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

[Sebastian Hilbert]

Am Freitag, 20. Mai 2011, 09:19:11 schrieb Chris Travers:
> On Thu, May 19, 2011 at 11:18 PM, Sebastian Hilbert
> 
> As for minimally what LedgerSMB would need:
> 
> For each invoice:
> 1)  Patient's contact/billing info on a new patient

That can be delivered easily. There is a patient object in GNUmed.

> 2)  Which patient is involved

Same as above. There is the status "active patient"

> 3)  Identifier for the invoice......
> 

Either supplied or auto generated by LSMB (and then handed back to GNUmed for 
reference)

> For each line item on the invoice
> 1)  An identifier for the part or service

This would be entered in LSMB initially and then handed to GNUmed (made 
available in a PhraseWheel I guess)

> 2)  Any price adjustment factors (discounts, etc)

Sure. Those would be supplied via the GNUmed plugin

> 3)  Quantity.

Same as above

> Anyhow keep in mind that the
> > doctor is the accountant in the majority of the cases so whatever we
> > come up with it might help the uptake of the software if a doctor
> > (rather then accountant) can handle the above steps.
> 
> I think that one thing that is important in thinking these things
> through is to try to be anything to anybody rather than everything to
> everybody.   If the doctor is the accountant bookkeeper and accountant
> though, often this means that the doctor will need to have access to
> some sort of accounting system that will track expenses against
> revenue.
>

tell you what. My gut tells me that 50% do not do it at all and get an idea 
when filing tax forms. 40% do it on paper or have someone (tax advisor) do it 
for them. 10% have electronic checking accounts and are notified of incoming 
payments then marking the invoice as paid.
 
> >> > 2)  Who reviews that data?
> >> 
> >>       I think we agree it should be
> >>       - the biller / accounts manager
> > 
> > they will be identical in many cases and many doctors have little
> > knowledge on how to operate a full fledges ledger.
> 
> Yeah.   I personally think one of the big limiting factors is going to
> be GL stuff.  Most people can figure out how to enter invoices in
> LSMB, but GL stuff requires some actual accounting knowledge.
> 
> I think that one of the things that is going to be required here is to
> sit down with doctors who are not so knowledgeable about accounting
> and find out how some of the screens can be altered to make it easier.

Excellent idea. I guess that would be your part :-)

>  I can just imagine now.....  "What?  I CREDIT the bank account I am
> transferring money from and DEBIT the one I am depositing into???"
> Fortunately this is becoming quite possible to do now.
> 

Ideally the user/doctor/accountant would not even have to know. This could be 
done automatically. At the end of the day all I am interested is.

Did I bill for that (managing my expenses) ?
Did it get paid ?
 

> >>       - working and viewing from the billing / accounting software
> > 
> > This will be critical. Doctors so far are used to view but more
> > importantly change invoices form "their EMR". This is not feasible in
> > our case where we explicitely want the smart of LSMB to handle this
> > properly. At the end of the day it boils down to the question wether or
> > not the physician (being the accountant) can hanle LSMB or not.
> 
> Yeah.......  I think this is going to take a while, and some pilot
> users, and a lot of evolution of the software....
> 

We have no deadline to meet. That makes it a whole lot easier.

> > 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)
> > 
> >>               - billing ./ accounting daemon / service might be allowed
> >> to query
> > 
> > it
> > 
> > you mean clinical data or billable items ? This is about push/pull.
> > Depending on the flexibility of LSMB the EMR billing plugin would push
> > data to LSMB and maybe keep a reference on the invoice number (created
> > in LSMB) and status of said invoice (open for additional data, closed).
> > But that would lure us away form doing it inside LSMB and I imagine it
> > to be hard to keep data consistent (EMR pushing data into invoice which
> > is closed/finalized in LSMB).
> 
> Honestly I would probably do this as an LSMB plugin, which would use
> dblink, DBI-link or similar to query the EMR db via a view.
> 
That will be the task for you and Karsten I guess.

> >> > 3)  How does it get sent out as an insurance claim or patient bill?
> >> 
> >>       This is maybe where Chris was wondering about whether & how to
> >> support on-line claiming?
> > 
> > LSMB could look at interfacing to FreeB or REMITT. This is independent of
> > the EMR.
> 
> Well, more looking at workflows here.  Someone maybe once a week,
> selects all invoices going out to a provider, clicks a button
> somewhere and bam, FreeB, etc is called......    Unfortunately LSMB
> isn't quite there to be able to do this as sanely as I would like.
> 

It does not have to. For the time being the REMITT/FreeB guys could be 
involved to pull the relevant data from LSMB. Let's keept the goodies for 
later :-)

BTW. What's next ?

Sebastian