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

[Chris Travers]

On Thu, May 19, 2011 at 3:09 PM, richard terry <address@hidden> wrote:
> On Friday 20 May 2011 06:38:52 Jim Busser wrote:
>
> My 2c worth is that Billing needs to be incorporated in any genuine medical
> record and not rely on external linking. At least in Australia, and I suspect
> many other countries, you will get no takeup at all without that. Here for
> example it needs to be integrated with on-line claiming.

Part of what I am looking at is what is necessary to provide
integration with something like on-line claiming.

>
> At least in most western countries they are inseperably linked, not only just
> because the staff need to know what is done, but because the clinical record
> may need to troll the item numbers pertinent to say chronic disease
> management.

I am not sure what you mean by inseparably linked.  Certainly data
needs to flow through a system in a way in which it can be tracked and
managed effectively, and certainly the EMR application is going to be
at least one initial point of entry for that data.  If that qualifies
as "inseparably linked" then we are in complete agreement.

I guess what I am seeing are two or three independent concerns which
have to answer questions like:

1)  Where should the data be entered?
2)  Who reviews that data?
3)  How does it get sent out as an insurance claim or patient bill?

So... Let's look at this from a couple different viewpoints and assume
that generally a given individual wants to use only one program to
enter data.

>From the first perspective is the doctor.  'Dropped scalpel,
discarded' might need to be entered even if it isn't billable, if one
is doing real-time stock-keeping (I am guessing single-doctor
practices don't, but some on the larger end of GNUmed might as time
goes on).  This wouldn't get turned into a patient bill, but it would
end up getting tracked somewhere in the accounting database since from
an accounting perspective, this represents a loss of an asset and an
accrual of expense.

Secondly, from the bookkeeper's/medical billing perspective, the
bookkeeper wants to only run one program, and is going to want to see
the data in the billing application only.  This probably means
reviewing bills, posting them, etc. in the accounting system.

Should a doctor be able to review data from the accounting side?
Absolutely.  Should a bookkeeper have access to the EMR side?
Probably not.

BTW, there is some talk on this list about deleting stuff from the
billing schema.  I'd actually suggest moving to a system where stuff
is marked billed so a greater paper trail is preserved.  Data could
then be purged periodically based on local requirements.  Since
PostgreSQL supports partial indexes, I suspect that performance would
not be a problem.

Best Wishes,
Chris Travers