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ISH_TARAS_RULES - Define Rules for Multiplication Factors

ISH_TARAS_RULES - Define Rules for Multiplication Factors

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In this Customizing activity, you can define institution-specific rules for determining multiplication factors automatically.

You can define a multiplication factor for a specific period in the rule table for multiplication factors, depending on the following factors:

  • Service catalog (field SC) (at present, only the in-house service catalog is supported in determining the multiplication factor)
  • Insurance provider type (SAP Ambulatory Care Management only)
  • Insurance provider (SAP Ambulatory Care Management only)
  • Contract scheme (field ContSc)
  • Performing organizational unit (field Perf. OU)
  • Movement type (field MT)

You can mask the following fields:

  • Service category (field SvceCtgry)
  • Service (Service field)
  • Contract scheme (field ContSc)
  • Performing organizational unit (field Perf. OU)
  • Movement category (field C)
  • Movement type (field MT)

For example, if you enter a wildcard (*) in the Service field, this rule applies to all services (apart from the other fields).

Please note the following rules when maintaining the table:

  • If you have not entered a wildcard for the service, you must enter one for the service category.
  • If you have entered a wildcard for the movement category, you must also enter one for the movement type.
  • Only the following values are allowed for the movement category:
  • 1 (Admission)

  • 4 (Outpatient Visit)

  • * (1 and 4)

  • If the case type is 2 (Outpatient Case), the movement category cannot be 1 (Admission).

To determine the multiplication factor, the system first attempts to read the most clearly specified record (the entry for which the farthest left wildcard field contains a value other than *) and progresses through the records with more wildcard entries. The actual access sequence is as follows:

Step Masked Fields During Search
1 tagru
2 tagru, bwart
3 tagru, bewty, bwart
4 tagru, erboe
5 tagru, erboe, bwart
6 tagru, erboe, bewty, bwart
7 leist
8 leist, bwart
9 leist, bewty, bwart
10 leist, erboe
11 leist, erboe, bwart
12 leist, erboe, bewty, bwart
13 tagru, leist
14 tagru, leist, bwart
15 tagru, leist, bewty, bwart
17 tagru, leist, erboe, bwart
18 tagru, leist, erboe, bewty, bwart

The field names have the following meanings:

  • tagru: Service Category
  • leist: Service Code
  • bwart: Movement Type
  • bewty: Movement Category
  • erboe: Performing Organizational Unit

System Procedure

  1. If you create a new service or delete the multiplication factor from an existing service in case-related service entry, the system processes the multiplication factor rules and enters the factor determined in the Multiplication Factor field.
  2. If the system does not find a multiplication factor in the case in question, it then reads user parameter TAS and uses this value as the multiplication factor.
  3. If user parameter TAS has also not been maintained, the system uses the value 1.000 as the multiplication factor.

To access the table, the system must first determine a movement category and a movement type. This takes place as follows:

  • Inpatient cases
  • If the service is assigned to an outpatient visit, the system uses this movement.

  • If the service is assigned to an outpatient visit, the system uses the admission movement.

  • Outpatient Case
  • If the service is assigned to a visit, the system uses this visit.

  • If the service is not assigned to a visit, the system uses the first outpatient visit.

When determining the multiplication factor for a certain service entered, the system then searches the rule table with the start date of the service.

18

Example 1

  • Inst: 1
  • CT (case type): 1
  • SC (service catalog): 1
  • Service: *
  • SvceCtgry: LAB
  • ContSc: *
  • Perf. OU (performing organizational unit): *
  • C (movement category): *
  • MT (movement type): *
  • Valid From: 01/01/2002
  • Valid To: 01/01/2003
  • MltFctr (multiplication factor): 1,5

Example 2

  • Inst: 1
  • CT (case type): 1
  • SC (service catalog): 1
  • Service: *
  • SvceCtgry: *
  • ContSc: *
  • Perf. OU (performing organizational unit): SURG
  • C (movement category): *
  • MT (movement type): *
  • Valid From: 01/01/2002
  • Valid To: 01/01/2003
  • MltFctr (multiplication factor): 1.2

Example 3

  • Inst: 1
  • CT (case type): 1
  • SC (service catalog): 1
  • Service: *
  • SvceCtgry: *
  • ContSc: *
  • Perf. OU (performing organizational unit): *
  • C (movement category): *
  • MT (movement type): *
  • Valid From: 01/01/2002
  • Valid To: 01/01/2003
  • MltFctr (multiplication factor): 1.0

In this example, the system determines a multiplication factor of 1.5 for all services of the category LAB. For all other services, the system determines the multiplication factor according to the performing organizational unit - 1.2 for organizational unit SURG and 1.0 for all other organizational units.

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If you specify a service group as the service, the specified multiplication factor applies to all the services in this group.

If a service is assigned different multiplication factors by means of a service group and directly in the table, the system uses the table entry. The assignment type specified in the institution-specific, time-dependent system parameter VERZOTYP is used to explode the service group.

Please note that the system does not check the time dependency with regard to overlaps. If there are several rules with the same priority for a key date, the system selects the rule with the latest start date to determine the multiplication factor.

The system uses the highest ranking insurance relationship or, if possible, the insurance relationship assigned to the service according to the insurance verification, to evaluate the Contract Scheme field. For example, this means it is possible to determine the special multiplication factors for privately insured patients with basic insurance in the German country version.






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