4/19/04 Instructions for completing the 2003 RHCF report.









April 19, 2004

Dear Client,

As part of our continuing service, the following documentation will to assist you in completing the N.Y. State RHCF-IV, annual cost report.

Except as noted otherwise, all reports are produced by program PMGEN.

Instructions are based on the latest version of Part I - Statistical Data.

Print the census reports for the entire year by specifying the range of dates from 1/1/03 - 12/31/03 before running the following reports. (Note: You can now run this report once for the entire year by specifying a range of dates from 1/1/03 - 12/31/03.)

Sincerely,

Reliable Health Systems, Inc.

encl.



Page 3, Part 1-3, Lines 10-11(Scr: 1-2-2)
Number of Days of Care
Total Medicaid Days - (Not)/Eligible Part B
              
Run program ARGEN2 [AR, 5, 10] from any menu and press ENTER.
Run the report as shown. Items that are in bold need are not initialized
and need to be entered.
              

     

Verify (Y/N): N
All Billing Types            Level of Care:         Budget    Ancillary


_ Medicaid                  Medicare                 Pvt     VA    Other   
===============             ================         ==================
X MEDICAID   MA             MEDICARE    MC           PRIVATE       PVT
_ NYS ADD ON

===========================================================================

              Report on Billing/ Cash Receipt/Outstanding (B/C/O): B
              Residents: A                    - ZZ    

    Processing Order: S            Report Type: G           Report Order By: 1
    (P)-By Posting Date       P- Pat.total R- Regular        1- Resident 2- Date
    (S)-By Service Date       S- Subtotal  G- Grand Ttl      3- Denial#  4- Bill

                 DATES                                      --- Ancillaries ---
  Posted :            12/31/2099  Billed/Not Billed: YY       No.  9999999
  Service: 01/01/2003 12/31/2003  User ID:  ZZZ            Bill types:  
  Logon  :            12/31/2099  Amounts: -99999.99 99999.99 Ancl.Class:  
  Billed :            12/31/2099  Source (credit) :  ZZ     Attend Dr.:  ZZZ
  Record Types    : YNYY YY       Rec.Type YYYY (Reg./X/V/A)  Diag.:   
  Reg/Coin/Elg/NonElg Bh/Thr      Denial No.:  99999     Receiv.From:   
  Room Category :  Z             Set to Bill  Z   Pending:  Z
           Type :  Z             Subtype(Mc:   9999
  Resident Participation                                  Include in Open Items
  Print Only Part.  :                                       Credits : 
  Bill Types(credit):  - 99                             Overpayment: 
  Report Header:                                         Print Option: S

      
The breakdown of days appear on the last line of the report:

              GRAND TOTALS                   281

              ELIG.B DAYS                    185
              NON ELIG.B DAYS(INCL BH)        96

Part 1-3 B8, line 18 Number of Bed Reservations established during year.

Add the total hospital and therapeutic bed hold days shown in the following two reports:

                       Title:  THERAPEUTIC BH ESTABLISHED 
				 
 From Resident:A              To:  ZZ            
      Activity Info.  From Date:01/01/03 To:12/31/2003  Detail/Master(A/M):A 
      Active as of    Latest Bill Code:                 Print Option: P
                                                                    
          Field    From Range  To Range  sort                   
                                                       
        1)47
        2)
         
        Print if All/Any fields are applicable (All/Any) :ANY  
---------------------------------------------------------------------------
 
                             DEMO Company	             
                      THERAPEUTIC BH ESTABLISHED
 
  ID   PATIENT NAME              THER BH         ACTIVITY-DATE
 ----- ------------------------ ---------------- -------------
 10000 Axxx,bbb                 THER BH       02   03/18/03
 10006 Bxxx,ddddd               THER BH       01   12/31/03
 10009 Cxxxx,eeeee              THER BH       03   03/18/03
                                THER BH       04   04/04/03
                                THER BH       01   07/17/03
                                THER BH       07   08/06/03
 10007 Dxxx,rrrrr           	THER BH       02   02/14/03
                                THER BH       02   05/10/03
                                THER BH       03   05/16/03
                                THER BH       01   06/30/03
                                THER BH       04   07/03/03
                                THER BH       05   07/15/03
                                THER BH       03   10/17/03
 10008 Exxxx,xxxx               THER BH       01              began before 03
 10087 Fxxxx,fffff              THER BH       01   04/07/03
 11101 Gxxxx,ccccc              THER BH       03   04/18/03
                                THER BH       03   04/25/03
                                THER BH       03   05/09/03
 10053 Hxxxx,wewewe             THER BH       01   10/11/03
                                THER BH       01   11/15/03
                                THER BH       01   11/27/03
 ----- ------------------------ ---------------- -------------
 00008                               21       52      20.00 <----
					   	
                 PATIENTS ON MORE THAN ONE BH IN COL.01  4

Therapeutic bedhold
 08 = Number of residents     
 21 = Number of occurrences  
 52 = Days used in the 33 occurrences  
 20 = Times Therapeutic BH established in current year   <----

                   Title:  HOSPITAL BH ESTABLISHED

 
 From Resident: A              To:  ZZ                     
      Activity Info.  From Date:01/01/03 To:12/31/2003  Detail/Master(A/M): A 
      Active as of    Latest Bill Code:                 Print Option: P
                                                                           
          Field    From Range   To Range  sort                        
                                        
        1)154
        2)
        3)
        4)
        5)
        6)
        7)
       10)  

Print if All/Any fields are applicable (All/Any) :ANY    
-------------------------------------------------------------------------
                         DEMO NURSING HOME                    
                       HOSPITAL BH ESTABLISHED
 
  ID   PATIENT NAME              HOSP BH          ACTIVITY-DATE
 ----- ------------------------- ---------------- -------------
 21252 xxxxxx,MARIA              HOSP BH       20   09/10/03
 10002 xxxxxx,JOSEPH             HOSP BH       21   08/10/03
 10005 xxxxxx,HARRY              HOSP BH       11   12/01/03
 80009 xxxxxx,JOE                HOSP BH       01   10/02/03
 10024 xxxxxx,JENNIE             HOSP BH       10   02/10/03
 10206 xxxxxx,MOZELLE            HOSP BH       09   01/01/03
 88888 xxxxxx,MEDICARE           HOSP BH       10   12/20/03
 23513 xxxxxx,ROSE               HOSP BH      356   01/10/03
 ----- ------------------------- ---------------- ------------
 00008                                8       438       8.00 <----
 


HOSPITAL bedhold
 08 = Number of residents     
 08 = Number of occurrences  
438 = Days used in the 08 occurrences  
 08 = Times Hospital BH established in current year <----
Note: Add the total in the previous report (20) to the total in this report (8)
        and insert the number in line 18.

Page 3, Part 1-3, Lines 19-21 (scr: 1-2-3)
Bed Reservations established and days


PATIENT RANGE    :  A-ZZ
FROM DATE        :  01/01/2003
TO DATE          :  12/31/2003
ACTIVITY MASTER  :  A
ACTIVE A/O       :  LEAVE BLANK
PRINT OPTION     :  P

                 FIELD      FROM RANGE    TO RANGE     SORT
                 -----      ----------    --------     ----
1)                46
2)                47
3)                46            11           20
4)                47            11           20


                                 ALL/ANY : ANY


--------------------------------------------------------------------------

                               Report Generator
 ID   PATIENT NAME     HOSP BH      THER BH       HOSP BH    THER BH
----- ------------ ------------- ------------ -------------- -------
30888 AGARS,GEORGE HOSP.BH -  09 THER.BH - 02 HOSP.BH -   09
                   HOSP.BH -  24              HOSP.BH -   24
30004 DOE,SAM      HOSP.BH -  07
31005 BETH,SARAH   HOSP.BH -  02              HOSP.BH -   02
----- ------------ ------------- ------------ -------------- -------
00003                    4    42     1      2       3     35    0

                      PATIENTS ON MORE THAN ONE BH IN COL.01       1
                      PATIENTS ON MORE THAN ONE BH IN COL.03       1


    The above report provides the answers to the following:
    


  8 ) Bed Reservations:  Total =  5   8a) Days = 44 (Hospital + Therapeutic)
  8b) Medicaid Bedhold:  Total =  35  8c) Days = 0 (Therapeutic)       


 
 

Page 5, Part 1-5, Lines 3-10 (Scr: 1-3-1)
Admissions during reporting period

 


PATIENT RANGE    :  A-ZZ
FROM DATE        :  01/01/2003
TO DATE          :  12/31/2003
ACTIVITY MASTER  :  A
ACTIVE A/O       :  LEAVE BLANK
PRINT OPTION     :  P

                 FIELD   FROM RANGE  TO RANGE  SORT
                 -----   ----------  --------  ----
1)                85                            1   skip at break - Y
                                                -   -----------------
2)                52

                            ALL/ANY : ALL
                                      ---
--------------------------------------------------------------------------

                           Report Generator

  ID   PATIENT NAME       HOSP TYPE ADMISSION            ACTIVITY-DATE
 ----- -----------------  --------- ------------------   -------------
 10234 BEICHLE,E.          01       HOPKIN    04/10/95     04/10/96
 10213 BIRUM,STAN          01       HOME      05/01/95     05/01/96
 10243 BREWSTER,F          01       HOPKIN    04/03/95     04/03/96
 10244 BREWSTER,S          01       HOPKIN    01/24/95     01/24/96
       [     4 ]
 10006 BACCHIERI,FAUSTINA  02       JOHN JAY  10/17/95     10/17/96
 10009 BEASLEY,RUTH        02       JOHN JAY  10/30/95     10/30/96
 10010 BENTLEY,MARY        02       JOHN JAY  11/28/95     11/28/96
       [     3 ]
 ----- ----------------   --------- ------------------   -----------
 00007                      7         7                      7.00


---------------------------------------------------------------------------


Note : Hosp. Types   (01) HOME     = 04
                     (02) HOSPITAL = 3
                     (03) SNF      = 0
                     (04) HRF      = 0
                     (05) OTHER    = 0
                     (00) FACILITY NOT ENTERED IN HOSPITAL TABLE         
 

Page 5, Part 1-5, Lines 14-21 (Scr: 1-3-2)
Discharges during reporting period



PATIENT RANGE    :  A-ZZ
FROM DATE        :  01/01/2003
TO DATE          :  12/31/2003
ACTIVITY MASTER  :  A
ACTIVE A/O       :  LEAVE BLANK
PRINT OPTION     :  P

                 FIELD  FROM RANGE  TO RANGE  SORT
                 -----  ----------  --------  ----
1)                85                           1   skip at break - Y
                                               -   -----------------
2)                86


                            ALL/ANY : ALL
                                      ---


---------------------------------------------------------------------------



                           Report Generator

  ID   PATIENT NAME         HOSP TYPE     FINAL DISCH       DATE
 ----- -------------------- --------- -------------------- --------
 10008 BALDI,MARIE           00           EXPIRED-HOME2641 08/01/96
       [     1 ]
 10011 BERG,ANNA             01           EXPIRED-OUT  559 01/10/96
 10213 DIRNDAUM,EVA          01           NO BEDHOLD    93 08/01/96
       [     2 ]
 10007 BAKTAY,EMERY          02           BH-RELEASE  5513 11/20/96
       [     1 ]
 ----- -------------------- --------- -------------------- --------
 00004                        4           4                   4.00

                     DAYS ON BH PRIOR TO RELEASE FOR COL.02      28

       Note : Hosp. Types   (01) HOME     = 2
                            (02) HOSPITAL = 1
                            (03) SNF      = 0
                            (04) HRF      = 0
                            (05) OTHER    = 0
                            (00) FACILITY NOT ENTERED IN HOSPITAL TABLE = 1     

Page 6, Part 1-6, Lines 1-11 (Scr: 1-4-1)
Ages of Patients

              PATIENT RANGE    :  A-ZZ
              FROM DATE        :  01/01/2003
              TO DATE          :  12/31/2003
              ACTIVITY MASTER  :  M
              ACTIVE A/O       :  12/31/2003 - 12/31/2003
              PRINT OPTION     :  P

                                FIELD     FROM          TO        SORT
                                -----     ----          --        ----
               1)                 18      M             MZ
               2)                 139     16            20
               3)                 139     21            54
               4)                 139     55            64
               5)                 139     65            69
               6)                 139     70            74
               7)                 139     75            79
               8)                 139     80            84
               9)                 139     85            89
              10)                 139     90

                                          ALL/ANY : ANY
                                      MUST INCLUDE FIELD:  1

--------------------------------------------------------------------------
           Rerun the same report for females changing the first range to :


                               FIELD      FROM          TO        SORT
                               -----      ----          --        ----
              1)               18         F             FZ              
--------------------------------------------------------------------------
           Note: If there are any resident in your facility in the age
                 range of 0 - 15 you will need to rerun this report
                 another 2 times as follows:

                                FIELD     FROM          TO        SORT
                                -----     ----          --        ----
               1)                 18      M             MZ
               2)                 139     0             15


                                FIELD     FROM          TO        SORT
                                -----     ----          --        ----
               1)                 18      F             FZ
               2)                 139     0             15


Page 7, Part 1-7, Line 19 (Scr: 1-4-3)
Patients Previously Private

Note: For lines 12 - 17 use the figures on the 12/31/2003 census report.
              PATIENT RANGE    :  A-ZZ
              FROM DATE        :  01/01/70
              TO DATE          :  12/31/2003
              ACTIVITY MASTER  :  M
              ACTIVE A/O       :  12/31/2003 - 12/31/2003
              Latest Bill Code :  11
              PRINT OPTION     :  P

                               FIELD      FROM RANGE    TO RANGE     SORT
                               -----      ----------    --------     ----
              1)                53            31

                                          ALL/ANY : ANY


   
    Note: If you have multiple Medicaid bill types other than type '11' you
	  should run this report as follows (and remove the '11' from
	  Latest Bill Code above):

              1)                53            31
              2)                120           1          1
 
                                          ALL/ANY : ALL


Page 8, Part 1-8, Lines 20-25 (Scr: 1-4-5)
New Admissions Payors


              PATIENT RANGE    :  A-ZZ
              FROM DATE        :  01/01/2003
              TO DATE          :  12/31/2003
              ACTIVITY MASTER  :  A
              ACTIVE A/O       :  LEAVE BLANK
              PRINT OPTION     :  P

                               FIELD      FROM RANGE    TO RANGE     SORT
                               -----      ----------    --------     ----
              1)                53            11           20
              2)                53  *         21           30
              3)                53            31           40
              4)                53            41

              *Facilities that have different codes for MC/Medicaid & MC/Pvt
               may add another line to separate them.

                                          ALL/ANY : ANY

Page 9, Part 1-9, Lines 26-50 (Scr: 1-5-1)
Length of Stay

              From any screen type LENOFSTY or [GM, 2, 10] 
              for the Length of Stay report.

              Enter 01/01/2003-12/31/2003 for the range of dates.

              The following is a sample printout.

------------------------------------------------------------------------------


                                          LENGTH OF STAY

                ID   PATIENT NAME          HOSP.TYPE DAYS DISCHARGE INFO.
              ------ --------------------- --------- ---- ------------------
               31029 FOX,SALLY             06          31 EXPIRED-HOME
                     [     1 FOR 01 + MONTHS ]
               31030 GREENE,TIMOTHY        01         121 NO BEDHOLD
                     [     1 FOR 04 + MONTHS ]
              ------ --------------------- --------- ---- ------------------
                                                        2


-------------------------------------------------------------------------------


              Note : Each Category is separated by Length of stay and facility
                   [ 1 FOR 01 + MONTHS ] = 1 patient for the 1+ Month category
                                           for 'expired in facility'.

                   [ 1 FOR 04 + MONTHS ] = 1 patient for the 4+ Month category
                                           for 'To Home' discharge. 




                               Hosp Types : 06 - Expired in facility
                                           See page 5 for other codes. 




Page 10, Part 1-10, Lines 1-41 (Scr: 1-6-1)
Patient origin by county


          PATIENT RANGE    :  A-ZZ
          FROM DATE        :  12/31/2003
          TO DATE          :  12/31/2003
          ACTIVITY MASTER  :  M
          ACTIVE A/O       :  12/31/2003-12/31/2003
          PRINT OPTION     :  P

                           FIELD      FROM RANGE    TO RANGE  SORT
                           -----      ----------    --------  ----
          1)                42                                 1 Skip at Break Y
          2)                13                                 2
          3)                10
                                      ALL/ANY : ANY