SAP Program RNLRECH1 - IS-H: Evaluate Billed Services by Insurance Provider Types

Description
With this program, you can create an evaluation for billed servicesbased on the invoices stored in the system.
The respective quantities and amounts are displayed.
You can also create the evaluation as a hit list sorted according toservice amount.

Selection criteria
You can use a number of parameters to specify which invoices should beevaluated.
Currency is a mandatory entry; the evaluation can be made with respectto one currency only.
You can also influence the layout and the level of detail of thestatistics by means of selection criteria, for example by enabling ordisabling the totals formation at insurance provider type level.

Totals statistics
The program creates statistics of the invoiced quantities and the netamounts for each service.
The statistics can be sorted in two ways:

  • According to the service text (this is the default sort criterion)

  • According to the total amount from all of the invoices created for this
  • service
    These statistics display invoices on patients (self-payers) underinsurance provider type '.P.', and lists invoices from insuranceproviders without insurance provider type under '..?' (only if youactually want to display each insurance provider type, see above).

    Display chief physician services or external physician services
    In the statistics, the values of each service can be displayedseparately, according to whether they occur in an external physicianperiod or chief physician period or not. The corresponding service isindicated (fields BARKZ or CARKZ) for such a period. Example:
    Service PFL performed from 06/03/94 to 06/15/94; Chief physician choicefrom 06/10/94 to 06/12/94. The service is divided up in the invoice asfollows:
    Service From To BARKZ CARKZ
    -------- -------- -------- ----- -----
    PFL 06/03/94 06/09/94
    PFL 06/10/94 06/12/94 X
    PFL 06/13/94 06/15/94
    If you set the selection parameters to make this kind of distinction,the values are displayed separately in each case; otherwise, this kindof split is ignored.
    Note: You specify in the service master whether this kind of divisionis always to be carried out for a service. If such a division iscarried out, this does not necessarily mean that a discount was alsocalculated for the affected service.

    Note for price-related insurance coverage
    In the case of services for which coverage is on a price rather than apercentage basis, the quantities are split in the output according to aparticular calculation logic. Let's assume that service X costs 100.-and that 60.- and 40.- is covered by insurance provider A and insuranceprovider B respectively. If the service quantity 3 is billed for, thequantity 1.8 is output for insurance provider A and the quantity 1.2for insurance provider B in the statistics. The quantity is thereforereduced proportionally, whereby the quantity output in the statisticsis the product of the value in the Quantity field in the serviceentry transaction and the quotient obtained by dividing each of theamounts covered by the total price. Rounding differences areunfortunately unavoidable with this procedure.
    Background information: This calculation is made when the statisticsprogram is running. The complete, unreduced quantity (3, in the aboveexample) is stored for each invoice item in the database. The totalprice of a service prorated among a number of insurance providerscannot be derived from an invoice item. Hence, the total price iscalculated here from the sum of the amounts covered for such a service.This ensures the correct output in the statistics even when only a partof the service was billed for and entered in the statistics. Coverage,must, however, exist with at least the status 'requested' for all partsof the service.