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ISH_MAIN: Proc. Rules for Gen. Single-Quantity and Summary PCs (New) ( RELNISH_604_ISHMAIN_TW1 )

ISH_MAIN: Proc. Rules for Gen. Single-Quantity and Summary PCs (New) ( RELNISH_604_ISHMAIN_TW1 )

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ISH_MAIN: Proc. Rules for Gen. Single-Quantity and Summary PCs (New)

Use

As of SAP ECC 6.0, Industry Extension Healthcare, Enhancement Package 4 (IS-H 604), Business Function SAP Patient Management (ISH_MAIN), you can use procedure rules to generate a single-quantity PC (procedure code) from case-related material consumptions and a summary PC from one or more single-quantity PCs. The system can then generate a billable additional charge from a summary PC using service rule R22.

Single-Quantity Procedure Codes

A single-quantity PC is a customer-specific quantity-based procedure that must always be entered together with a quantity and unit of measure. Since single-quantity PCs are not official procedures, you must enter them with charge type 81 ("Quantity-Based PC"). Medical staff can use a single-quantity PC to document the quantity of a particular active ingredient that is consumed during the course of the treatment period. The quantity consumed comprises case-related material consumptions that are entered using one or more single-quantity PCs.

Summary Procedure Codes

A summary PC is an officially defined procedure for collating the corresponding customer-specific quantity-based procedures (single-quantity PCs). A summary PC must not have charge type 81 and does not have a quantity or a unit of measure. A summary PC is a procedure that is relevant for generating additional charges. Single-quantity PCs are used to determine which official procedure code is to be documented for the quantity of an active ingredient administered in a case from the total quantity for all single-quantity PCs.

The procedure rules P1 or P2 are available for generating single-quantity and summary procedure codes. The procedure rules are part of the new procedure framework function. Like to service rules, the system can use procedure rules to create, change, or cancel procedures using event-controlled procedure rule Customizing settings and function modules, provided the prerequisites defined in the function module are met.

Procedure Rule P1

Procedure rule P1 checks and generates a single-quantity PC if there is a case-related material consumption and the material used is assigned to a single-quantity PC in Customizing under SAP Healthcare - Industry-Specific Components for Hospitals -> Medical/Nursing Documentation -> Maintain Assignment of Single-Qty Proc.Code to Matl and Summary Proc.Code. If you cancel the material consumption used to generate the single-quantity PCs, the system also cancels the corresponding single-quantity PCs.

Each individual material consumption counts towards additional charges such as those for blood transfusions, administering medication, or radiotherapy. In the case of Blood, the system determines the additional charges in transfusion units (TU). For example, 16 TU of blood would result in an additional charge: 16 TU means that blood was administered 16 times.

While the actual quantity of blood administered in milliliters with each individual transfusion is of course important from a medical point of view, it is irrelevant when generating additional charges. In this context, each individual material consumption counts.

You can generate single-quantity procedure codes with a quantity of 1 by selecting the indicator in the new Indiv. column in Customizing under SAP Healthcare - Industry-Specific Components for Hospitals -> Medical/Nursing Documentation -> Maintain Assignment of Single-Qty Proc.Code to Matl and Summary Proc.Code. Procedure rule P1 then generates the corresponding single-quantity PC with a quantity of 1 and counts these single-quantity PCs singly when calculating the summary PC.

If you select the indicator in the Indiv. column for the assignment rule in the Customizing activity, procedure rule P1 works as follows: the system generates the corresponding single-quantity PC with a quantity of 1 and the unit of measure from the assignment rule (for example, ST) for each case-related material consumption. This means each single-quantity PC is created independently of the actual material consumption and the actual unit of measure for the consumption.

Example of Additional Charges ZE33.01

ZE33.01 is defined as follows in the service master: ZE33.01 "Thrombocyte Concentrates (8-800.80 - 16 TU up to 24 TU)". This means that ZE33.01 can be billed if at least 16 but no more than 23 transfusions of thrombo concentrates were administered.

There must be a summary PC 8-800.80 for the case so that service rule R22 (Generate Additional Charges) can generate ZE33.01. The system can generate the summary PC using procedure rule P2 if at least 16 but no more than 23 single-quantity PCs exist for the administration of thrombocyte concentrates.

The system can generate the required number of 16 - 23 single-quantity PCs using procedure rule P1 if at least 16 but no more than 23 material consumptions of thrombo concentrates are recorded in the system ("case-related material consumption"). For example, if thrombo concentrates are administered three times ("material consumption") in quantities of 450 ml, 400 ml, and 350 ml, procedure rule P1 generates three single-copy PCs, each with a quantity of 1 and the unit of measure ST. This means each transfusion is assigned a quantity of 1 (representing one transfusion) and the unit of measure selected in the Customizing activity for the assignment rule.

Procedure Rule P2

Procedure rule P2 generates a summary PC if single-quantity PCs exist for the case and single-quantity PCs are assigned to summary PCs in Customizing under SAP Healthcare - Industry-Specific Components for Hospitals -> Medical/Nursing Documentation -> Maintain Assignment of Single-Qty Proc.Code to Matl and Summary Proc.Code. If you cancel one or more single-quantity PCs that have led to the generation of a summary PC, the system cancels the summary PCs and, if applicable, creates a new summary PC.

Note: If you want the system to generate a billable additional charge when it generates a summary PC, activate service rule R22 (DE: Generate Additional Charges (FPV)).

The system calculates some age-dependent additional charges using a variety of age-dependent summary PCs. In doing so, the system can generate different summary PCs for the same single-quantity PC and material depending on the patient's age.

You can define age-dependent summary PCs in Customizing under SAP Healthcare - Industry-Specific Components for Hospitals -> Medical/Nursing Documentation -> Maintain Assignment of Single-Qty Proc.Code to Matl and Summary Proc.Code. When executing procedure rule P2, the system checks whether the summary PC in question is age-dependent.

If this is the case, the system checks whether the patient's age on the admission date is between the minimum and maximum ages for the procedure code. If this is also the case, the system generates the summary PC.

You must enter the minimum and maximum ages in the master data for the summary PC beforehand. To generate single-quantity PCs using procedure rule P1 and summary PCs using procedure rule P2, you must also make settings in the following Customizing activities:

  • SAP Healthcare - Industry-Specific Components for Hospitals -> Medical/Nursing Documentation -> Maintain Assignment of Single-Qty Proc.Code to Matl and Summary Proc.Code
  • SAP Healthcare - Industry-Specific Components for Hospitals -> Patient Accounting -> Procedure Rules -> Define Rule Types and Maintain Check Procedure

Effects on Existing Data

Effects on Data Transfer

Effects on System Administration

Effects on Customizing

To generate single-quantity PCs using procedure rule P1 and summary PCs using procedure rule P2, you must make settings in the following Customizing activities:

  • SAP Healthcare - Industry-Specific Components for Hospitals -> Medical/Nursing Documentation -> Maintain Assignment of Single-Qty Proc.Code to Matl and Summary Proc.Code
  • SAP Healthcare - Industry-Specific Components for Hospitals -> Patient Accounting -> Procedure Rules -> Define Rule Types and Maintain Check Procedure

The following events (callup points) are available for the procedure framework check procedure:

  • NPR000: Procedure Check During Procedure Entry
  • NPR001: Procedure Check in DRG Work Station
  • NPR002: Procedure Check in Surgery Data
  • NPR003: Procedure Check for Readmission
  • NPR004: Procedure Check for Entry of Case-Rel.Matl. Cons.
  • NPR005: Procedure Check Before Billing
  • NPR006: Procedure Check Before Test Billing

Further Information

Notes

The system currently only supports automatic generation of procedures and services during entry of case-related materials in transaction NMMC1. The system does not generate procedures or services when saving case-related material consumption in transactions NMM5 and NMM7.

When you enter services for a case in transaction NL10N, the system performs all the procedure actions defined in Customizing for event NPRC000 when you save. When you execute the Rules function in service entry, the system only processes service rules. The Rules function is linked to the current object; this means the system does not process procedure rules when you select the Rules function in service entry.






Vendor Master (General Section)   TXBHW - Original Tax Base Amount in Local Currency  
This documentation is copyright by SAP AG.

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