Billing PPA Cases by Certificate (RNABDT02_604)

 

Note Note

This function is only relevant as of IS-H 605.

End of the note.

If you activate the business function SAP Patient Management: Treatment Certificates (ISH_TC), you can bill PPA cases at both treatment certificate and case level.

You can do this using the IS-H: PPA Billing by Certificate report (RNABDT02_604), which you can access by means of transaction NA62. Communication between the SAP system and the amasys outpatient billing system takes place using Web services.

Treatment certificate billing takes place for each billing organizational unit (OU) (this corresponds to a place of work number). A treatment certificate has a billing indicator, which is set to Final Billed once PPA billing has been performed successfully. The user cannot make changes to a treatment certificate once final billing has taken place. Once all the treatment certificates for a PPA case have been billed, the PPA case is final billed.

Until now, the system only supported and billed one treatment certificate for a PPA case in integrated PPA billing (report RNABDT02, transaction NA67).

Note Note

For more information, see the documentation for the business function SAP Patient Management: Treatment Certificates (ISH_TC) in the SAP Library at http://help.sap.comInformation published on SAP site under Start of the navigation path SAP ERP Next navigation step SAP ERP Enhancement Packages (English) Next navigation step Business Functions (SAP enhancement package 5 for SAP ERP 6.0) Next navigation step SAP Patient Management: Treatment Certificates End of the navigation path.

End of the note.

Caution Caution

The IS-H: PPA Billing report (RNABDT02) is no longer available once the business function SAP Patient Management: Treatment Certificates (ISH_TC) has been activated. You then need to use the IS-H: PPA Billing by Certificate report (RNABDT02_604) instead. This business function is available for the country version Germany as of enhancement package 5 (EHP5).

End of the caution.

Features

Once the business function SAP Patient Management: Treatment Certificates (ISH_TC) has been activated, a PPA case can have a number of treatment certificates, to which you can assign different billing OUs provided the following conditions apply:

  • All the treatment certificates are within the quarter for the case.

  • All billable services in a PPA case are remapped in the same way. A specific remapping for each billing OU or visit type is not permitted.

  • All the treatment certificates for the case are billed using the IS-H: PPA Billing by Certificate report (RNABDT02_604). PPA billing and IS-H billing cannot both take place within one PPA case.

  • Every treatment certificate that you want to bill using the IS-H: PPA Billing by Certificate report (RNABDT02_604) requires a movement-treatment certificate assignment. To make this assignment, select the Assign Movement -> Certificate checkbox in the treatment certificate when you enter a treatment certificate for a visit.

  • The PPA insurance relationship applies to all treatment certificates. The system uses the insurance card data in the insurance relationship when billing all the treatment certificates for the case. If you enter an additional treatment certificate for a case in a new OU, make sure the insurance card is read again. If you want to enter insurance card data for each place of work number (billing OU for the treatment certificate), you should only enter treatment certificates for one place of work number for each case.

  • If you want to enter a treatment certificate for a visit, you must select the Assign Movement -> Certificate indicator in the treatment certificate. To do this, you need to make the following settings in Customizing under Start of the navigation path SAP Healthcare - Industry-Specific Components for Hospitals Next navigation step Patient Accounting Next navigation step Insurance Verification and Certificates Next navigation step Treatment Certificates - Maintain Automatic Processing End of the navigation path:

    • If you only want to enter one certificate for each case, edit the Movement Assignment field.

    • If you want to enter more than one certificate per case, edit the Assign Movement -> Certificate field in the above Customizing activity.

Processing Billing Blocks

You can use a billing block to exclude cases from transfer to the PPA billing system.

Note Note

Please note that the system only excludes a case with a billing block from transfer if message NB115 is configured as an error message in Customizing.

If there are several treatment certificates that can be transferred for a case, the system does not transfer any of them if the case has a billing block.

You can change the type of the message displayed for a case with a billing block, or suppress the message altogether, in Customizing under Start of the navigation path SAP Healthcare - Industry-Specific Components for Hospitals Next navigation step Basic Settings Next navigation step System Parameters Next navigation step Message Control Next navigation step Maintain Messages End of the navigation path.

End of the note.
Remarks on Case Formatting for PPA Billing

  • Generating the EBM code

    You must observe certain syntax rules when formatting the case and patient data for PPA billing. The system uses form routine format_ebm_service(NBDT) to convert the service code from SAP Patient Management to a syntactically correct EBM code (for example, E1234 -> 01234).

    The form routine removes the prefixes from services that are used to split service catalogs in the in-house service catalog and inserts a leading zero. EBM services have the following syntax:

    nnnnn oder nnnnn[G-alpha] mit n = 0.1…..9 und G-alpha = A.B…..Z

  • Determining treatment certificate diagnoses per treatment certificate

    If you use the IS-H: PPA Billing by Certificate report (RNABDT02_604) to perform PPA billing, the system does not transfer all the treatment certificate diagnoses for a case to amasys when billing a treatment certificate. The system only transfers the treatment certificate diagnoses that are assigned to the same movements as the treatment certificate to be billed.

  • Determining the referring physician for each treatment certificate

    If you use the IS-H: PPA Billing by Certificate report (RNABDT02_604) for PPA billing, the system no longer determines the referring physician from the first visit not canceled for the case when billing a referral certificate. When doing this, the system determines all the visits that are assigned to the referral certificate to be billed. The system transfers the first referring physician determined from these visits to amasys.

  • Remarks on the PPA work station

    If you activate the business function SAP Patient Management: Treatment Certificates (ISH_TC), the following changes apply to the PPA work station:

    • Movement-related access

      The system checks whether the treatment certificate that is assigned to the current visit is billable. If there are several treatment certificates with the same billing organizational unit (OU) for the case, the system also checks these. The system does not check the case in its entirety, since a case can have treatment certificates with different place of work numbers (BSNR).

    • Creating a new visit

      When you create a new visit, it is not yet assigned a certificate with a billing OU. This means that in this case, all the traffic light icons in the PPA work station are red, even if the case already has other billable certificates.

    • Service filter for each treatment certificate

      If you need to enter different treatment certificates for your PPA cases, it is advisable to use a filter displaying the services for each treatment certificate in the service subscreen.

    • Description

      Each certificate is assigned a filter, which you can use to display which services are assigned to a certificate.

    • Entering a PPA case when there is more than one certificate

      There is no automatic movement-certificate assignment, but services are assigned automatically to a treatment certificate if you have assigned the services and the certificate to the same movement.

      You must always assign a certificate to a movement.

    Caution Caution

    Check the movement-certificate assignment and the certificate-service assignment for each certificate in the Treatment Certificates subscreen.

    End of the caution.

  • Notes on insurance relationships

    If you activate the business function SAP Patient Management: Treatment Certificates ((ISH_TC), the following change applies to the insurance relationship: There is only one insurance relationship (IR) for all the certificates for the case. If you want to enter a new treatment certificate in a different organizational unit (OU), it is advisable to re-read the insurance card so that the last read date recorded in the IR is up to date. If the read date of the insurance card is before the first treatment, amasys displays a warning.

  • Billing or resetting old cases

    You can use the IS-H: PPA Billing by Certificate report (RNABDT02_604) to bill PPA cases that you created before you activated the business function SAP Patient Management: Treatment Certificates (ISH_TC). You can also reset PPA cases billed before you activated the business function SAP Patient Management: Treatment Certificates (ISH_TC) using the IS-H: Reset PPA Billing report (RNABDT02_604_UNBILL). If you do this, the system determines the billing indicator for the treatment certificate dynamically for old billed cases and displays it in the treatment certificate transaction.

Resetting Billing Using RNBDT02_604_UNBILL

You can use the IS-H: Reset PPA Billing report (RNABDT02_604_UNBILL) to reset PPA billing for billed PPA cases and treatment certificates for outpatient PPA cases in SAP Patient Management. This allows you to reverse PPA billing runs that have taken place in SAP Patient Management. You can also use the report to reset PPA cases billed using report RNABDT02.

Caution Caution

This report is a critical application. Take special care when executing it, since it directly influences the billing status of outpatient cases and treatment certificates. PPA does not provide for partial or full cancellation of a quarterly PPA billing run. Once you have transferred a quarterly billing run to your panel physician association, it is not standard procedure to reset it, either fully or in part.

For more information about when and how to use report RNABDT02_604_UNBILL, see the report documentation.

End of the caution.

Caution Caution

The IS-H: Reset PPA Billing report (RNABDT02_UNBILL) is no longer available once the business function SAP Patient Management: Treatment Certificates (ISH_TC) has been activated. You then need to use the IS-H: Reset PPA Billing report (RNABDT02_604_UNBILL) instead.

End of the caution.