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RNABG000 - IS-H: Determine Cost Portions with Workers' Comp. Assoc. Billing

RNABG000 - IS-H: Determine Cost Portions with Workers' Comp. Assoc. Billing

BAL Application Log Documentation   General Material Data  
This documentation is copyright by SAP AG.
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Description

In outpatient Workers' Compensation Association billing, the amount invoiced is broken down for accounting purposes. The system determines the WCA physician costs that are to be reimbursed to the hospital, and the total amount of the medical services performed.

The following costs are reimbursed:

  • Material costs
These are general personnel and material costs, and also the costs incurred through the use of medical instruments and apparatus. They also include certain types of material costs.
  • WCA physician's fee to hospital
Since the material costs mentioned above do not cover all the costs incurred by the hospital, the physician has to give a certain percentage of his/her fee to the hospital. This portion of the fee covers the following costs:
  • Administrative services including secretarial staff

  • Setoff of damage against benefits

You can use this program to periodically calculate the totals of the following cost portions per WCA physician/organizational unit:

  • Material costs
  • WCA physician's fee to hospital
  • Physician's daily attendance fees

These cost portions are output in the local currency. This is the currency of the company code to which the institution in question is assigned. If amounts have been invoiced in different currencies, all amounts are translated into the local currency.

The invoices for the WCA physicians are output and broken down by the following billing types:

  • General treatment
  • Special treatment

Note

  • The report only includes invoices that were transferred successfully to Financial Accounting.
  • The incoming payments from Financial Accounting are included when the cost portions are determined.
  • If an invoice is included in a report run, the system does not make any internal note of this. Consequently, if you run the report again, invoices that have already been evaluated are displayed again.

It is recommended that you start the report periodically. Also, please ensure that the invoice creation periods do not overlap, and that there are no gaps between periods.
One way of ensuring this is to save the report variants used for each report run.

Requirements

Selection screen

You must enter data in the following selection screen fields:

  • Institution
  • Invoice creation period
  • At least one billing type
  • At least one cost element

To avoid long response times, you are advised to restrict your selection.

If you want to run the report for individual cases, please enter the cases in question. In this case, please ensure that the creation period specified covers all the cases you have selected.

In order to execute this report, you require authorization S_PROGRAM, and also the authorization group specified in the report attributes.

Output

In the list that is output, data is displayed for each WCA physician (organizational unit).

The data for each WCA physician is broken down by billing type. All the invoices for each WCA physician and billing type are displayed. The following information is displayed for each invoice:

  • Case with check digit
  • Patient's name
  • Invoice number
  • Date on which invoice was created
  • Total amount of individual invoice
  • Total costs per invoice and per cost elements selected
  • Material costs per invoice if cost element Material costs was selected
  • Physician fees per invoice if cost element Physician fees was selected
  • Portion of WCA physician's fee to hospital if cost element Transfer free was selected

The system displays a subtotal per billing type per WCA physician. The overall total for each WCA physician is also output.
A subtotal and overall total are output for the following fields:

  • Total of cost portions for all selected cost elements
  • Material costs
  • Physician fees
  • Portion of physician fee for hospital (transfer fee)

You can display more detailed information on a case or invoice.
To do so, position your cursor on the case number (or invoice number) in question, and select the appropriate field. If you chose a case number, the Case Monitor screen appears. If you chose an invoice number, the Invoice Overview screen appears.

Note

  • The check digit for a case is only displayed in the list if the digit check indicator was set for your institution in Customizing.
  • In Customizing, you can also specify that only one invoice should be issued even if the billing type changes. If you make this setting in Customizing, you will be able to list identical invoices under different billing types. If you have set the system parameter specifying that the visit type of the first visit is to be used for outpatient billing, the setting described above does not apply.

Example

Note

If the results of the report are not what you expected, please inform your systems administrator, and ask him/her to check that all the necessary settings have been made in the section of the IMG for SAP Healthcare entitled Define outpatient WCA billing.






BAL_S_LOG - Application Log: Log header data   BAL Application Log Documentation  
This documentation is copyright by SAP AG.

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