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

[Karsten Hilbert]

Hello Chris,

a hearty welcome to the GNUmed community.

> I am Chris Travers, co-founder of LedgerSMB and owner of Metatron
> Technology Consulting.  I am interested in trying to contribute to
> discussions of billing and accounting connections of GNU Med to other
> programs.  I program proficiently in Perl and Python, as well as
> various procedural languages that work in PostgreSQL.
> 
> My thinking after doing some very basic research on the subject is
> that you'd really need a set of three fairly loosely tied components:
> EMR (GNU Med), the financial accounting system, and the billing
> gateway.   I guess what I would like to hear are:

This is most certainly the way one needs to go about this.
Medical billing is, uhm, complex. No language I know offers
an adjective to adequately describe it (or distance oneself
from it). Insane, perhaps, maybe that's it.

> 1)  What are others in the community currently using in the areas of
> billing and accounting?

We've got three "solutions":

- patient demographics exchange with local specialised
  billing program (CA MSVA format)

- patient demographics exchange with (German) legacy
  "practice management" (== billing) software

- LaTeX template based "fixed bill" printing where nothing
  but the patient demographics changes between bills to
  different patients

> 2)  How are these integrated with GNU Med?

1/2) data exchange via standard file format

3) tightly integrated via our document/forms printing code

> 3)  What are your biggest headaches currently?  What can be done to ease them?

Re Germany there's two fairly distinct bill targets that can
be identified:

        state-insured patients

                Forget about it. interface with a legacy billing
                solution. Technically it's got nothing to do with
                bill writing either.

                On this front you may be aware of REMITT and FreeB
                which are specialized US medical billing engines.

        privately-insured patients

                Those will need a standard paper bill as can be
                produced with, say, LedgerSMB.

Focussing on the latter I think there's great potential,
even for Germany (we've had it desired by users). Several
parts are needed for that (in sequential order of
happening):

- a place to initiate selection of items to be put on bills
        - needs to be done in GNUmed itself
- a place to enable selection of items to be put on bills
        - either in GNUmed or elsewhere
- a place to (manually) invoke generation of bill(s)
        - nice if doable from GNUmed
        - can be done elsewhere, too
- a place generating bills
        - best done in a "bill generator" like LedgerSMB
        - may need to be able to apply a few rules
          re deductions for certain patients (but this
          may be implemented via appropriate billable
          items, too)
- a place to print bills
        - can be done from GNUmed if PDF produced by bill generator
        - no problem doing from bill generator itself
- a way to inform GNUmed about the generated bill
        - bill-as-PDF is fine but do deliver a bill ID
          in machine-readable format for later querying
        - so it can store a copy thereof, if the user so wishes
        - billing solutions may go away/switch/etc but
          the user will want to keep a copy with the patient

Now, other things are needed that don't fit in the sequence:

- a way to manage billable items (products, in ERP speak)
- a way to keep track of invoice status
        - nice if queriable/query-invokable from within GNUmed

Tell you what, we *have* looked at LedgerSMB before, found
it to be a fair candidate but lacked the time to implement
the above :-)

Karsten
-- 
GPG key ID E4071346 @ gpg-keyserver.de
E167 67FD A291 2BEA 73BD  4537 78B9 A9F9 E407 1346