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ISH_SG_CHARGE_SCHEME - SG: Maintain Estimation Procedure

ISH_SG_CHARGE_SCHEME - SG: Maintain Estimation Procedure

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It is common practice in certain countries (e.g. Singapore) to submit an estimated invoice to a patient when he/she is admitted to hospital. This estimated invoice both provides the patient with information and is the basis for calculating the down payment or deposit he/she may be required to make to the hospital.

Every hospital may have its own way of calculating this estimated invoice. The general procedure for creating estimated invoice included in the standard SAP software delivery enables you to define how the estimated invoice is to be calculated in your institution.

The estimation procedure assumes the existence of two types of charge:

  • Non-recurrent charges (e.g. for a surgery)
  • Daily charges (e.g. for accommodation, nursing care)

A charge type can have multiple components that are used to calculate the total amount for the charge type.

These charge components can be processed in a variety of ways. For example, the various components can simply be totaled. Alternatively, only specific combinations of components may be taken into account when calculating the total amount for the charge type.

  • Example 1:
Calculation of daily charges with the following charge components:
  • Accommodation charge

  • Daily treatment charge

In this case, the total amount is the sum of the individual components.
  • Example 2:
Calculation of non-recurring charges with the following charge components:
  • Charge for surgery when specific surgical procedure codes exist

  • Charge for surgery when specific table of operation exists

  • Average charge for treatment when specific diagnosis exists

In example 2, the amounts of the various components are not added together to produce the total amount for this charge type. In this case, the amount for one component produces the total amount for the charge.

Since not all data is available when the estimated invoice is created, there should be components which allow an invoice to be estimated using relatively little data. However, when more exact data allows the estimation to be as accurate as possible, there should also be components which take the more detailed data into account for the estimation.

You can set up the estimation procedure such that charges are not calculated twice by mistake.

You have to have performed the following IMG activities to be able to maintain the estimation procedure:

  • Define the corresponding rules for calculating the amounts for the various charge components.
  • Maintain the respective estimation tables that are accessed by the rules.

In the estimation procedure, maintain the rules that are to be executed for calculating the estimated invoice. Store the following information for each rule in your estimation procedure:

  • Assign your rule to a step.
  • If you assign more than one rule to a step, you can specify the order in which the rules are to be processed by making an appropriate entry in the field Count..
  • Using the indicator Excl, you can control whether the system stops processing further rules within a step in the procedure after the corresponding rule has been successfully processed.
  • Using the indicator Stop, you can control whether the system stops processing other rules in the procedure after the corresponding rule has been successfully processed.
  • If you use several rules for calculating the amount charged for the same components, you should assign these rules to the same step. The most specific rule (i.e. the rule which requires the most exact data for calculating the amount charged) should be assigned the lowest value in the field Count. and the most general rule should be assigned the next highest value. The field Excl should be selected for all rules.
  • If you have a rule which determines a charge that covers the patient's complete stay in the hospital, you should assign this rule to the lowest step in the estimation procedure. Select the field Stop for this rule.

You find the rules SAP provides for calculating the amount for a charge component in client 000 by choosing SG: Maintain estimation procedure in the IS-H Implementation Guide. The rules are in the SAP name range (from A* to W*). You can maintain the related estimation tables in the IS-H Implementation Guide by choosing SG: Maintain SAP Estimation Tables.

The following rules are delivered with the standard system:

  • S_OPTAB
Calculates an estimated amount for a specified table of operation.
  • S_ACCOMOD
Calculates an estimated amount for accommodation. Since this is a daily charge, you need to set the indicator Daily. If you deselect this indicator, the amount determined for the accommodation will be charged once only, even if the patient's estimated length of stay exceeds one day.
  • S_MEDCASE
Calculates an estimated amount for a medical case. This rule should only be evaluated if the system cannot determine a charge for a surgery for the case. In this situation, a non-recurring charge is calculated in relation to the department of the case.
  • S_SERVICE
Calculates the value of a service. For this, the system determines the value from the catalog column specified.
Charge factor value determination is not carried out

It is possible to add your own rules to the estimation procedure. When doing this, note the following:

  • The rule name must be within the customer name range (X*, Y*, Z*).
  • The function module for calculating the charge must use a standard interface. This is described in function module ISH_GET_ESTIMATED_AMOUNT_OP. To ensure this, copy this function module, then tailor the copy to meet your requirements.
  • If your rule calculates a charge that is incurred daily, select the indicator D (daily) when maintaining the rule.
  • Messages must be sent via the function module MESSAGE_STORE.
  • Create the corresponding estimation tables.
  • Generate maintenance views for the estimation tables (transaction code SE54).
  • Maintain the estimation tables using transaction SM30.

Use the F1 help function when maintaining your data.






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