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ISH_MM_ABRECHNUNG - Set Up Material Billing

ISH_MM_ABRECHNUNG - Set Up Material Billing

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The IS-H system allows you to bill for material consumption at case level (consumed material, which was entered, for example using the Clinical Process Builder [NV200] variant SAP Case-Related Material Consumption [or transaction NMMC1} and registered in the table IS-H: Material Entered for Case [NMATV] in the system).

Consumed material is billed for at case level using material services. These are performed services of a case that each respresent a specific material consumption for the case. The system generates material services automatically by means of the service rule type R24.

As a prerequisite to billing for material services, the related (material) prices must be stored in the system. Case-related billing of consumptions is only performed for those materials flagged accordingly in the material master. For these materials, you must store the price in relation to the base unit of measure of the material in the IS-H system (see below).

For each material, there are two possible settings (mode for case-related material billing defined in the material master), which stipulate how the material's case-related consumption is to be billed for. With the first mode, billing is based on a single material service. The second mode accommodates billing use the default material service. Different materials can be billed for in different modes.

Mode 1

You use the single material service to bill for the consumption of a highly specific material for a case. You define the reference for this service to the specific material in the service master. Here you also stipulate the price of the material or of the material service for a base quantity of the material (you store the price in the service master columns).
The description you enter for the single material service in the service master should designate the related material.
You can define multiple single material services in the service master that all refer to the same material. When billing is performed, multiple material services occur and are billed for in relation to the consumption of this material.

Mode 2

You can bill for the material consumption using the default material service. The default material service acts as a placeholder for the consumption of any material that is to be billed for at case level. There can be only one default material service for each service catalog. This is defined in Customizing (see below). You do not define a material reference nor a price for this service in the service master. It is recommended that the description you use there for the default material service be as general as possible and show that this service represents any material consumption. When default material services appear in the insurance verification request for the case, the description of the related consumed material (i.e. the description from the material master and not the service master) is displayed. For each material you wish to bill for, you must store the price for a base quanity (for each material number) in a condition table. In addition, for pricing purposes, you must enter a corresponding condition for the occurring (default) material services in your pricing procedure, which evaluates the specified condition table (see below).

Irrespective of the material billing mode of the consumed material, the following specific features apply for the generated material services compared with other performed services for a case:

  • The quantity of a material service is always set to 1 by the service rule type R24. When the quantity is changed manually, the service rule type resets it to 1. The quantity refers to the material service here (one item "Material Service" exists). The quantity of the related material is thus not saved in the quantity field of the material service, but is determined from the material consumption associated with the material service not until billing is performed. It is recommended that you implement a separate unit of measure for material services, for example, material service unit, and assign it in the service master. This helps prevent confusing the service quantity with the material quantity.
  • The prices stored for the materials or for the single material services refer to one item of the material in the base unit of measure (of the material as per the material master). If the material consumption quantity has not been entered in the base unit of measure, it is converted into the quantity in relation to the base unit of measure, when billing is performed. The billed price of the material consumption (i.e. of the material service) is the product of the defined material price and the material quantity in the base unit of measure.
  • If you manually stipulate the price for a material service generated by the service rule type R24, the system also assumes that this price refers to 1 item of the material in the base unit of measure (of the material as per the material master). In such cases, the billed price for the material consumption (i.e. of the material service) is also calculated as descriped above. It is a multiple of the price manually entered in the material service, equivalent to the quantity of consumed material measured in the material's base unit of measure.
  • The invoiced quantity is shown in the billing document items on the Invoice Overview tab page in Case-Related Invoice Processing. When a material service is concerned, this is the billed material quantity. The billed quantity (of the service) is visible on the Service Overview tab page. For a material service, this is the quotient from billed material quantity ( = invoiced quantity) and consumed material quantity. If the material quantity was 100% billed for, 1 is shown here. This 1 is the equivalent of the service quantity specified by the service rule type R24.
  • For material services that were generated by service rule type R24 in mode 2, the multiplication factor has no effect on the final price. The service rule type sets the quantity to 1, and, in the event of a manual change, resets it to 1.
  • If the service rule type R24 generates a material service in mode 2, it overwrites the service description from the service master with the material description from the material master. For this reason, it is recommended that you set the Alternative Service Text indicator for the default material service in the service master.
  • For material services generated by the service rule type R24, a text different than that from the service master can be output as the description of the individual items on the invoice form. In the case of named material services, the respective description of the material from the material master is available in the structure T_RNFP1 and in the contained fields LTEXT and KTXTCONC in the form's interface.
  • If you enter material services manually, the system does not automatically create the reference to a material consumption. The reference from a material service to a material consumption is only created if the service rule type R24 generates material services on the basis of an existing material consumption. For this reason, it is not expedient to manually create a performed service on the basis of the default material service, or without the use of the service rule type R24. This would be of no informative value and could not be correctly billed for on account of failed price determination. For this reason, the service rule type R24 deletes default material services if these do not have a reference to a material consumption or a material. Single material services without reference to a material consumption or material are also identified by the service rule type and only give rise to an information message here. Single material services can in fact be billed for without a reference to a material consumption.
    If you want to see the material consumption (i.e. the sequence number of the material consumption) that is related to a material service, you need to switch to the list display in service maintenance (Ctrl+F3), change the layout, and transer the Seq. No. Material field from the set of available columns into the displayed columns. In addition, you can also display the Material Number, Material Quantity, Material Unit of Measure, and Material Short Text fields. The latter also relate to the material consumption to be billed for using the material service.

The following section describes the settings you need to make in order to bill for material consumption at case level in your system.

Settings in Overview

  • Check whether the service rule type R24 (Create and Adjust Material Services) is active in the desired billing period in your institution.
  • Check whether all materials, for which you wish to enable billing for case-related material consumption, are flagged accordingly by means of the case-related material billing mode defined in the material master.
  • If there are materials, whose case-related consumption you want to bill for using single material services, check whether the single material services relevant for the material are contained in the service master.
  • If you want to bill for material consumption using a default material service, check whether the default material service that is associated with the in-house service catalog has been defined in Customizing. Check whether this service is contained in the service master.
  • If the want to bill for material consumption using a default material service, check whether your pricing procedure contains a condition type that determines the price of the relevant materials.

Settings in Detail

  1. Activate service rule type R24.

The service rule type R24 (Create and Adjust Material Services ) creates material services for case-related material consumptions. It deletes material services whose associated material consumption was canceled. It updates material services if important changes have occurred in the related material consumption. The registered material consumptions remain unchanged by the actions of the service rule type R24.
  • Define in Customizing whether the service rule type R24 has been activated, at which callup points it is to function, and whether it is to perform its actions with or without user confirmation. Note that the callup point NLRG18 (Service Check at Entry of Case-Related Material Consumption) is new. If the service rule type R24 is active for this callup point, it can create and adjust material services in realtime when a save is made in the (NV200) variant "SAP Case-Related Material Consumption" (or transaction NMMC1) in the Clinical Process Builder.
    To do this, in Customizing for IS-H choose SAP Healthcare - Industry-Specific Components for Hospitals -> Patient Accounting -> Service Rule Types -> Define Rule Types and Maintain Check Procedure.

Note:
The service rule type R24 updates material services with related material consumption whenever one of the following conditions is satisfied:.
  • a requesting departmental organizational unit, different than that in the material service is specified in the material consumption

  • a requesting nursing organizational unit different than that in the material service is specified in the material consumption

  • a performing organizational unit different that that in the material service is specified in the material consumption

  • the in-house material catalog valid when the material is administered does not match the service catalog for the material service

  • the material referenced in thematerial service does not match that of the material consumption

  • the quantity field of the material service does not contain the value 1

  • in mode 2 , the multiplication factor for the material service does not contain the value 1

  • the start date or the end date of service performance (ACTUAL) is not the date when the material is administered

  • the start time or the end time of service performance (ACTUAL) is not the time when the material is administered


If the service rule type R24 creates material services, it fills the free comment text with the quantity and unit of measure of the material consumption. In mode 2, it also fills the service text with the decription of the material (from the material master) instead of from the service master.
  1. Material: Set mode for case-related material billing.

Configure for which material you want to allow billing for the case-related consumption and according to which mode (mode 1 and mode 2 were described above).
  • Stipulate the mode for the case-related material billing for billing-relevant material in the material master. The value "Case-Related Billing Not Supported" is the default setting here.
    To do this, in the SAP Easy Access menu , choose Logistics -> Materials Management -> Material Master -> Change -> MM02 - Immediately. Go to the Basic Data Pharmacy view, and set the desired mode in the Material Billing input field in the Other Data section.
  1. Service master: Create single material services
For the materials whose case-related consumption is to be billed for using single material services , you must make sure that the relevant single material services exist in the service master.
  • (Optionally) create a unit of measure for material services . To do this, use the transaction CUNI. You can, for example, thus create the nondimensional unit of measurement MSU with the description 'Material Service Unit' for the ISO code PCE (piece).
  • For the material abc (this is an example), create a service, as the single material service for the material, with the following properties:
    Make the entry for your institution and as per the in-house service catalog. On the Service Textstab page, specify, for example, the short description of the related material abc as the service short text. On the Columns tab page, enter the material price that is to estimated for each base quantity of the consumed material abc when billing is performed. On the Classificationtab page, flag the service as Billable for Inpatientand/or Billable for Outpatient. On the Othertab page, for the unit of measure specify the unit you have defined for material services , or otherwise leave the Unit field blank. In the Materialfield, enter the material abc (material number from the material master).
    To do this, in the SAP Easy Access menu , choose Hospital -> Basic Data Administration -> Service Master Data -> Service -> NT01 - Create.
  • Repeat the last step for further single material services that relate to other materials.
  1. Create default material service
For the materials whose case-related consumption is to be billed for using the default material service , you must make sure that the default material service exists in the service master and that it is defined as such in Customizing.
  • Create a material with the following properties as the default material service in the service master:
    Make the entry for your institution and as per the in-house service catalog. On the Service Texts tab page, for the short text use as general a text as possible that expresses that this service represents any material consumption. Choose, for example, the short text 'General Material Consumption'. (Imperatively) set the Alternative Service Text indicator (otherwise the service rule type R24 is unable to overwrite the service text with the material description and aborts when creating material services). On the Columnstab page, leave all of the fields empty. On the Classification tab page, flag the service as Billable for Inpatientand/or Billable for Outpatient. On the Other tab page, for the unit of measure enter the unit you defined for material services , or otherwise, leave the Unit field empty. Leave the Material field empty.
    To do this, in the SAP Easy Access menu , chooseHospital -> Basic Data Administration -> Service Master Data -> Service -> NT01 - Create.
  • Define the default material service as such for your institution and as per the in-house service catalog.
    To do this, in Customizing for IS-H choose SAP Healthcare - Industry-Specific Components for Hospitals -> Integration with Materials Management -> Maintain Basic Data -> Define Default Material Service , and create an entry for which you specify your in-house service catalog as the service catalog.
  1. Set up price determination for default material services
For the materials whose case-related consumption is to be billed for using the default material service , you must make sure that the prices relevant for the material are found and used during the billing process.
  • Create a condition table for storing the material prices. The parameter value (i.e. key field of the condition table) should be Material.

    Example: Condition table 989 with temporal validity and type T with the selected field Material.
    You create the condition table in Customizing for IS-H by choosing SAP Healthcare - Industry-Specific Components for Hospitals -> Patient Accounting -> Billing -> Pricing (Using Conditions) -> Conditions -> Create Condition Tables.
  • Define and activate an access sequence for this condition table.

    Example: Access sequence ZMAT with reference to condition table 989.
    To do this, in Customizing for IS-H choose SAP Healthcare - Industry-Specific Components for Hospitals -> Patient Accounting -> Billing -> Pricing (Using Conditions) -> Conditions -> Define Access Sequences.
  • Create a condition type, and refer to the access sequence you defined beforehand.

    You should store the following values:
  • Condition class: B (prices)

  • Calculation type: C (quantity)

  • +/- sign: " " (empty)

  • Valid from Before: 3 (first day of the year)


Example: Condition type ZMAT with reference to access sequence ZMAT.
To do this, in Customizing for IS-H choose SAP Healthcare - Industry-Specific Components for Hospitals -> Patient Accounting -> Billing -> Pricing (Using Conditions) -> Conditions -> Define Condition Types.
  • Add this condition type to your pricing procedure. You can, for example, add this condition type after base price determination using formula 501. Enter the formula 510 to determine the condition basis (BasFrm column) for your condition type. (The latter formula simply ensures that the base price of the material determined by your condition type is correctly displayed on the invoice and in the invoice overview.)
    To do this, in Customizing for IS-H choose SAP Healthcare - Industry-Specific Components for Hospitals -> Patient Accounting -> Billing -> Pricing (Using Conditions) -> Pricing Procedure -> Maintain Pricing Procedure.
  • Enter the necessary condition records (i.e. the valid material prices) for the condition table you created beforehand. Make sure that the created condition records have the correct temporal validity. Here, take into account (only) the materials whose case-related consumption is to be billed for using a default material service .
    To do this, in Customizing for IS-H choose SAP Healthcare - Industry-Specific Components for Hospitals -> Patient Accounting -> Billing -> Pricing (Using Conditions) -> Conditions -> Maintain Condition Records.

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