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Re: [Gnumed-devel] Introducing myself and questions on billing/accountin
From: |
Sebastian Hilbert |
Subject: |
Re: [Gnumed-devel] Introducing myself and questions on billing/accounting |
Date: |
Fri, 20 May 2011 08:18:54 +0200 |
User-agent: |
KMail/1.13.6 (Linux/2.6.38.4-23-desktop; KDE/4.6.0; i686; ; ) |
Am Freitag, 20. Mai 2011, 06:41:01 schrieb Jim Busser:
> On 2011-05-19, at 5:05 PM, Jim Busser wrote:
> > On 2011-05-19, at 4:36 PM, Chris Travers wrote:
> >> Currently LSMB doesn't even support purging old data.
> >
I don't see any need for purging data. With today's computers there is no
reason resource wise.
Later on the status of a record could be marked differently (after a certain
period) but the data will stay available anyway.
Let's talk some numbers here. Even if a larger practice (e.g. 5 radiologists)
see 100 patients per day and write 100 invoices per day this should translate
to 36500 invoices per year at most. Given how few data an invoice is made of I
cannot imagine there should be any problem for a Postgres database handling
this data for a 10 year period (365000 invoices).
> > Don't in any way apologize… there is a lot to be said for data integrity.
> > Also, the accounting records are unlikely to b individually large as I
> > do not imagine that accounting much stores large image or sound or video
> > files!
>
+1
> So… what more remains to be clarified before some schematizing and/or
> prototyping might be able to begin?
>
> > 1) Where should the data be entered?
>
> I think we agreed to accept flexibility
>
> - where clinically relevant, in the EMR
> - where not clinically relevant, directly in billing/accounting software
> - clinic gets to decide what is clinically relevant
>
I believe we need to cleanly seperate a few scenarios here. In an ideal world
you would simply bill what you did and what you used (materials) just like a
carpenter.
This could be the very first implementation. For that we have identified that
we currently lack a way to enter billables.
There could be
a) a plugin where one would manually enter billables (e.g. fetching billable
items from LSMB) sending it off to LSMB
b) some sort of tagging /marking) medical data (procedures, diagnoses) in the
EMR as billable item so it will appear in said plugin before sending off to
LSMB
In a lot of health systems doctors == accountant so doctors are under the
impression that the EMR is providing them the billing software while in
reality the billing software is inclueded into the EMR (abstracted so far that
the doctor does not notice)
To make this clear. Here in Germany I am not aware of any software that could
automatically detect billable items. These softwares need the doctor to enter
an abstract billing code which is connected to a certain amount of money.
So you would enter code 1 for an initial assessment of the patient and this
code is then translated into a human readable billable item and associated
amount of money.
Furthermore those integrated billing systems rarely have any clue to properly
handle invoices when looking from bookkeepers perspective. I am not aware of
any sofware that is used to balance income and cost. It is not the norm that a
practice uses software to track used ressources (drapes and stuff) , bills for
those and at the end of the day looks at the cost.
The situation here in Germany is like this:
patient comes in
doctor does some vodoo
doctor enters some billing codes for that vodoo (mostly top of the head) into
some plugin
rules on combination of billable items are checked
doctor presses 'create invoice' at any time
invoice is printed and amount is added to 'unpaid bills'
That is it.
May in some cases you can change the bill later on but that mainly involves
going to a list of bills, opening one of them, adding or removing codes and
pressing 'print this now' again.
I am not even sure the change is tracked. Anyhow keep in mind that the doctor
is the accountant in the majority of the cases so whatever we come up with it
might help the uptake of the software if a doctor (rather then accountant) can
handle the above steps.
> > 2) Who reviews that data?
>
> I think we agree it should be
> - the biller / accounts manager
they will be identical in many cases and many doctors have little knowledge on
how to operate a full fledges ledger.
> - working and viewing from the billing / accounting software
This will be critical. Doctors so far are used to view but more importantly
change invoices form "their EMR". This is not feasible in our case where we
explicitely want the smart of LSMB to handle this properly. At the end of the
day it boils down to the question wether or not the physician (being the
accountant) can hanle LSMB or not.
> - with some sane way to acquire clinical information as needed to
> support
> payment - EMR may push it
In Germany this is implied by the textual representation of the billing code
one enters. In our scenario billable items (articles) in LSMB will have item
code (which for Germany could be identical to the billing codes of the GOÄ
coding system) and a textual representation.
I am not aware that other clinical information will be needed for billing (it
might even be forbidden to have this information on an invoice)
> - billing ./ accounting daemon / service might be allowed to
> query
it
you mean clinical data or billable items ? This is about push/pull. Depending
on the flexibility of LSMB the EMR billing plugin would push data to LSMB and
maybe keep a reference on the invoice number (created in LSMB) and status of
said invoice (open for additional data, closed). But that would lure us away
form doing it inside LSMB and I imagine it to be hard to keep data consistent
(EMR pushing data into invoice which is closed/finalized in LSMB).
A future EMR plugin could try to interact with LSMB in realtime but that would
mean to replicate the LSMB GUI inside the EMR (which is what most doctors are
used to). This is definetely *not* first working version material.
> - failing the above the MOA or doctor might have to manually
> provide
it
Inside LSMB that is ?
>
> > 3) How does it get sent out as an insurance claim or patient bill?
>
> This is maybe where Chris was wondering about whether & how to support
> on-line claiming?
>
LSMB could look at interfacing to FreeB or REMITT. This is independent of the
EMR.
GNUmed <-> LSMB <-> gateway/data mangler -> REMITT
GNUmed <-> LSMB <-> gateway/data mangler -> PÄV (private patient claims
processing house)
> --> suggest see this page, second section ("Q & A with a Mediclaim
> developer") http://wiki.gnumed.de/bin/view/Gnumed/BillingBritishColumbia
>
> --> re insurer's data specification requirements:
>
> yes, this could be integrated to be pushed out *by* the EMR
>
We want to keep away as far as possible :-) Maintaining changes is a PITA.
> *or*
>
> it could be integrated into the accounting program provided it
> would
be
> granted an EMR user account that would permit a daemon / background
> process to fetch the needed data from the schema… yes??
>
or rather extended. There could be a LSMB <-> REMITT gateway
Our intial consideration would be to have something working that completely
ingnoes this step and works like this
GNUmed <-> LSMB
Regards,
Sebastian
- Re: [Gnumed-devel] Introducing myself and questions on billing/accounting, (continued)
- Re: [Gnumed-devel] Introducing myself and questions on billing/accounting, richard terry, 2011/05/19
- Re: [Gnumed-devel] Introducing myself and questions on billing/accounting, Karsten Hilbert, 2011/05/19
- Re: [Gnumed-devel] Introducing myself and questions on billing/accounting, Chris Travers, 2011/05/19
- Re: [Gnumed-devel] Introducing myself and questions on billing/accounting, Jim Busser, 2011/05/19
- Re: [Gnumed-devel] Introducing myself and questions on billing/accounting, Karsten Hilbert, 2011/05/19
- Re: [Gnumed-devel] Introducing myself and questions on billing/accounting, Chris Travers, 2011/05/19
- Re: [Gnumed-devel] Introducing myself and questions on billing/accounting, Jim Busser, 2011/05/19
- Re: [Gnumed-devel] Introducing myself and questions on billing/accounting, Jim Busser, 2011/05/20
- Re: [Gnumed-devel] Introducing myself and questions on billing/accounting, Jim Busser, 2011/05/20
- Re: [Gnumed-devel] Introducing myself and questions on billing/accounting, Karsten Hilbert, 2011/05/20
- Re: [Gnumed-devel] Introducing myself and questions on billing/accounting,
Sebastian Hilbert <=
- Re: [Gnumed-devel] Introducing myself and questions on billing/accounting, Chris Travers, 2011/05/20
- Re: [Gnumed-devel] Introducing myself and questions on billing/accounting, Sebastian Hilbert, 2011/05/20
- Re: [Gnumed-devel] Introducing myself and questions on billing/accounting, Jim Busser, 2011/05/20
- Re: [Gnumed-devel] Introducing myself and questions on billing/accounting, Sebastian Hilbert, 2011/05/20
- Re: [Gnumed-devel] Introducing myself and questions on billing/accounting, Karsten Hilbert, 2011/05/20
- Re: [Gnumed-devel] Introducing myself and questions on billing/accounting, Karsten Hilbert, 2011/05/20
- Re: [Gnumed-devel] Introducing myself and questions on billing/accounting, Karsten Hilbert, 2011/05/20
- Re: [Gnumed-devel] Introducing myself and questions on billing/accounting, Jim Busser, 2011/05/20
- Re: [Gnumed-devel] Introducing myself and questions on billing/accounting, Karsten Hilbert, 2011/05/20
- Re: [Gnumed-devel] Introducing myself and questions on billing/accounting, Sebastian Hilbert, 2011/05/20