Description
This report determines the copayment to be made for inpatient stays.Copayments already made or set demands for copayment are taken intoaccount. A demand for copayment can be generated automatically for anyremaining copayment amount. The program calculates the demand forcopayment to the day, that is, if the copayment amount required by theinsurance provider changes, the modified amount is taken into accountwhen the copayment amount is calculated. You can print a form (eventNE1700) for each demand for copayment generated.
The program is primarily intended to be run for discharged patients,since the exact copayment amount can be determined for such patients.Should it prove necessary, you can also process non-discharged patientdata either by using a case selection, or by flagging the appropriateoption on the selection screen. If you select the checkbox GenerateRequest for Non-Discharged Cases Before Max. Copayt Amount Reached,the system always generates copayment requests for non-dischargedcases, even if the maximum amount to be paid per year has not yet beenreached. If you do not select this option, the system only calculatesthe copayment for non-discharged patients if the maximum copaymentamount for the calendar year has been reached on account of theduration of the present hospital stay.

Case Selection Options
The program selection screen offers you the following case selectionpossibilities:

• Selection using case selection. You can create a case selection from
the Patient Accounting application area menu by choosing Billing ->Case Selection -> Create.

• Selection using cases.


• Selection of discharged patients.

The option Only if Processed On lets you further restrict theselection of cases to those patients whose discharge was created orchanged in the specified time frame.

• Selection of non-discharged patients.

You can select no more than one of these options.

Additional Specifications on the Selection Screen
Besides selecting the cases to be processed, you can set a number ofadditional parameters on the selection screen:


• Generate copayment requests for non-discharged cases before maximum
copayment amount reached. This parameter is explained above.

• Reverse copayment requests: If you select this option, existing
copayment requests can be reversed (for details, see below).

• Change due date: If you select this option, the system modifies the due
date of existing copayment requests in accordance with the conventionsdescribed below.

• Test mode: If you select this option, the system determines and
displays the actions to be performed, but does not perform them.

• Print form: If you select this option, the system prints a form (event
NE1700, work organizer type ZUZG) for generated copayment requests.

• Printer: You can specify a printer (in particular for background
processing with form printout).

• Reverse copayment requests: If you select this option, the system
reverses existing copayment requests (detailed description below).

• Change due date: If you select this option, the system adjusts the due
date for existing copayment requests in accordance with the rules givenbelow.

• Output incorrect cases only: If you select this option, the system only
outputs those cases for which an error occurred during processing.

• Test mode: If you select this option, the system determines and outputs
the actions to be carried out, without, however, actually performingthem.

Cases with Several Insurance Relationships Requiring Copayment
The program can also process cases with several insurance relationshipsrequiring copayment, provided these do not overlap chronologically.
The days for which copayment is required are divided among theseinsurance relationships in accordance with the validity of therelationships.
The program takes into account previous copayment days in the calendaryear, which you can maintain for the case-related insurancerelationship for this purpose. If several insurance relationshipsrequiring copayment exist for the case, the program first only uses theprevious copayment days of the (chronologically) first insurancerelationship. The previous copayment days of the other insurancerelationships result from the copayment to be made for the(chronologically) first insurance relationship, and are thusautomatically determined by the program.

Actions that Can Be Performed by the Program
The program generates and reverses copayment requests. It also changesthe due date of existing copayment requests, if desired.
If the total of the copayments made and the open copayment requestscorresponds exactly to the amount of the copayment to be made, only thedue date of the outstanding requests is corrected. To achieve this, youneed to have selected the appropriate option on the selection screen.
If the total does not correspond precisely to the amount to be paid,further processing is governed by the setting of the option Reversecopayment requests on the selection screen:


• The option is selected: All open copayment requests are reversed. A new
copayment request is created to the sum of the amount to be paid bycrediting the amounts already paid.

• The option is not selected: Open copayment requests are handled like
copayments made and are not reversed. If, as a result, the total of allcopayments made exceeds the amount to be paid, the program issues themessage "... too much copayment made ...". If the amount is less thanthe sum to be paid, the program generates a copayment request for thedifference amount.
New copayment requests are always posted in the currency that isdefined for the insurance provider in the current period in theCustomizing table "Copayment amount per day". If, on account of achange of period, various currencies are involved, the programtranslates the different daily amounts into the currency of the mostrecent period, and posts the document in this currency.
If the system finds an error in a case (a message with type Error (E)is output), no changes will be made to postings/documents. However, theactions that should have been carried out are output in the log.

Due Date, Posting Date and Document Date of Copayment Requests
The due date of a copayment request is first determined using the "Duedate" setting in Customizing for copayment requests. If the value Relative to discharge date is maintained, but the patient has stillto be discharged, the program uses the system date. The program thenadds the value specified in the institution-specific system parameter"Difference to reference date (copayment)" (technical name ZUZ_DAYS).If this system parameter is not maintained, the default value 14 isused.
The due date determined cannot be earlier than the posting date. Ifthis were to be the case, the posting date is used as the due date.
New copayment requests are updated in FI with the admission date as theposting date. If the period is blocked in Financial Accounting, thesystem date is used as the posting date. The system date is used as thedocument date.

Special Rules of Copayment Obligation and Copayment Waiver
The program takes a number of special rules of copayment obligationinto account, some of which can be influenced by Customizing parametersfor copayment (see below).


• No copayment for patients who have not yet completed their 18th year on
the day of admission

• Copayment for delivery cases


• Copayment for discharge day


• No copayment for day patient cases.

In case-related insurance relationships, it is not necessary tomaintain the copayment waivers "Less than 18 years", "Day patienttreatment", "Delivery case" and "Max. copayment/year made". The dataentered in the system means that these waivers are automaticallyrecognized and correctly processed by the system.
The copayment waivers Delivery casemay give rise to a limited copayment obligation, for example, if thepatient reaches the end of their 18th year during their hospital stay,or if they remain more than six days in the hospital after delivery.This is why the program ignores these copayment waivers and regards theinsurance relationship as requiring copayment.
The program also processes cases with the copayment waiver daypatient treatment. It does not generate a copayment request (sincecopayment is waived for the case), but looks for any unnecessarycopayments and copayment requests.
In place of the copayment waiver Max. copayment/year made, thenumber of previous copayment days should be correctly maintained(generally 14). If the (internal) copayment waiver max.copayment/year made or Not paid despite reminder ismaintained, the case is not processed.

Background Processing
If the test mode is not deactivated, that is, adjustments are actuallycarried out in Financial Accounting, long runtimes can occur. The liverun should therefore be carried out in the background.
In such cases, you should specify a printer for form printout. If youdo not make an explicit entry, the program uses the * entry in thetable of terminal-to-printer assignments.

Customizing Parameters
The legally stipulated maximum number of days requiring copayment mustbe maintained for a specific institution and period in the systemparameter "Legally required copayment in days per calendar year"(ZUZ_MAXD) in Customizing. The default value is 14. You can change thisvalue using the SAP enhancement NZUZ0001.
The copayment amount per day must also be maintained for a specificperiod in Customizing.
Note that the admission date is relevant for determining the values ifthe time-dependent parameters. This equally applies when a changeoccurs during the patient's hospital stay.
The West/East indicator is determined from the field Supplement tostatus of the insured. If 9 occurs in the first position of this field,the amount 2 is used. In all other cases (even when the field isempty), the amount 1 is used.
You can tailor the program's behavior to meet your own requirementsusing further parameters set in Customizing for copayment requests. Forinstance, you can control whether and how much copayment is to be madefor particular cases and situations.


• Handling of cases that are hospitalized overnight and for less than 24
hours
Only 1 day is determined as requiring copayment
2 days are determined as requiring copayment (default)

• Handling of absences

Ignore absences - all days of absence require copayment
First and last days of absence require copayment, but not absenceslasting the whole day
Only the last day of absence requires copayment (default)

• Handling of delivery cases (maintain delivery data!)

A copayment waiver applies to the whole case.
A copayment waiver applies to the day of delivery and up to the 6th dayafter the delivery (default).
A copayment waiver applies to the case from the day of admission up tothe 6th day after the delivery.
A copayment waiver applies to the case from the 3rd day before to the6th day after the delivery.

• Handling of the day of discharge

Day of discharge never requires copayment
Day of discharge always requires copayment
Day of discharge in principle requires copayment, but not when patientis discharged into an external hospital (default).

• Handling of deceased patients (discharge with discharge type 'death' or
maintain death data!)
No copayment obligation (default)
Copayment obligation
If you select the option Reverse copayment requests, a validreason for reversal must be maintained under the group headerGenerate copayment request/receivable in the activityMaintain Parameters for Copayment Requests in Customizing forIS-H.

More Information
The program can be used both with the receivable procedure and thecollection procedure.
The event NE1700 and the work organizer type ZUZG are provided forprinting the generated copayment requests. If errors occur during formprintout, their cause is listed in the program output.

Output
The report generates a log of all cases for which either a problem hasoccurred or automatic adjustments have been carried out.
For each case, the header information contains the case number, name,customer, date of admission and discharge, and, if appropriate, theinformation that the case has been discharged into an externalhospital.
Any messages generated during the calculation of copayment days areoutput beneath the header. In dialog mode, you can display a detailedexplanation for these messages by clicking the pushbutton Long text
.
Below the messages, the program outputs, for each insurancerelationship requiring copayment, the insurance provider (number andname), previous copayment days, basis for calculating copayment (days,amount per day, and total amount). If the copayment amount required byan insurance provider changes within the calculation period, only thetotal amount and not the amount per day is displayed. A message isissued accordingly.
A row containing all posting-relevant information is output for eachexisting copayment or copayment generated. If actions are carried out,the type and success of the action are output. When forms are printedfor generated copayment requests, the degree of success of the printoperation (including troubleshooting tips) is output.
If you are running the program in live mode, an error message is issuedif the program cannot find the FI customer for an insurance providerwhen generating a copayment request.

Further Information
This program functions on the basis of the legal stipulations validthroughout the Federal Republic of Germany and known to SAP AG at thetime of development.
Please appreciate that rules that are specific to customers or toparticular Federal states can only be accommodated in exceptional casesin the standard software. In such cases, please contact yourconsultancy agency.
If stipulations to the contrary are known to you, please forward theseto SAP along with the related documents (legal texts, regulations,etc.).