Description
With this program, you can generate an evaluation of services that havebeen billed for. The respective quantities and amounts for each payer(that is, insurance providers or head office of the insurance provider)and insurance provider type are output. In addition, the percentage ofthe total amount paid is output per insurance provider and perinsurance provider type.
You can use a number of parameters to specify which invoices should beevaluated.
Further notes related to this:

• You can limit the evaluation to certain services by means of the
service type; for example, an evaluation could be carried out withrespect to nursing charge services.

• By default, self-payers are also evaluated in the list. If you do not
desire this, do not make an entry in the Insurance providerfield, and specify Not equal to in the selection options.
Meaning: All invoiced services for which an insurance provider wasbilled are selected except for services for which private patients andself-payers are billed.
In the group box Output you can specify the form in which thelist is to be output.

• You can directly stipulate the format of the list by specifying a
layout (SAP List Viewer).

• Setting the indicator With billing, flat rate days calculates
the billing days and days covered by flat rates for each insuranceprovider. You can, however, only calculate these days for inpatient(day patient) cases that are final billed and discharged. You mustconsequently make the corresponding selection specifications. The listcontains the total of billing days and days covered by flat rates andalso the percentage portion per insurance provider. The programcalculates the days as follows: It first determines the billing daysand the days covered by flat rates for each case. Next it determinesthe invoice portion of each selected service with regard to the totalof all of the selected invoice items for the case, and multiplies thebilling days and days covered by flat rates with this portion dependingon the charge type of the service. The result is output for thisservice. This method enables you to control which invoice items are tobe included in the distribution of the days to the various insuranceproviders, for example, services with the charge types 12, 13 and 30.

• The indicators Breakdown by sex and Breakdown by age-group

let you increase the level of detail of the evaluation.Breakdown by sex breaks down the quantities and amountsaccording to the patient's sex (male/female/unknown). If you flagBreakdown by age-group, the system reads the age-groupclassification for the age-group category Invoice statistics (
R1), and allocates the amounts in relation to the patients' ageto the corresponding age-groups. The patient's age is determined whenthe invoice is created. Please note that this program supports amaximum of eight age-groups.

• The percentage portions are only output for the total values.

INCLUDE ISH_EXTRACT_REP OBJECT DOKU ID TX

Output
The program creates statistics for the invoiced quantities and netamounts for each insurance provider type, payer, and service (andbilling agreement in the country version Switzerland).
The list displays invoices addressed to patients (self-payers) withempty insurance provider type and invoices addressed to insuranceproviders without insurance provider type under '..?'. For self-payerinvoices, the payer column remains empty thereby optimizing the layoutof the statistics.
The percentage portions are only output once per insurance provider/type in the output list. This is expedient, for example, when creatingsubtotals via the insurance provider or the insurance provider type. Itis then possible to build totals via the percentage portions.

Note Relating to Price-Related Coverage
In the case of services for which coverage is on a price basis ratherthan on a percentage basis, the quantities are output proportionatelyaccording to a special calculation logic. Let's assume that service Xcosts 100.-. 60.- is distributed to insurance provider A and 40.- toinsurance provider B. If the service is now billed for with thequantity 3, the quantity 1.8 is output for insurance provider A and thequantity 1.2 for insurance provider B. The quantity is reducedproportionately. Here the quantity is taken into account with the sameproportion that the respective price comes to in relation to the totalprice. With this method, rounding differences are unfortunatelyunavoidable.
Some background information about this: This calculation is made atstatistics runtime. The integral, non-reduced quantity (3 in the aboveexample) is stored for each invoice item in the database. The totalprice of a service distributed between several insurance providerscannot be derived from an invoice item. This is the reason why thetotal price is calculated from the sum of the price-related coveragefor such a service. This ensures that the correct figures are output inthe statistics if only a portion of a service was billed for andentered in the statistics. However, an insurance verification documentat least with the status 'Request' must exist for all service portionsof each service of this type.