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

[Sebastian Hilbert]

Am Freitag, 20. Mai 2011, 12:50:34 schrieb Karsten Hilbert:
> On Fri, May 20, 2011 at 08:18:54AM +0200, Hilbert, Sebastian wrote:
> > This could be the very first implementation. For that we have identified
> > that we currently lack a way to enter billables.
> 
> And we don't plan to gain one this time around. Let ${LSMB}
> handle managment of billables. Let GNUmed sync that.
> 
> We need a way to select items-to-bill from the billables list.
>

That is what I meant.
 
> > 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
> 
> Not in the first iteration or else I don't understand what
> you want to achieve with that.
> 

I meant an input method for items to bill instead of billable.

> > To make this clear. Here in Germany I am not aware of any software that
> > could automatically detect billable items. 

items to bill that is


> > These softwares need the
> > doctor to enter an abstract billing code which is connected to a certain
> > amount of money.
> 
> I wish it was. It is only connected to an
> once-theoretically-agreed-upon-but-long-broken-promise-of-perhaps-to-be-pai
> d amount.

Yeah but that is of no concern here as the doctor has no control over the 
amount anyway.

> 
> > >   - 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)
> 
> You need to put some sort of clinical hint on the bill so
> the patient easily identifies with his duty to pay.
> Typically, that's one or more diagnoses.

You do not. 

http://www.derprivatpatient.de/fileadmin/alte_uploads/pdf/musterrechnung_01.pdf

It might just help the patient to decide to actually pay for it.

> There's an
> (unsolved) legal problem what happens when the insurance
> company learns of previous history of the patient when some
> older diagnosis ends up on the bill.
> 

I am not sure any diagnosis is needed at all. Maybe this is different for each 
insurance company.

Where I work patient sign consent forms that insurance companies may get 
billing related diagnoses.

Sebastian