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RNL26700 - IS-H Billing Evaluation: Disproportionate Share Adjustment Data

RNL26700 - IS-H Billing Evaluation: Disproportionate Share Adjustment Data

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Description

The program evaluates billing information and supplies the data necessary for the German disproportionate share adjustment (according to §267 SGB).

For each insurance provider and accounting period (quarter) the total of the invoiced amounts is displayed for each status of insured. Possible copayments are not included.

Requirements

The data survey is only necessary for the statutory health insurance funds and that is why the evaluation should be limited by means of the insurance provider type.

Selection parameters

By means of the selection parameters, the program can be limited to certain insurance types or insurance providers. You can also do this via the invoice date.

You can also choose to limit the evaluation to a certain quarter ('only for quarter'), by specifying a quarter. In this case, please respect the format 'YYYYQQ', for example 199401 for the 1st quarter of 1994. If you do not specify a quarter, the system determines the respective quarter automatically for all selected invoices.

By means of a number of further options you can specify

  • Whether the output is to be normal (standard) or enhanced
  • Ehether the amounts for each status of the insured person are to be totalled via the case types in the selection (standard) or not
  • Whether the amounts for each identical status of the insured person are to be totalled (standard), or are to be displayed separately for every single invoice of a case (caution: size of the list!). Note that amounts are always posted separately for patients with an empty status of the insured person.
  • Whether the end date of the invoice line items or the invoice date is to be used for assignment to the calculation period (standard). In the first case, the end date of the last invoive line item is used for quarter assignment.
  • Whether cases with missing status of the insured person are to be considered (standard) or not. If this is the case, every case with empty status is then displayed in a separate line.

Output

The data can be printed as a data entry form, or output in a file.

Printout:
If an enhanced log is requested, a list of the affected cases and the invoices is created in addition to the data entry form data. This list has the following structure:

  • Case number
  • Patient name
  • Insurance provider type
  • Insurance provider number
  • Status of insured (five-digit)
  • Invoice amount
  • Relevant date calculation period
  • Document number of the invoice.

You can replace the default printout of the data entry form by your own print formatting routines to which you can refer at the program start (please set 'next page' selection parameter).

As regards sorting, you can use functions you have created yourself for a general page header and for the data of the data entry form.

You can use the routines

  • Form TOP-OF-PAGE
  • Form SORT and
  • Form DATA ENTRY FORM

of program RNL267DR as references. Please do not change program RNL267DR but only copy it if required.

File output:
The selection screen (2nd page) also allows you to output data into a file Two different methods are available: you can either output the file on the application server or on the local presentation server. You have to enter a file name (including path) and the recipient of the file to do this. In this case, the file format corresponds to the file format prescribed in the outline agreements for §267 SGB. To ensure correct file contents, you must make settings on the selection screen in such a way that the amounts for each status of insured are output and cases without status of insured are not taken into account .

Notes

  • An apparently incorrect report of several lines repeating the same combination of insurance provider, quarter and status can then occur if different health insurance numbers (institute indicator numbers) have been entered or imported for the same insurance provider.
  • If an invoice is cancelled for a period for which this evaluation has already been carried out, this is not settled with the values of a subsequent quarter. However, the evaluation can be carried out repeatedly for the period in question.
  • If you carry out billing for several quarters, the invoice is added to the later quarter. The amounts are not divided among the different quarters.





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