Description
In outpatient Workers' Compensation Association billing, the amountinvoiced is broken down for accounting purposes. The system determinesthe WCA physician costs that are to be reimbursed to the hospital, andthe total amount of the medical services performed.
The following costs are reimbursed:

• Material costs

These are general personnel and material costs, and also the costsincurred through the use of medical instruments and apparatus. Theyalso include certain types of material costs.

• WCA physician's fee to hospital

Since the material costs mentioned above do not cover all the costsincurred by the hospital, the physician has to give a certainpercentage of his/her fee to the hospital. This portion of the feecovers the following costs:
Administrative services including secretarial staff
Setoff of damage against benefits
You can use this program to periodically calculate the totals of thefollowing cost portions per WCA physician/organizational unit:

• Material costs


• WCA physician's fee to hospital


• Physician's daily attendance fees

These cost portions are output in the local currency. This is thecurrency of the company code to which the institution in question isassigned. If amounts have been invoiced in different currencies, allamounts are translated into the local currency.
The invoices for the WCA physicians are output and broken down by thefollowing billing types:

• General treatment


• Special treatment

Note

• The report only includes invoices that were transferred successfully to
Financial Accounting.

• The incoming payments from Financial Accounting are included when the
cost portions are determined.

• If an invoice is included in a report run, the system does not make any
internal note of this. Consequently, if you run the report again,invoices that have already been evaluated are displayed again.
It is recommended that you start the report periodically. Also, pleaseensure that the invoice creation periods do not overlap, and that thereare no gaps between periods.
One way of ensuring this is to save the report variants used for eachreport run.

Precondition
Selection screen
You must enter data in the following selection screen fields:


• Institution


• Invoice creation period


• At least one billing type


• At least one cost element

To avoid long response times, you are advised to restrict yourselection.
If you want to run the report for individual cases, please enter thecases in question. In this case, please ensure that the creation periodspecified covers all the cases you have selected.
In order to execute this report, you require authorization S_PROGRAM,and also the authorization group specified in the report attributes.

Output
In the list that is output, data is displayed for each WCA physician(organizational unit).
The data for each WCA physician is broken down by billing type. All theinvoices for each WCA physician and billing type are displayed. Thefollowing information is displayed for each invoice:


• Case with check digit


• Patient's name


• Invoice number


• Date on which invoice was created


• Total amount of individual invoice


• Total costs per invoice and per cost elements selected


• Material costs per invoice if cost element Material costs was
selected

• Physician fees per invoice if cost element Physician fees was
selected

• Portion of WCA physician's fee to hospital if cost element Transfer
free was selected
The system displays a subtotal per billing type per WCA physician. Theoverall total for each WCA physician is also output.
A subtotal and overall total are output for the following fields:

• Total of cost portions for all selected cost elements


• Material costs


• Physician fees


• Portion of physician fee for hospital (transfer fee)

You can display more detailed information on a case or invoice.
To do so, position your cursor on the case number (or invoice number)in question, and select the appropriate field. If you chose a casenumber, the Case Monitor screen appears. If you chose an invoicenumber, the Invoice Overview screen appears.
Note

• The check digit for a case is only displayed in the list if the digit
check indicator was set for your institution in Customizing.

• In Customizing, you can also specify that only one invoice should be
issued even if the billing type changes. If you make this setting inCustomizing, you will be able to list identical invoices underdifferent billing types. If you have set the system parameterspecifying that the visit type of the first visit is to be used foroutpatient billing, the setting described above does not apply.

Example

Note
If the results of the report are not what you expected, please informyour systems administrator, and ask him/her to check that all thenecessary settings have been made in the section of the IMG for SAPHealthcare entitled Define outpatient WCAbilling.