Enhancements

1. Replace charge master (CHARGE) records with Bill Item Master.
   1. Currently, all CHARGE records are a distinct list of all CDM bill codes in Millennium.  This does not accurately reflect the structure of how Millennium generates or stores charges.
   2. The new model uses the bill item as the distinct unit for CHARGE records.  A bill item represents a clinical “thing”, such as an orderable, DTA (used to collect documentation), formulary product, supply item, accommodation code (room and bed charge), blood bank product, radiologic procedure, surgical procedure, etc.  Furthermore, bill items exist also for every unique combination of the clinical things.  Naturally, there are many bill items (average system has ~500,000).
   3. Three CHARGEXD records are provided to give additional detail about the charge:
      1. Bill Item Detail:  describes the clinical things the bill item represents
      2. Bill Codes:  lists the kinds of codes the bill item will use when a charge is generated (CDM, Rev Code, HCPCS, CPT, etc), and the charge point (when and how the charge should generate).
      3. Price Schedule:  lists the pricing on the bill item (may be more than one).
   4. The corresponding app for configuring charging in Cerner is DB Pricing Tool (CSPricingTool.exe).  This contains the bill item tree that lists all bill items in Millennium.
   5. Bill items are created automatically when new clinical things are built by analysts.  The codes and prices on a bill item must be built manually in DB Pricing Tool.
2. Replace Service Item code (ENCSIHDR-2) with bill item id.
   1. A new extension is provided (Service Item Detail) to provide the CDM, and numerous other details on the charge.
3. RESPHDR will now refer to the account holder of the financial encounter (Account), not the guarantor.
   1. Account accrues all liabilities across all financial encounters at that billing entity for the patient.  However, the guarantor is related to each encounter, and may be responsible for only some of the encounters.
   2. Guarantor is now provided in the Encounter-Person Relationship extension, which is unique to each encounter.
4. Add Encounter-Person Relationship extension (ENCXD).
   1. Provides one record for each person and their relationship to the encounter (power of attorney, emergency contact, guarantor(s)).
5. Add Encounter Location History extension (ENCXD).
   1. Provides one record for each encounter location history record.  Some records may appear the same from one to another.  This is a dump of the ENCNTR_LOC_HIST table in Cerner.
6. Add Encounter APR-DRG record (ENCAPR).
7. Add 11 new records (User-Defined Lookup, or UDL) in a new “u” file:
   1. Code Value (selected codesets), Location, Personnel, Medication, Item Definition, Order Catalog, Task, Discrete Task Assay (DTA), Price Schedule, Nomenclature (selected vocabularies), Service Resource.
   2. UDLs are used as selection lists that extensions can reference.  This allows the user to select from several alternate attributes for a categorical value.
      1. For example:  when referring to a location, using the Location UDL allows the user to select the location long name (Three North), short name (3N), parent facility (ABC Medical Center), or numerous other attributes of a location (alias, code, location type, etc).
   3. UDL is not the same as UDA.  UDAs are not supported in the interface.