Billing for Drugs and Medical Products
The billing process for drugs and medical products with the addition of flat rate services is relevant for private hospitals in France that adhere to the regulations for service-based billing (T2A billing) for acute treatment (MCO).
Note
The functions described here are available in the SAP system if you have activated the business function SAP Patient Management: Country Version France
(ISH_CV_FR).
Introduction and Legal Background
Private hospitals in France are subject to the regulations for service-based billing (T2A) and bill the social insurance fund directly for their services. The hospitals can bill for certain drugs (UCD services) and medical products (LPP services) in addition to the GHS, GHT, SE, and dialysis flat rates. The list of drugs and medical products for which billing is possible is specified by law.
For more information about the billing rules, see the guide to billing for drugs and medical products at private hospitals (in French): "Guide Pratique pour la Facturation des Médicaments Produits et Prestations Facturables en sus de Prestations d’Hospitalisation par les Etablissements de Santé Privés", which is available on the Assurance Maladie homepage.
Billing for Drugs and Medical Products with a Reduced Purchase Price
If the hospital negotiates a price lower than the reference price for drugs and medical products, the hospital can bill part of the difference between the reference price and purchase price using the margin share rate.
The margin share rate is a percentage value used to map the difference between the reference price of a service and its purchase price. The statutory margin share rate in France is currently set at 50%.
Example
A drug has a reference price of EUR 100. The hospital purchases the drug at a purchase price of EUR 90. The hospital can then bill for this drug at a price of EUR 90 plus a margin share rate of EUR 5. The margin share rate is calculated as follows:
(reference price - purchase price) * 50%
You can define margin share rates and bill them in the SAP system.
Process
If you want to bill for drugs and medical products according to the above conditions, you must note the following in the SAP system: