Description
This program makes proposals for the billability of flat rates per caseand procedures surcharges and checks whether the flat rates per case andprocedures surcharges already assigned to the case are authorized forbilling.
The program determines flat rates per case/procedures surcharges on thebasis of the ICD/ICPM combinations assigned to the case and in relationto the rules defined in the Customizing activityDefine assignment rules for flat rates percase/procedures surcharges. It can generate the following messages:
No ICPM codes assigned to the case (no charge proposal)
No ICPM flagged as main surgical procedure - flat rates cannot bedetermined
No FR or PS proposal defined for the combination of ICD and ICPM codes
FR or PS can be billed for - service has been entered
FR or PS can be billed for - service has not been entered
Moreover, the program checks the validity of the flat rates per case andprocedures surcharges assigned to the case. It checks whether the flatrates per case and procedures surcharges assigned to the case arecovered by the number of flat rates per case and procedures surchargesdetermined.

Selection Parameters
The following can be specified to select the dataset to be evaluated:

• A billing selection ('selection indicator')


• Movements (either in the admission interval or the discharge interval)


• Departmental organizational units


• Case numbers

You can specify case numbers in addition to other selection criteria.Departmental OUs can only be specified in conjunction with anotherselection.
The departmental OU of a case that is still open is the departmental OUof the movement valid at the current date. For discharged cases, this OUis the departmental OU of the discharge movement. If there are severalmovements at the key date (system date), the last movement of the dayapplies.
An option enables you to specify whether final billed cases should beincluded in the evaluation.
It is also possible to restrict the evaluation to cases for which ICPMcodes were entered also.
You can sort the cases included for the evaluation by patient name, casenumber or discharge date. Moreover, you can decide whether informationon surgical procedures codes/diagnoses or surgeries/relevant rulesshould be displayed in the initial list.

Output
The output list displays the diagnoses (ICD codes) and surgicalprocedures (ICPM codes) per case. If these ICD/ICPM combinations storedfor the case point to a valid assignment rule, this rule is output alongwith the service code, service text, identification of a flat rate percase or a procedures surcharge, rule number and its ICD/ICPM definition.
For each flat rate or procedures surcharge proposed, the system outputsthe corresponding movement (surgery) in which the service was performed.
The messages mentioned above relating to the flat rates per case andprocedures surcharges are also displayed.
A number of specifications relating to the case such as names, admissiontype and admission date, discharge type and discharge date and thebilling status are displayed.
You can call the transactions for maintaining Services,Diagnoses and Surgeries directly by choosing thecorresponding function keys. Changes you make in these transactions takeimmediate effect in the output list.
The function key Messages lists all messages relating to flatrate determination and those relating to the charge check from theprogram Check Charges (RNLBTAG0) separately. You can also branchto the message long texts from this list.
The function Compare charges enables you to simulate thevaluation of defined case configurations for an individual case.
The function key Generate creates the proposed services (flatrates per case or procedures surcharges). When flat rates per case aregenerated, the system cancels any existing nursing charges up to themaximum length of stay covered by the flat rate and may then createdaily nursing charges for the period thereafter.
The system cancels all services with the charge type Base nursingcharge, Departmental per diem and General nursing charge
. Whether or not services are to be created as of the maximum lengthof stay depends on whether your billing procedure complies with thetransitional regulation or not. If you do not bill according to thetransitional regulation, the base nursing charge is taken from theservice specified in the Customizing activityConfigure proposal of flat rates per case/procedures surcharges and the departmental per diem is determined inrelation to the respective movement.
If your billing procedure does comply with the transitional regulation,the service specified in this Customizing activity will be used for thegeneral nursing charge.
You also make the settings for billing according to the transitionalregulation in this table.
The services generated are created with the date and the organizationalunit of the respective surgery for which the service was performed. Forpost-operative flat rates (as of 5th amendment to the BPflV 1995), anassignment to a surgery can be determined, since these flat rates arenot performed within a surgery and surgical procedures codes are notdefined for these flat rates. Here the system would send a dialog boxfor you to specify the date to be generated for these flat rates. Thedate corresponds to the day on which the wound has healed and, as such,marks the end of flat rate for acute treatment. The system proposes theadmission date plus the standard length of stay covered by thecorresponding acute treatment flat rate.
If flat rates per case for newborns (flat rate type = 6) are generated,the system does not cancel nor align the daily nursing charges.


• The program only checks inpatient cases for which final billing has not
taken place.

• If you execute the program for a specified admission or discharge period
(i.e. by movement), it only selects cases that have movements with thestatus 'actual'. In other words, cases for which an admission is plannedare not evaluated. In contrast, should you execute the program with aspecified selection indicator, all movements (including those planned)are taken into account.
Please note the following prerequisites for the FR/PS determination:

• The results of the FR/PS determination depend on the specifications in
the control table for the FR/PS determination search logic.

• The ICD/ICPM to PS/FR assignment table must be correctly maintained.


• The check based on the ICD codes cannot be restricted to a specific
diagnosis type.

• For certain flat rates per case and procedures surcharges, exclusion
criteria relating to age and sex can be defined which prevent a chargeproposal depending on the sex and age of the patient. If necessary,check the settings for these services in the service master.

• Moreover, certain charge proposals are dependent on the flat rate type
specified in the service master of the flat rate per case in question.For instance, a flat rate with the type Obstetrics (hospital stay ofunder 24 hours will only be proposed for cases of less than 24 hoursduration.

• Postoperative flat rates are only proposed if the corresponding acute
treatment flat rate is also contained in the proposal quantity. However,this check does not apply if you entered the number of previous dayspertaining to an admission in the other case data. Here the system wouldrecognize a previous patient case or an admission from an externalhospital, in which the acute treatment flat rate was performed in aprevious case or in the transferring hospital.

• When the flat rate for the postoperative phase is generated, the system
checks if the minimum length of stay has been reached. For dischargedcases, the program compares the period between the discharge date andthe service performance date of the flat rate (date at which the woundis healed) with the minimum length of stay defined. For non-dischargedcases, the program uses the current date instead of the discharge date.This flat rate per case can only be generated if the minimum length ofstay is reached. Moreover, the post-operative flat rate can only begenerated if the assigned acute treatment flat rate exists as a billableor non-billable service.
The generation of flat rates per case and the resulting cancellation andcreation of daily nursing charges is dependent on the specifications inthe Customizing activity Configure proposalof flat rates per case/procedures surcharges.
Flat rates per case can also be generated for interim-billed cases; thesimultaneous modification of daily nursing charges is, however, subjectto certain restrictions. For example, if services to be modified(pre-admission and post-discharge treatment flat rates, base nursingcharges or departmentals per diem) are interim-billed, these are notcancelled when flat rates per case are generated. As a result of this,it may also not be possible to create new services as of when themaximum length of stay is reached in order to prevent overlappingperiods. In these cases the system generates a message prompting you tocheck the charges after generation.
Please note that you can also use the flat rate generation program toalign the daily nursing charges with the current case configuration. Ifyou entered the flat rates manually, but did not delimit the dailynursing charges when the maximum length of stay was reached, you canalign the daily nursing charges with the current case configuration bygenerating the flat rate per case. A second flat rate per case is notgenerated by the program.
When you generate flat rates for newborns (flat rate per case type = 6)the daily nursing charges are not canceled. These flat rates can also begenerated several times for each case.