Files > BILLING EXEMPTIONS

name

BILLING EXEMPTIONS

number

354.1

location

^IBA(354.1,

description

DO NOT EDIT THIS FILE. Under normal operation it is not necessary to edit the fields in this file directly. The option Manually Change Copay Exemption (Hardships) can be used to update and correct entries by creating a new exemption. If many patient records have problems the option Print/Verify Patient Exemption Status can be used to correct the entries. This file will hold the time sensitive data that is used to determine if a patient can be exluded from any type of billing for a period of time. The initial use of this file is for storing the time sensitive data related to whether or not a patient is exempt from pharmacy copay requirement due to income below the pension level. The file then maintains the audit trail of changes to exemptions and historical data about exemptions. The data in this file should be retained for approximately the current calendar year and the past calendar year. The ability to purge data in this file will be added at a future time. Per VHA Directive 10-93-142, this file definition should not be modified.

Fields

#	Name	Location	Type	Details	Index	Description
.01	effective date(+)	0;1	DATE-TIME		B	Enter the effective date of the exemption. Patients will be given 1 year of exemption from the Medication Copayment requirement from this effective date. For patients who's exemption is based on income data, every effort will be made to keep this effective date consistent with the Means Test Date of Test or the Copayment Income Test Date of Test.
.02	patient(+)	0;2	POINTER	354	AP	This is the patient that this Billing Exemption Entry is for. The Patient must be in the Billing Patient File. The Current Status for an exemption will be automatically stored in the Billing Patient file.
.03	type(+)	0;3	SET OF CODES	1:COPAY INCOME EXEMPTION		This is the type of exemption that this entry is for. Each type of exemption will have its own record.
.04	status(+)	0;4	SET OF CODES	1:EXEMPT 0:NON-EXEMPT	AS	This is the Exemption Status of this record. Enter whether the patient is exempt or not exempt from the TYPE of billing of this record. Generally this data element will be entered by the system.
.05	exemption reason(+)	0;5	POINTER	354.2	AR	Enter the reason that the patient is exempt or not exempt from this type of billing. Entry of this field will automatically update the STATUS of this exemption record to the STATUS of the Exemption Reason. For exmple, an exemption reason of "In Receipt of Pension" will automatically trigger a STATUS of Exempt for the Pharmacy Copay Income Exemption.
.06	how added	0;6	SET OF CODES	1:SYSTEM 2:MANUAL		This field indicates whether this record was automatically added by the system or manually entered by a user. This field will always be entered by the system.
.07	user adding entry	0;7	POINTER	200		This is the user who was responsible for adding this entry. If the entry was SYSTEM added then the user would be the signed on user when the exemption was created. This may be a user who edited the patient record or who entered a prescription or a user who corrected an exemption. All changes except Hardship exemptions will be considered SYSTEM added. If the entry was Manually added then this is the user who entered the Hardship exemption.
.08	date/time added(+)	0;8	DATE-TIME			This is the date and time this entry was added. The date time added will be different from the effective date in many cases, where the entry is based on actual income data and where there are changes to an exemption status. When the exemption is based upon the fact that the patient is recieving pension, etc. the effective date and the date added may be the same.
.09	alert	0;9	POINTER	354.4	ALERT	Future use. An alert or mail message may be posted in association with the creation or editing of an exemption record. If Alerts are used, then this field will store the pointer to the alert entry. Once an alert has been resolved it will be deleted.
.1	active(+)	0;10	SET OF CODES	1:ACTIVE 0:INACTIVE	AA	Only 1 record for an effective date can be active at a time. When it is necessary to change a patient's exemption status the user will be asked if this is the currently active record. If yes, then all other records for the effective date will be inactivated automatically.
.11	electronic signature	0;11	FREE TEXT			Enter your Electronic Signature. This field will be required whenever a user trys to create an exemption that is different from the exemption computed by the system. This would be required in order to create a hardship exemption.
.12	second electronic signature	0;12	FREE TEXT			A second electronic signature for hardship exemptions will be implemented in a future release. |
.13	retro cancel bills start date	0;13	DATE-TIME			If this exemption requires retroactively canceling prior charges, this is the beginning date for the retroactive cancellation. This must be tracked to prevent duplicate retroactive cancellations of the same charges.
.14	retro cancel bills end date	0;14	DATE-TIME			If this exemption requires retroactively canceling prior charges, this is the ending date for the retroactive cancellation. This must be tracked to prevent duplicate retroactive cancellations of the same charges.
.15	prior year thresholds	0;15	DATE-TIME		APRIOR	This field will contain the date of the threshold used to calculate exemptions based on income only if the date of the threshold was over 1 year in the past. This will be used by the add threshold option to list and recompute these exemptions when new thresholds are entered.
.16	reminder letter date	0;16	DATE-TIME			This field is used to indicate the date on which the income test reminder letter was printed, based on this exemption. This field is updated during the nightly background job which prints the letters. If this exemption is encountered after a letter has already been printed (based on this exemption) another letter will not be printed.