Medical Billing Flows

Billing in medical practises means charging (medical) services or products. Generally there are two service billing flows:

• Direct billing flow - There exists no framework on which the bill is restricted. The bill is directly written to the patient which is paying the bill.
• Health insurance billing flow - There exists frameworks defined by health insurance providers to which the doctor has to adhere to get the money (e.g. TARMED, TARDOC, GOÄ, EGO, ... )

Direct billing flow

Services behave like products and are charged like products.

Health insurance billing flow

Performed service billing

Precursor for a position to be billable through a health insurance is a medical indication.

• Uncharged - no billable positions exist, which reference to this performed service
• Ready for billing - a billable positions exists, which references to the performed service. Each billing position has a medical indication
• Billed - the billable positions referencing this service are now assigned to a billing position.

Bill issuance status

• Draft with Errors - The bill draft is created, but could not be validated or is incomplete
• Draft OK - The bill draft has been created and validated and is ready for being issued.
• Bill issued - The bill has been issued and has received a bill number, and is also transported into book-keeping (bookings have been made)
• Cancelled - The bill was issued and then cancelled. Bookings have been made to revert the bookings of the issuance

While the bill changes its status, the performed services status is changing as well. On issuance and cancellation, there have to be book-keeping bookings each with transaction numbers for bookkeeping.

Bill delivery status

Each practise needs to track information on how the bill is transmitted to the patient. So we need to track these status info:

• IsETransmitted
• IsPaperTransmission
• DateOfSendout
• HasResponse_Confirmed
• HasResponse_Rejected
• DateOfResponse

See also

• Kordeus.CORE