TECHNICAL METHODS OF CALCULATION OF CHARGES
The Charging-Billing System should be able to calculate charges based on factors according to policies set by the hospital.
It should be able to differentiate charges based on:
- Service Delivery System
- Financial Class/Charge category
It should enable the hospital to charge different rates for various service delivery systems i.e.:
- Outpatient Service
- Emergency Service
- Inpatient service
- Day Care Service
- Home care Service
- Teleconsultation service
The Charging-Billing System should enable the solution provider and users to build reference tables listing all chargeable items, the quantum of charges for each item and assign a charge code for each item.
The System should be able to:
- Facilitate the hospital to assign charges for a chargeable item either as a charge code or a fixed quantum
- Receive and accumulate charges for all chargeable items incurred by a patient based on data provided by the Patient Management application and the Order-Entry Result-Reporting application
- Calculate the total for each service instance (visit) by simple addition and also using various charging formula
- Produce a cumulative interim bill
- Produce a final bill
- Print bills on demand
LINK BETWEEN PATIENT MANAGEMENT & CHARGING-BILLING SYSTEMS
The Charging-Billing System should acquire data on patient identity, registration, visits, encounters, discharge, service delivery system financial class and the payment method (out of pocket, insurance, paid by employer) from the Patient Management System (PMS).
LINK BETWEEN CHARGES AND ORDER-TASKS
The Charging-Billing system has an interface with the Order-Entry Result-Reporting System (OERRS) and acquire data regarding all orders made and tasks performed.
For the purposes of creating an invoice, charges can be determined as soon as orders are made but for purposes of billing, charges are dropped only when the task is performed. The invoice is used if the hospital policy is for payment to be made up-front before a service is given.
The application software should determine the actual charge based on the charge code and make further calculations (discounts and mark-ups) based on policies.
LINK BETWEEN CHARGING-BILLING & BILL PAYMENT COLLECTION
The Charging-Billing System should transfer information regarding clients, their financial class and charges incurred to the Bill Payment Collection System. Information regarding the payment method is also required but the data is obtained (directly or indirectly) from the Patient Management System (PMS).