)
Question
Integer

BLAISE NAME: FFeeTotChrg
Field kind: Datafield
Field Size: 6

{Continuous Answer.} Answers allowed: 1

Help Available (EvpvChrgHelp)
Context Header:

ArrayMin:

Min value: -1

ArrayMax:

Max value: 999999

Show Card (

)

Look Up File (

)

{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} FLAT FEE GROUP:
{NAME OF FLAT FEE EVENT GROUP}

Question Text:
How much was the total charge, including any amounts that may be paid by health insurance or other sources?
{Include charges for procedures such as x-rays, lab tests, or diagnostic procedures that are listed separately on the
bill or statement.}
IF WORKING FROM DOCUMENTATION, ENTER TOTAL CHARGES. DO NOT DEDUCT DISCOUNTS
OR DISALLOWED OR DENIED CHARGES.
HELP: F1

Responses:
REFUSED
DON'T KNOW
Programmer
Instructions:

RF
DK

If the amount is $0, go to BOX_60. Otherwise, go to FF150.
Soft check: If amount is > $100,000, display the following message: "VALUE IS HIGHER THAN
USUAL. VERIFY AND CORRECT IF NEEDED."
Hard check: Amount cannot be < 0.

Display
Instructions:

Testing/Editing
Notes:

Display 'Include charges for procedures such as x-rays, lab tests, or diagnostic procedures that
are listed separately on the bill or statement.” if FF90 is coded '1' (YES, AND
DOCUMENTATION AVAILABLE). Otherwise, use a null display.

Variable collected at MEPSSpring2018.FF_Main
Variable stored at MEPSSpring2018_Event.FF_Main

FF - Page 18 of 26

MEPS_V2

Flat Fee (FF) Section
(Que

Full Detail Spec
FF150
Item Type:
Type Class:
Answer Type:

(FF1120)
Question
Integer

BLAISE NAME: FFeeAmtUPay
Field kind: Datafield
Field Size: 6

{Continuous Answer.} Answers allowed: 1

Help Available (AmtUPayHelp)
Context Header:

ArrayMin:

Min value: -1

ArrayMax:

Max value: 999999

Show Card (

)

Look Up File (

)

{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} FLAT FEE GROUP:
{NAME OF FLAT FEE EVENT 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

FF160
FF160
FF160

Soft check: if amount is > $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 FF140. Display ‘total
charge’ if FF130 is coded ‘2’ (NO), ‘RF’ (REFUSED), ‘DK’ (DON’T KNOW), or is not
asked.
For {AMT TOT CH} display the dollar amount entered at FF140.

Testing/Editing
Notes:

(FF1125)
(FF1125)
(FF1125)

Variable collected at MEPSSpring2018.FF_Main
Variable stored at MEPSSpring2018_Event.FF_Main

FF - Page 19 of 26

MEPS_V2

Flat Fee (FF) Section
(Que

Full Detail Spec
FF160
Item Type:
Type Class:
Answer Type:

(FF1125)
Question
Enumerated
TYESNO

Help Available (AnySrcPayHelp)
Context Header:

BLAISE NAME: FFeeAnySrcPay
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} {STR-DT} FLAT FEE GROUP:
{NAME OF FLAT FEE EVENT GROUP}

Question Text:
Has any private insurance company, HMO, Medicare, Medicaid, or any other source made any payments for the
services for {FLAT FEE GROUP}?
HELP: F1

Responses:

Display
Instructions:

Testing/Editing
Notes:

YES
NO
REFUSED
DON'T KNOW

1
2
RF
DK

FF170
BOX_40
BOX_40
BOX_40

(FF1130)
(FF1145)
(FF1145)
(FF1145)

For '{FLAT FEE GROUP}' display the name of the flat fee group selected at FF10 or entered at
FF30.

Variable collected at MEPSSpring2018.FF_Main
Variable stored at MEPSSpring2018_Event.FF_Main

FF - Page 20 of 26

MEPS_V2

Flat Fee (FF) Section
(Que

Full Detail Spec
FF170
Item Type:
Type Class:
Answer Type:

Help Available (
Context Header:

(FF1130)
Question
Enumerated
TSOURCEPYM

)

BLAISE NAME: FFeeSOPRoster
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} {STR-DT} FLAT FEE GROUP:
{NAME OF FLAT FEE EVENT GROUP}

Question Text:
Who else paid?
PROBE: Anyone else?
ENTER ALL THAT APPLY.
CTRL-A: ADD
CTRL-E: EDIT
CTRL-D: DELETE

Responses:

{Name of Source of Payment}1
{Name of Source of Payment} 2
{Name of Source of Payment} 3
{Name of Source of Payment} 4
{Name of Source of Payment} N
EMPTY

1
2
3
4
5
Empty

FF - Page 21 of 26

FF180
FF180
FF180
FF180
FF180

(FF1135)
(FF1135)
(FF1135)
(FF1135)
(FF1135)

MEPS_V2
Full Detail Spec

Programmer
Instructions:

Flat Fee (FF) Section
(Que

Roster behavior:
1. Multiple select allowed.
2. Multiple add allowed.
3. Pressing CTRL-A displays a pop-up with a blank text entry field and a selectable pick list
of 15 common sources of payment. (See below for a detailed list). The interviewer can type a
new source or select one from the list. Upon return to FF170, the added source will appear on
the roster as selected.
GOVERNMENT SOURCES:
- 'Medicare'
- 'Medicaid{/STATE NAME FOR MEDICAID}'
- 'SCHIP/{STATE NAME FOR CHIP}'
- 'VA (VETERAN'S ADMINISTRATION)/CHAMPVA'
- 'Tricare'
- 'Military Facility'
- 'Indian Health Service'
- 'Worker's Compensation'
PRIVATE SOURCES:
- 'AARP'
- 'Aetna'
- 'Blue Cross/Blue Shield'
- 'Cigna'
- 'Delta Dental'
- 'Kaiser/Kaiser Permanente'
- 'United Healthcare'
- Other Source not listed
4. Limited delete allowed. If interviewer adds a source of payment, delete is possible for that
source only, as long as the interviewer has not left the screen. If delete is attempted when it is
not allowed, CAPI displays the following error message: 'DELETE ALLOWED ONLY
WHEN SOURCE IS FIRST ENTERED.'
If 'Other Source not listed' is selected, CAPI should display a text box for entry.
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
Display '/STATE 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 'STATE NAME FOR CHIP' under all conditions (substituting the real state name for program).
FF - Page 22 of 26

MEPS_V2

Flat Fee (FF) Section
(Que

Full Detail Spec

For the specific name to use by state, see the plan fill file.

Testing/Editing
Notes:

Variable collected at MEPSSpring2018.FF_Main
Variable stored at MEPSSpring2018_Event.FF_Main

BLAISE NAME: PayFAmtPaid
Field kind: Datafield
ArrayMin:

FF180
Item Type:

(FF1135)
Question

Type Class:

Integer

Answer Type:

{Continuous Answer.} Answers allowed: 1

Help Available (
Context Header:

Min value: -99999

Field Size: 6

)

Show Card (

ArrayMax:

)

Max value: 999999

Look Up File (

{PERSON'S FIRST MIDDLE AND LAST NAME} {STR-DT} FLAT FEE GROUP:
{NAME OF FLAT FEE EVENT GROUP}

Question Text:
How much did {SOURCE} pay?
ENTER AMOUNT.
TOTAL CHARGE: ${TOTAL CHARGE}

Responses:
REFUSED
DON'T KNOW

RF
DK

FF - Page 23 of 26

)

MEPS_V2

Flat Fee (FF) Section
(Que

Full Detail Spec

Programmer
Instructions:

Preloaded Grid Type 2- including FF180
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 FF150; 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 FF160 (FFeeAnySrcPay) OR FF170 (FFeeSOPRoster). IF {SOURCE} IS THE
ONLY SOURCE OF DIRECT PAYMENT, GO TO FF160 (FFeeAnySrcPay) AND CODE ‘2’ (NO). IF
THERE ARE OTHER SOURCES OF PAYMENT, GO TO FF170 (FFeeSOPRoster) AND DELETE
{SOURCE} FROM THE LIST OF SOURCES OF DIRECT PAYMENT. IF RESPONDENT DOES NOT
KNOW HOW MUCH{SOURCE} PAID, CODE “DK” AT FF180 (PayFAmtPaid).” CAPI displays
FF160 (FFeeAnySrcPay), FF170 (FFeeSOPRoster), and FF180 (PayFAmtPaid) as options to
return to.

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 FF170 for this event-provider pair and the
‘PERSON/FAMILY’ record.
For TOTAL CHARGE, display amount entered at FF140, otherwise, display "N/A" if FF140
=empty, DK, RF.

Testing/Editing
Notes:

Variable collected at MEPSSpring2018.FF_Main.FF180Grid.FF180Grid[1..25]
Variable stored at MEPSSpring2018_Event.FF_Main.FF180Grid.FF180Grid[1..25]

FF - Page 24 of 26

MEPS_V2

Flat Fee (FF) Section
(Rout

Full Detail Spec
BOX_40

Route Details:

(FF1145)

Item Type: Route

Type Class: If Then

If FF140 (TOTAL CHARGE) or 'AMOUNT PAID' by any source of direct payment (all
payments sources, including PERSON/FAMILY entered or displayed at FF180) is coded
'RF' (REFUSED) or 'DK' (DON'T KNOW), go to BOX_60.
Otherwise, continue with BOX_50.

BOX_50

Route Details:

(FF1150)

Item Type: Route

Type Class: If Then

Determine if there is an underpayment. Subtract the total payment (PERSON/FAMILY
entered at FF150 plus all payments sources entered at FF180) from the total charge entered
at FF140.
Determine what 3% of the total charge is. Compare that value with $5 and
determine which of these two values is greater. CAPI will use the greater value to
compare against the remainder.
If the value of the remainder is > 3% OR $5 (whichever is higher) of the total charge,
continue with FF190.
Otherwise, go to BOX_60.
NOTE: Negative values (overpayments) are not eligible for FF190.

FF - Page 25 of 26

MEPS_V2

Flat Fee (FF) Section
(Que

Full Detail Spec
FF190
Item Type:

(FF1155)
Question
Enumerated

Type Class:
Answer Type:

TYESNO

Help Available (
Context Header:

)

BLAISE NAME: FFeeElsePay
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} {STR-DT} FLAT FEE GROUP:
{NAME OF FLAT FEE EVENT GROUP}

Question Text:
Does anyone in the family or any other source expect to make additional payments for the services for {FLAT
FEE GROUP}?

Responses:

Display
Instructions:

Testing/Editing
Notes:

BOX_60

Route Details:

YES
NO
REFUSED
DON'T KNOW

1
2
RF
DK

BOX_60
BOX_60
BOX_60
BOX_60

(FF1160)
(FF1160)
(FF1160)
(FF1160)

For '{FLAT FEE GROUP}' display the name of the flat fee group selected at FF10 or entered at
FF30.

Variable collected at MEPSSpring2018.FF_Main
Variable stored at MEPSSpring2018_Event.FF_Main

(FF1160)

Item Type: Route

Type Class: If Then

If the event provider pair that launched the flat fee section represents a HS event and
HS50 is coded ‘4’ (GIVE BIRTH TO A BABY) or ‘5’ (TO BE BORN) OR a MV event and MV100
is coded ‘2’ (SOMEWHERE ELSE), go to the EF section.
Otherwise, return to the Event Driver for this Event-Provider Pair. Flag the status of CP as
‘Processed’ for all event-provider pairs in the flat fee group.

[End of FF]

FF - Page 26 of 26