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

[Karsten Hilbert]

On Thu, May 19, 2011 at 03:50:37PM -0700, Chris Travers wrote:

> [...] and certainly the EMR application is going to be
> at least one initial point of entry for that data.

It will always remain a vital point of entry for
items-to-bill. Both manually invoked and automatically
generated. That's not a design decision but a given fact.

Or else I could say GNUmed can do billing right now: Install
LSMB, configure it for your needs and happily generate
invoices. Then we needn't have this discussion.

> 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?

There must be a way to *select* (not manage) items to bill
for from within the EMR. Initially manually only.

> 2)  Who reviews that data?

Items to be billed for should be listable in the EMR and
ACKed for being handed to, say, LSMB.

After that review from within LSMB only is fine.

Who ?  Anyone with appropriate permissions.

> 3)  How does it get sent out as an insurance claim or patient bill?

GNUmed should like to not touch this question even with a
ten-foot pole.

> 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

Regardless of who does and who doesn't do this is of no
concern to

- initial implementation
- billing per se

Stock keeping is NOT an objective in this discussion IMHO.

If people want to track assets in LSMB, fine. If they want
to abuse the first iteration of billing to help with that,
fine: create a fake patient "discarded items" and bill
discarded items to that patient for whom an invoice is never
generated.

> 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.

Fine. When ACKed by the doctor data gets moved to LSMB. Let
the beancounters frolick there to their heart's content :-)

> This probably means
> reviewing bills, posting them, etc. in the accounting system.

Yes.

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

Agree.

> BTW, there is some talk on this list about deleting stuff from the
> billing schema.

Not really.

> I'd actually suggest moving to a system where stuff
> is marked billed so a greater paper trail is preserved.

Even if a DELETE were issued against billing tables those
could be under audit control so data only gets transferred
to the audit log.

Should performance really become a concern there's a bunch
of stuff PG can do for us: partial indexes, even index based
table partitioning. I doubt it will matter.

Karsten
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