The process of billing

Four elements are of importance for the billing process.

• activity registration
• compose claims
• split up claims per party involved
• claim amount

Per element, a description will follow.

activity registration

Contracts with insurance companies are all based on an occurred number of activities. Some activities are paid for a single occurence, some in a bundle of mutliple occurrences.

Each registered activity needs to be of a certain type in order to connect a price to the occurrence of that activity. This price differs per patient and per type of activity. In order to compose proper claims, the first need is to keep track of the activities occurred for a patient. [BR] Please note that for some insurance companies the price of an activity (like the intake) is EUR 0. (not paid for)

compose claims

Based on the activities, the contracts with insurance companies are matched in order to determine what the claim should look like. Some parts of the full cycle of care are claimed on a single occurrence, others are claimed based on a number of occurrences. (SampleBillingProcess? will be provided)

Sometimes claims are only created when some prerequisites are fullfilled. Most insurance companies require an acknowledged application including authorization.

split up claims

When it is clear what the amount is to be claimed, seperate amounts that sum up to the total are claimed (billed) to different parties. The insurance company is one party but the patient or even the clinic as such may take up a part of the total sum. Most of the times this is based on the contract with the insurance company, alhough this may be an agreement with another party too. Like the clinic deciding to take up part of the costs in order to guarantee the result of the treatment.

claim amount

Billing of patients works in different ways.

• A private agreement with the insurance company gives you the right to bill (part of) the treatment.
• Based on DBC (Diagnose Behandel Combinatie) with a fixed or negotiable amount to bill to the insurance company
• An agreement to bill (a part of) the amount on the patients account.
• An agreement to pay back part of the amount to the patients account.

Of course a combination of these options is possible. It is possible and preferable to bill all amounts for the insurance companies using the vecozo services. The vecozo services are manual available via the web or automatic via a webservice.

At least the manual service makes use of the vektis standards, an ASCII format to give billing information to the vecozo website via uploading.

What the webservice expects (XML or ASCII EI standards), needs investigation.

Billing in the application - phase I

The goal is to connect billing to planned treatments. At the first stage, billing is manually ordered by the user.
In order to match the goal to the first phase, billing is at this first stage connected to a planned treatment. (but there is no planning connected to the treatment yet)

The name of the planned treatment, is the 'product name' to be billed. The product name, combined with insurance contract data and the registered activities will create the price to be billed.

• On an user interface level, a bill is added to the page with outstanding 'invoices' (consumed treatments).
• Based on the contract details, the amount is divided into the parts to be paid by the different parties.
• For each party, an invoice is created based on specification (for the insurance company, this is a vektis file, for a patient, it is a pdf)
• It may be possible that a part is billed to the company (kind of discount)
• It is important to ensure that it is possible to connect the parts to the total amount. (e.g. it is possible to show all bills involved for a treatment)
• Each generated file, can be processed according to a defined process. (like the vektis file being uploaded, or the PDF being printed).
• It is required to keep track on the process and see what activities are billed - or not -

User interfaces

On the patients view, an addition tab is created with an overview of billed items and their state. A new billing action is created at this page.

Next to that a single view of the all billed items and their state is given in order to keep track on the process. This screen will be extended with functionality to connect to a accounting software. (at a later phase, this is automated)

This has a connection to the appointments (and show / no-show registration).