public IHttpActionResult ProfessionalPaymentRate(PaymentRateRequestModel oPaymentRate)
{
string sIPAddress = Request.GetOwinContext().Request.RemoteIpAddress;
try
{
PaymentRateReturnModel oPaymentRateReturn = oPaymentCalc.CalculateProfessionalPaymentRate(oPaymentRate);
oLogger.LogData("ROUTE: api/MPFS/ProfessionalPaymentRate; METHOD: POST; IP_ADDRESS: " + sIPAddress);
return(Json <PaymentRateReturnModel>(oPaymentRateReturn));
}
catch (Exception ex)
{
oLogger.LogData("ROUTE: api/MPFS/ProfessionalPaymentRate; METHOD: POST; IP_ADDRESS: " + sIPAddress + "; EXCEPTION: " + ex.Message + "; INNER EXCEPTION: " + ex.InnerException);
return(InternalServerError());
}
}
public PaymentRateReturnModel CalculateGlobalPaymentRate(PaymentRateRequestModel oPaymentRate)
{
const string CPTMod = "";
if (oPaymentRate.PaymentRateScope.Equals("National"))
{
var GlobalNationalPaymentRate = Convert.ToDouble(oRVU.CalculateGlobalRVU(oPaymentRate.CPTCode)) * ConversionFactor;
return(new PaymentRateReturnModel()
{
Scope = oPaymentRate.PaymentRateScope,
Locale = oPaymentRate.Locale,
PaymentRate = GlobalNationalPaymentRate,
CPTCode = oPaymentRate.CPTCode,
CPTMod = CPTMod
});
}
else
{
var oLocaleGPCI = oGPCIRepo.RetrieveGPCIByLocale(oPaymentRate.Locale).FirstOrDefault();
var oGlobalCPTCode = oMPFSRepo.RetrieveMPFSByGlobalCPT(oPaymentRate.CPTCode).Where(c => c.Mod.Equals(CPTMod)).FirstOrDefault();
var oValidCPT = ValidateCPT(oGlobalCPTCode);
var GlobalRegionalPaymentRate = (
(Convert.ToDouble(oLocaleGPCI.PW_GPCI) * Convert.ToDouble(oValidCPT.Work_RVUs2)) +
(Convert.ToDouble(oLocaleGPCI.PE_GPCI) * Convert.ToDouble(oValidCPT.Non_Facility_PE_RVUs2)) +
(Convert.ToDouble(oLocaleGPCI.MP_GPCI) * Convert.ToDouble(oValidCPT.Mal_Practice_RVUs2))
) * ConversionFactor;
return(new PaymentRateReturnModel()
{
Scope = oPaymentRate.PaymentRateScope,
Locale = oPaymentRate.Locale,
PaymentRate = GlobalRegionalPaymentRate,
CPTCode = oPaymentRate.CPTCode,
CPTMod = CPTMod
});
}
}
public List <CaseSummaryReturnModel> GetCaseSummary(List <CaseCode> lstCaseCodes, CaseSummaryRequestModel oCaseSummary)
{
List <CaseSummaryReturnModel> lstCaseReturn = new List <CaseSummaryReturnModel>();
foreach (var caseCode in lstCaseCodes)
{
CaseSummaryReturnModel oCaseReturn = new CaseSummaryReturnModel();
PaymentRateReturnModel oPaymentRateReturn = new PaymentRateReturnModel();
PaymentRateRequestModel oPaymentRateRequest = new PaymentRateRequestModel();
PaymentRateCalculations oPaymentCalculations = new PaymentRateCalculations();
if (oCaseSummary.treatment_setting.Equals("Hospital"))
{
var OppsByCPT = oOPPSRepo.GetOPPSCByCPT(caseCode.CaseCode1).FirstOrDefault();
if (OppsByCPT.Payment_Rate_ == 0 || OppsByCPT.Payment_Rate_ == null)
{
oCaseReturn.payment_rate = 0;
}
else
{
oCaseReturn.payment_rate = Convert.ToDouble(OppsByCPT.Payment_Rate_);
}
oCaseReturn.cpt_code = OppsByCPT.HCPCS_Code;
oCaseReturn.number_of_treatments = 0;
oCaseReturn.treatment_cost = oCaseReturn.payment_rate * oCaseReturn.number_of_treatments;
oCaseReturn.treatment_setting = oCaseSummary.treatment_setting;
lstCaseReturn.Add(oCaseReturn);
}
if (oCaseSummary.treatment_setting.Equals("Global"))
{
oPaymentRateRequest.CPTCode = caseCode.CaseCode1;
oPaymentRateRequest.Locale = oCaseSummary.locality;
oPaymentRateRequest.PaymentRateScope = oCaseSummary.scope;
var GlobalCalculation = oPaymentCalculations.CalculateGlobalPaymentRate(oPaymentRateRequest);
oCaseReturn.cpt_code = GlobalCalculation.CPTCode;
oCaseReturn.number_of_treatments = 0;
oCaseReturn.treatment_setting = oCaseSummary.treatment_setting;
oCaseReturn.payment_rate = GlobalCalculation.PaymentRate;
oCaseReturn.treatment_cost = oCaseReturn.payment_rate * oCaseReturn.number_of_treatments;
lstCaseReturn.Add(oCaseReturn);
}
if (oCaseSummary.treatment_setting.Equals("Professional"))
{
oPaymentRateRequest.CPTCode = caseCode.CaseCode1;
oPaymentRateRequest.Locale = oCaseSummary.locality;
oPaymentRateRequest.PaymentRateScope = oCaseSummary.scope;
var ProfessionalCalculation = oPaymentCalculations.CalculateProfessionalPaymentRate(oPaymentRateRequest);
oCaseReturn.cpt_code = ProfessionalCalculation.CPTCode;
oCaseReturn.number_of_treatments = 0;
oCaseReturn.treatment_setting = oCaseSummary.treatment_setting;
oCaseReturn.payment_rate = ProfessionalCalculation.PaymentRate;
oCaseReturn.treatment_cost = oCaseReturn.payment_rate * oCaseReturn.number_of_treatments;
lstCaseReturn.Add(oCaseReturn);
}
if (oCaseSummary.treatment_setting.Equals("Technical"))
{
oPaymentRateRequest.CPTCode = caseCode.CaseCode1;
oPaymentRateRequest.Locale = oCaseSummary.locality;
oPaymentRateRequest.PaymentRateScope = oCaseSummary.scope;
var TechnicalCalculation = oPaymentCalculations.CalculateTechnicalPaymentRate(oPaymentRateRequest);
oCaseReturn.cpt_code = TechnicalCalculation.CPTCode;
oCaseReturn.number_of_treatments = 0;
oCaseReturn.treatment_setting = oCaseSummary.treatment_setting;
oCaseReturn.payment_rate = TechnicalCalculation.PaymentRate;
oCaseReturn.treatment_cost = oCaseReturn.payment_rate * oCaseReturn.number_of_treatments;
lstCaseReturn.Add(oCaseReturn);
}
}
return(lstCaseReturn);
}
public PaymentRateReturnModel CalculateTechnicalPaymentRate(PaymentRateRequestModel oPaymentRate)
{
const string CPTMod = "TC";
Double TechnicalRegionalPaymentRate = 0;
Double TechnicalNationalPaymentRate = 0;
if (oPaymentRate.PaymentRateScope.Equals("National"))
{
TechnicalNationalPaymentRate = Convert.ToDouble(oRVU.CalculateTechnicalRVU(oPaymentRate.CPTCode)) * ConversionFactor;
return(new PaymentRateReturnModel()
{
Scope = oPaymentRate.PaymentRateScope,
Locale = oPaymentRate.Locale,
PaymentRate = TechnicalNationalPaymentRate,
CPTCode = oPaymentRate.CPTCode,
CPTMod = CPTMod
});
}
else
{
var oLocaleGPCI = oGPCIRepo.RetrieveGPCIByLocale(oPaymentRate.Locale).FirstOrDefault();
var oGlobalCPTCode = oMPFSRepo.RetrieveMPFSByGlobalCPT(oPaymentRate.CPTCode);
if (!oGlobalCPTCode.Any() || oGlobalCPTCode == null)
{
return(new PaymentRateReturnModel()
{
Scope = oPaymentRate.PaymentRateScope,
Locale = oPaymentRate.Locale,
PaymentRate = TechnicalRegionalPaymentRate,
CPTCode = oPaymentRate.CPTCode,
CPTMod = CPTMod,
HasError = true,
ErrorMessage = "Global CPT has a null error."
});
}
if (oGlobalCPTCode.Count() == 1)
{
if (oGlobalCPTCode.FirstOrDefault().Work_RVUs2 == "NA" || oGlobalCPTCode.FirstOrDefault().Work_RVUs2 == "" || oGlobalCPTCode.FirstOrDefault().Work_RVUs2 == "0")
{
var TechnicalCPT = oGlobalCPTCode.FirstOrDefault();
TechnicalRegionalPaymentRate = (
(Convert.ToDouble(oLocaleGPCI.PW_GPCI) * Convert.ToDouble(TechnicalCPT.Work_RVUs2)) +
(Convert.ToDouble(oLocaleGPCI.PE_GPCI) * Convert.ToDouble(TechnicalCPT.Non_Facility_PE_RVUs2)) +
(Convert.ToDouble(oLocaleGPCI.MP_GPCI) * Convert.ToDouble(TechnicalCPT.Mal_Practice_RVUs2))
) * ConversionFactor;
return(new PaymentRateReturnModel()
{
Scope = oPaymentRate.PaymentRateScope,
Locale = oPaymentRate.Locale,
PaymentRate = TechnicalRegionalPaymentRate,
CPTCode = oPaymentRate.CPTCode,
CPTMod = CPTMod
});
}
else
{
return(new PaymentRateReturnModel()
{
Scope = oPaymentRate.PaymentRateScope,
Locale = oPaymentRate.Locale,
PaymentRate = TechnicalRegionalPaymentRate,
CPTCode = oPaymentRate.CPTCode,
CPTMod = CPTMod
});
}
}
else
{
if (!oGlobalCPTCode.Any() || oGlobalCPTCode == null)
{
return(new PaymentRateReturnModel()
{
Scope = oPaymentRate.PaymentRateScope,
Locale = oPaymentRate.Locale,
PaymentRate = 0,
CPTCode = oPaymentRate.CPTCode,
CPTMod = CPTMod
});
}
var TechnicalCPT = oGlobalCPTCode.Where(c => c.Mod.Equals(CPTMod)).FirstOrDefault();
if (TechnicalCPT.Work_RVUs2 == "NA" || TechnicalCPT.Work_RVUs2 == "")
{
TechnicalCPT.Work_RVUs2 = "0";
}
if (TechnicalCPT.Non_Facility_PE_RVUs2 == "NA" || TechnicalCPT.Non_Facility_PE_RVUs2 == "")
{
TechnicalCPT.Non_Facility_PE_RVUs2 = "0";
}
if (TechnicalCPT.Mal_Practice_RVUs2 == "NA" || TechnicalCPT.Mal_Practice_RVUs2 == "")
{
TechnicalCPT.Mal_Practice_RVUs2 = "0";
}
TechnicalRegionalPaymentRate = (
(Convert.ToDouble(oLocaleGPCI.PW_GPCI) * Convert.ToDouble(TechnicalCPT.Work_RVUs2)) +
(Convert.ToDouble(oLocaleGPCI.PE_GPCI) * Convert.ToDouble(TechnicalCPT.Non_Facility_PE_RVUs2)) +
(Convert.ToDouble(oLocaleGPCI.MP_GPCI) * Convert.ToDouble(TechnicalCPT.Mal_Practice_RVUs2))
) * ConversionFactor;
return(new PaymentRateReturnModel()
{
Scope = oPaymentRate.PaymentRateScope,
Locale = oPaymentRate.Locale,
PaymentRate = TechnicalRegionalPaymentRate,
CPTCode = oPaymentRate.CPTCode,
CPTMod = CPTMod
});
}
}
}
public PaymentRateReturnModel CalculateProfessionalPaymentRate(PaymentRateRequestModel oPaymentRate)
{
const string CPTMod = "26";
Double ProfessionalNationalPaymentRate = 0;
Double ProfessionalRegionalPaymentRate = 0;
if (oPaymentRate.PaymentRateScope.Equals("National"))
{
ProfessionalNationalPaymentRate = Convert.ToDouble(oRVU.CalculateProfessionalRVU(oPaymentRate.CPTCode)) * ConversionFactor;
return(new PaymentRateReturnModel()
{
Scope = oPaymentRate.PaymentRateScope,
Locale = oPaymentRate.Locale,
PaymentRate = ProfessionalNationalPaymentRate,
CPTCode = oPaymentRate.CPTCode,
CPTMod = CPTMod
});
}
else
{
var oLocaleGPCI = oGPCIRepo.RetrieveGPCIByLocale(oPaymentRate.Locale).FirstOrDefault();
var oGlobalCPTCode = oMPFSRepo.RetrieveMPFSByGlobalCPT(oPaymentRate.CPTCode);
if (oGlobalCPTCode.Count() == 1)
{
if (oGlobalCPTCode.FirstOrDefault().Work_RVUs2 != "NA" || oGlobalCPTCode.FirstOrDefault().Work_RVUs2 != "")
{
var ProfessionalCPT = oGlobalCPTCode.FirstOrDefault();
ProfessionalRegionalPaymentRate = (
(Convert.ToDouble(oLocaleGPCI.PW_GPCI) * Convert.ToDouble(ProfessionalCPT.Work_RVUs2)) +
(Convert.ToDouble(oLocaleGPCI.PE_GPCI) * Convert.ToDouble(ProfessionalCPT.Facility_PE_RVUs2)) +
(Convert.ToDouble(oLocaleGPCI.MP_GPCI) * Convert.ToDouble(ProfessionalCPT.Mal_Practice_RVUs2))
) * ConversionFactor;
return(new PaymentRateReturnModel()
{
Scope = oPaymentRate.PaymentRateScope,
Locale = oPaymentRate.Locale,
PaymentRate = ProfessionalRegionalPaymentRate,
CPTCode = oPaymentRate.CPTCode,
CPTMod = CPTMod
});
}
else
{
return(new PaymentRateReturnModel()
{
Scope = oPaymentRate.PaymentRateScope,
Locale = oPaymentRate.Locale,
PaymentRate = ProfessionalRegionalPaymentRate,
CPTCode = oPaymentRate.CPTCode,
CPTMod = CPTMod
});
}
}
else
{
var ProfessionalCPT = oGlobalCPTCode.Where(c => c.Mod.Equals(CPTMod)).FirstOrDefault();
if (oGlobalCPTCode == null)
{
return(new PaymentRateReturnModel()
{
Scope = oPaymentRate.PaymentRateScope,
Locale = oPaymentRate.Locale,
PaymentRate = 0,
CPTCode = oPaymentRate.CPTCode,
CPTMod = CPTMod
});
}
if (ProfessionalCPT.Work_RVUs2 == "NA" || ProfessionalCPT.Work_RVUs2 == "")
{
ProfessionalCPT.Work_RVUs2 = "0";
}
if (ProfessionalCPT.Non_Facility_PE_RVUs2 == "NA" || ProfessionalCPT.Non_Facility_PE_RVUs2 == "")
{
ProfessionalCPT.Non_Facility_PE_RVUs2 = "0";
}
if (ProfessionalCPT.Mal_Practice_RVUs2 == "NA" || ProfessionalCPT.Mal_Practice_RVUs2 == "")
{
ProfessionalCPT.Mal_Practice_RVUs2 = "0";
}
ProfessionalRegionalPaymentRate = (
(Convert.ToDouble(oLocaleGPCI.PW_GPCI) * Convert.ToDouble(ProfessionalCPT.Work_RVUs2)) +
(Convert.ToDouble(oLocaleGPCI.PE_GPCI) * Convert.ToDouble(ProfessionalCPT.Facility_PE_RVUs2)) +
(Convert.ToDouble(oLocaleGPCI.MP_GPCI) * Convert.ToDouble(ProfessionalCPT.Mal_Practice_RVUs2))
) * ConversionFactor;
return(new PaymentRateReturnModel()
{
Scope = oPaymentRate.PaymentRateScope,
Locale = oPaymentRate.Locale,
PaymentRate = ProfessionalRegionalPaymentRate,
CPTCode = oPaymentRate.CPTCode,
CPTMod = CPTMod
});
}
}
}
