Re: [Gnumed-devel] Introducing myself and questions on billing/accounting

[Jim Busser]

On 2011-05-18, at 11:27 PM, Sebastian Hilbert wrote:

> 1) That leads to the question if GNUmed passes on billable items and LSMB 
> processes them by reviewing them and creating an (e.g.) printed invoice what 
> happens if at the LSMB level somone decides to kick a few billable items.

kick = void / cancel / kill (presumably) ?

> It is of any concern to the EMR / doctor ? Would the doctor be interested to 
> know that a billable item was not billed ?

Some would. The report need not be issued by the EMR, it could be issued by the 
accounting system and it would be up to the doctor to request / arrange to be 
provided such a report.

IMHO it would greatly complicate the EMR if it becomes necessary to try to 
update the status of billable items in the EMR after they had been exported and 
tagged with status = "Exported / Uploaded"

> 2) On a completely different matter (on of interest later on and might not 
> pertain to LSMB at all): Here in Germany there exist a set of rules which 
> billable items can be combined and which cannot.
> <snip>
> weightings
> <snip>

We have a similar situation in BC Canada where to bill a "regular" consultation 
you employ one fee code and provide an ICD-9 (minimum 3 character) diagnostic 
code whereas to bill a "complex" consultation you employ a *different* fee code 
and must provide either three ICD9 diagnostic codes or one code plus comments 
describing the other two.

Supporting this kind of thing would require one or both of:

- develop a differential export…
        some items go to a dedicated (insurer-knowledgeable) billing program
        other items go to the accounting software for direct patient billing

- or develop, in the EMR, a way to configure the information to be supplied to 
the accounting program (which may then have to pass it to a dedicated 
(insurer-knowledgeable) billing program)

-- Jim