Re: [Gnumed-devel] Billing/LedgerSMB gap analysis

[Karsten Hilbert]

On Wed, Jun 15, 2011 at 01:26:45PM -0700, Jim Busser wrote:

> 
> > What I think we'd need to do this with a minimum of grace would be an
> > add-on for handling third party payments.  In this model, you'd have
> > an additional bill-to contact that would get the first invoice, and a
> > second bill-to contact that would get the invoice if declined,
> > refused, etc.  For private pay, there would be no additional bill to
> > contact.
> 
> A fee of $35.00, which could work multiple ways:
> 
> 1) the bill for $35.00 is sent to the insurer InsurCo who refuses to pay
>       --> the bill-to gets changed from InsurCo to patient-pay
>       ? does LSMB allow it to be later seen that InsurCo was approached but 
> refused? 
> 
> 2) the bill for $35.00 is sent to the insurer InsurCo who will pay only $25
>       --> does this remain a single bill, whose balance is paid by someone 
> else?
>       or is $10.00 "split off" to make a new bill?
> 
> 3) it is known in advance that insurCo will pay only $25.00
>       --> $10.00 "split off" to make a new bill payable by patient
>       --> the remaining $25.00 "is right away billed to InsurCo
> 
> Does LSMB already handle the above?

Well, as far as I understood Chris' gap analysis, no, it
does not. He also said that the current LSMB structure does
not easily support this model.

However, we are trying to define a use case even easier than that:

        The bill for $35.00 goes to the patient and if they
        don't pay up within, say, 4 weeks, we send out the Gang
        of Five.

That use case will apply in large swaths of the world.

Karsten
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