Description
This report generates a list that compares the number of days of apatient's stay with the billable charges for a case.
The number of days' stay is calculated based on the formula defined inthe section entitled Charge Proposal. If the case has not beendischarged, the key date is taken as the last day of the patient's stayand included in the number of days' stay calculation.
The report only selects inpatient and day-patient cases that have notbeen canceled. If you use the discharge date as a selection criterion,the report will only select discharged cases. You can also use the keydate to delimit cases that have not been discharged. Day-patient casesare selected only if the admission type of the case in question isflagged as a day-hospital case.
You can also restrict your selection by specifying a case type. Pleasenote, though, that outpatient cases are not selected.
You can include finally billed cases by selecting the correspondingselection option.
You can also specify that only cases containing errors should beselected. You can specify an error type in this case. This will meanthat only cases as of the (highest) error type (message type) aredisplayed. If, for example, you specify message type "W", only caseswith error type "W" and "E" will be output. If you only want the reportto display cases where the comparison value is not equal to zero,select the option Only cases with comparison difference.
Note that, if you select an individual case, all the additionalselection restrictions will not be taken into account. This case willbe displayed, even if you define further selection criteria that wouldexclude it. This also applies if, for example, only one case isselected on the basis of the admission date specified.

Comparing billable days and the corresponding charges allocated
The billing days and days covered by the flat rates per case are usedfor this comparative calculation.
Billing days include all departmental per diems up to a maximum lengthof stay billed in accordance with the German Federal Regulation forHospitals (1995) or general nursing charges for billing in accordancewith the transitional regulation (Germany). Day-patient nursing chargesare treated in the same way as departmental per diems.
The basic nursing charge is not included in the comparative calculationsince it normally corresponds to the departmental per diem (exception:some combinations of flat rate patients in intensive care/cardiacsurgery). For this reason, if the departmental per diem and basicnursing charge differ, these values are highlighted in red by way ofwarning.
The following charge types are not taken into account:

• Personal items


• Flat rates for outpatient billing

The following section shows you how the comparative calculation isconducted by explaining the various start times of the maximum lengthof stay calculation, which is controlled by the type of flat rate percase:

• Normally, the maximum length of stay is calculated as of the admission
date.

• In the case of case flat rates with the maximum length of stay
'Intensive', the start of the maximum length of stay is taken as thedate of admission to the cardiac surgery unit, or the start date of thesurgery itself.

• In the case of flat rate patients in obstetrics, the maximum length of
stay is calculated as of the third day before the infant is born.
In the case of intensive care unit patients who have undergone cardiacsurgery, it should be noted that a departmental per diem is charged inaddition to a case flat rate for the pre-op phase (from admission totransfer to the cardiac surgery unit) - pre-op days output as pop
.
The calculation of an 'Intensive' departmental per diem is also takeninto account if the 'Intensive' maximum length of stay is exceeded.Here, the number of billable departmental per diem records iscalculated by comparing the extent to which the 'Intensive' maximumlength of stay is exceeded and the extent to which the general maximumlength of stay is exceeded.
In the case of flat rates for obstetrics cases, per diem nursingcharges can also be charged before the maximum length of stay commencesif the mother-to-be is admitted more than 3 days before she gives birth(these pre-natal days are specified as ppt).
In the case of flat rates for cases undergoing acute treatment orfollow-up treatment, the maximum lengths of stay for both case flatrates are added together.
In the case of flat rates for Group 17 cases (until these patients aretransfered to a geriatric unit), per diem nursing rates can be chargedon the day of transfer (this renders the maximum length of stay of theflat rate per case invalid).
You can use a client-dependent system parameter (technical nameGVDRELVB) to specify how pre-admission visits are to be includedin the calculation of the maximum length of stay.
Days from an earlier flat rate case that can be credited to the currentmaximum length of stay are output in the Previous dayfield.

Additional Information
You can use the Messages pushbutton to check messages concerningcase plausibility with regard to billing in accordance with the GermanFederal Regulation for Hospitals (1995). These messages state whether:


• The services for flat-rate-per-case patients were complete (flat rate
per case plus departmental per diem, taking maximum length of stay intoaccount)

• The flat rates per case and special charges are calculated at the same
time

• The departmental per diem is stored correctly (based on the
organizational unit of the movement)

• The maximum length of stay has been exceeded for a flat rate


• Intensive care unit patients who have undergone cardiac surgery have
exceeded the 'Intensive' maximum length of stay and the general maximumlength of stay.

• Gaps in services (billing days)

The Charge proposal function allows you to display a list ofpossible flat rates and special charges (depending on the ICD/ICPMcombinations defined for the case). A check is performed against thecontents of valid rules in the control table for the charge proposal.
You can obtain additional information by displaying a graphic depictingthe patient's stay. For each day, you can display information comparingthe billing days, days covered by flat rates per case, and thecorresponding movements in graphical form. In addition to the graphic,the appropriate movements along with their corresponding services are a
lso displayed. This information is displayed directly if an individualcase is selected. If several cases are selected, the messages andgraphic can be displayed for each case by choosing the appropriatefunction key.
Please note that only movements and services that affect the chargecheck are output. Outpatient visits are not output unless they havebeen flagged as surgical outpatient cases. Pre-admission andpost-discharge visits are not displayed in the graphic. Services thatare output include all departmental per diems and basic nursingcharges, or the general nursing charge in the case of billing inaccordance with the German Transitional Regulation. As an immediateservice, only the flat rate per case is used for calculating the dayscovered by the flat rate in question.
Note that the graphic can only display one piece of information for agiven day. If, for example, a billing day and a day covered by the flatrate per case both exist, the information for the day covered by theflat rate charge is displayed. In the same way, a billing day overridesa day of absence.

Output
Beside the comparison, the color-coded message type is displayed (I =Information, W = Warning, E = Error).
In the section giving details on the stay, the number of pre-admissionand follow-up visits, and the number of days of absence are displayed.
Flat rates for pre-admission and follow-up treatment are displayedbeside the nursing charges (departmental per diem, basic nursingcharge, general nursing charge). The flat rate per case included in thecalculation of the maximum length of stay is displayed along with theservice code and, if applicable, with the general maximum length ofstay and the intensive care maximum length of stay. If the maximumlength of stay is shorter than the actual length of stay, the maximumlength of stay is highlighted yellow to show that the departmental perdiem should be checked.
The columns for pre-op and pre-natal days show the possible payment ofper diem nursing charges before the start of the flat rate. The paiddays from an earlier case to be credited to the maximum length of stayof the current flat rate case are displayed in the correspondingcolumn.
If only one case is selected, the following information is displayed:


• Comparison (displayed in a similar way as for several cases)


• Graphical representation of the case


• Movements and corresponding services relating to the graphic


• Messages relating to the current case

The output list of the ABAP List Viewer functionality can be defaultedon the selection screen with a display variant. You can differentiatebetween display variants for a single-case display (only a single casein the selection) and for several cases. For each mode, you can saveseparate display variants in the output list which you can enter in theselection screen.
Precondition

• If the report is to run correctly, then the charge types and the types
of flat rate per case in the service master must be defined completelyand correctly.

• Make sure the maximum lengths of stay for flat rates per case are
stored in the menu option 'Extras for Germany'.

• The checks performed for intensive care unit patients who have
undergone cardiac surgery require that the specialist area be definedcorrectly in the organizational unit in question in accordance with theGerman Federal Regulation for Hospitals (1995). The 'Intensive care'flag must also be set.

Messages
The following are checked and displayed in the form of messages:
1. Information on the falt rate stored for the case (if any)
2. Information on the number of procedures surcharges
3. Check that the departmental per diem and basic nursing charge havethe same number of days (does not apply to flat rate patients inintensive care who have undergone cardiac surgery)
4. Information that flat rates and procedures surcharges are billed atthe same time
5. Information regarding the date on which the maximum length of stayis reached
6. Check that a departmental per diem is stored, if the maximum lengthof stay is exceeded
7. Information that neither a departmental per diem nor a flat rate percase has been stored
8. The number of billing days missing as compared to the number ofdays' stay, taking the flat rate patient or budget patient into account
9. The excess number of billing days entered as compared to the actualnumber of days' stay
10. Check for more than one flat rate to be billed per case
11. Check whether flat rate per case and flat rate for pre-admissiontreatment are calculated simultaneously
12. Check whether flat rate per case and flat rate for follow-uptreatment are calculated simultaneously and that the maximum length ofstay is not exceeded
13. Check whether maximum length of stay has been defined for anexisting flat rate per case
14. Check whether flat rate for follow-up treatment can be calculated,and whether a service exists with the appropriate charge type
15. Check that patient is more than 14 years old as exception for thecalculation of a flat rate per case
16. Check for flat rates pre-admission treatment when definingpre-admission visits for non-flat-rate patients
17. Check for flat rates for follow-up treatment when definingfollow-up visits for non-flat-rate patients
18. Check for departmental per diem corresponding to the movement inquestion. Here, a check is performed for the departmental per diemdefined for the departmental organizational unit in question, and theassignment of this per diem to the corresponding period of themovement.
19. Check whether departmental per diem exists for the entire period ofthe movement (i.e. from the start date to the end date)
20. Date on which the 'Intensive' maximum length of stay (IntensiveMLS) is reached for intensive care unit patients who have undergonecardiac surgery
22. Information that Intensive MLS (but not gen. MLS) has been reached
23. Information if period by which Intensive MLS exceeded > gen. MLS
24. Information if period by which Intensive MLS exceeded < gen. MLS
25. Information if period by which Intensive MLS exceeded = gen. MLS
26. Number of billable pre-op days for intensive care unit patients whohave undergone heart surgery, and who are flat rate patients
27. Number of billable days missing for intensive care unit patientswho have undergone heart surgery, and who are flat rate patients
28. Date on which general MLS is reached for intensive care unitpatients who have undergone cardiac surgery, and who are flat ratepatients
29. Check whether per diem charges were entered at same time as flatrates per case, and MLS has not yet been reached

Example
Example 1: Flat rate patient where MLS is exceeded
Stay: October 1 - October 10
Maximum length of stay: 7 days
Departmental per diem: October 8
Comparison : -2 days
Reason: As soon as the maximum length of stay has been reached (October7), the departmental per diem can be billed - but this is not the casehere. October 9 could be billed; October 10 is the day of discharge,and, therefore, is not billed.
Example 2: Flat rate patient who has undergone cardiac surgery (maximumlength of stay not exceeded)
Admission: October 1
Transfer to cardiac surgery unit: October 3
Transfer to ICU of cardiac surgery unit: October 5
Transfer to cardiac surgery unit: October 9
Discharge: October 12
Flat rate with general maximum length of stay: 11 days
Flat rate with 'Intensive' maximum length of stay: 5 days
No departmental per diem defined
Comparison: -2 days
Reason: The maximum length of stay for the flat rate is not calculateduntil the patient is admitted to the cardiac surgery unit; in theexample above, this is not exceeded. The pre-op phase (i.e. before thepatient is transferred to the cardiac surgery unit can be billed usingthe departmental per diem and basic nursing charge. However, this isnot the case here (October 1 and 2). The 'Intensive care' maximumlength of stay is not reached.