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

[Chris Travers]

On Wed, May 18, 2011 at 3:52 PM, Jim Busser <address@hidden> wrote:

>>> - it is possible for the staff to spawn a billing item in absence of a 
>>> patient encounter
>>> (for example, the office is asked to fill in a form or to provide copies of 
>>> something)
>>
>> Does that need to be in the EMR system?  Or would that be handled in
>> the sales order/invoice workflow on the accounting side?
>
> I am strongly convinced that it needs to be possible to directly-enter some 
> charges in the accounting system. I see it three ways:
>
> - where charges arise as part of (during) the delivery of care, it is 
> reasonable that it be some record in the EMR that gives rise to the billing. 
> This is important for a couple of reasons:
>        - to provide / channel / supply data needed for the billing
>        - where the above cannot be done automatically, to assist a lookup
>        - as an audit check of missed billings
>        - to be able to reference, if questioned, the actually-delivered 
> service

In GNUmed terms this is an "encounter," even if the patient isn't
actually encountered, is it not?
>
> - where charges may have nothing to do with the delivery of care, it should 
> be possible to directly-enter charges in the accounting system e.g.
>
>        - charges for supplies that an office might re-sell as a convenience 
> to patients
>        - administrative charges or charges that do not relate to a care visit
>
> - gray-zone… if the staff or doctor is not sure, they could create 
> (originate) a charge from the EMR

There are a couple other important cases that crop up in the
not-so-perfect real world.

The first is something like 'We just got these H1N1 vaccines in and
trying to bill for them but the it's is not showing up in the list.'
In this case, the best option IMO is to have an 'unknown good/service'
record which can be annotated, and let accounting adjust it in the
process of the entry.  You want to capture the data as quickly as
possible and with as much data as possible.

Hmmm as I think about this I am actually rethinking my structure here
a bit....  Instead of the components in the order I was looking at
them, the following would probably work better:

GNUmed -> import schema (probably on LedgerSMB db) -> accounting
system -> billing gateway.

My reason for changing the proposal to this linear approach is to
support the following overall workflow:

1)  Doctor enters EMR info, including billing stuff
2)  Bills get input into accounting system
3)  Bills get reviewed by billing department and posted to the books
as receivable.
4)  Bills get submitted (either to private pay individuals or to
insurers whether public or private).

This human review is absolutely critical in every business I have ever
looked at.  It reduces data entry errors, provides some level of
sanity checks, and avoids a lot of problems.  Then the data can be
pulled and sent to the billing gateway through a third party engine.

Best Wishes,
Chris Travers