The Medical Activities, Patient Billing and Invoicing ES bundle is intended to support the processes of documentation of medical activities, of patient invoicing and of payment handling. The bundle curently covers services for the Business Objects "Medical Activity", "Patient", and "Billing Patient Encounter Group".
In Healthcare there are a lot of systems where medical activities (charges) are captured: e.g. the administrative systems where the patient can order TV or telephone at his bedside, the lab systems where information about the performed test is entered (blood tests etc.), departmentals where information about the performed diagnostic measures (CT, NMR, X-Ray) is captured. All these medical activities have to finally be available for the billing process. Through the availability of services around medical activities, these systems can be much better integrated with SAP Patient Management which offers the billing functionality.
But it's not only A2A integration that this bundle supports, the services could also be used within existing clinical or administrative systems in order to make billing relevant information available there so that the user has all information directly available without having to change systems. This is for example true for a scheduler who plans inpatient or outpatient visits. In many hospitals the fact that a patient is privately insured makes a difference in planning. The bundles offers a service that allows the scheduler to view this information and to take it into account in this planning process.
Audience
The bundle is designed for Healthcare Providers like Hospitals or Rehab Centers.
Nurses, Schedulers, Planners, Admins as well as Clerks will find the Bundle of great value.
Increased efficiency is created by offering a interface for sending medical activities to SAP Patient Management and avoiding re-entering the data.
Also, by offering UI services can directly be integrated in the UIs of other applications (e.g. clinical applications or scheduling systems)
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Medical Activities, Patient Billing and Invoicing (click to enlarge) |
Business Objects and Service Operations
This Enterprise Services Bundle contains the following interfaces with related service operations:
Service Operations of Component Healthcare Business Partner Data Management
| Interface | Service | Description |
|---|---|---|
| Patient Action In | Check Patient Bad Debt Party | To check whether a patient is potentially a bad debt party. |
Service Operations of Component Patient Financials
| Interface | Service | Description |
|---|---|---|
| Billing Patient Encounter Group Action In | Calculate Accrual | To calculate the accrued revenue of a billing patient encounter group. |
| Manage Medical Activity In | Maintain Medical Activity | To collectively maintain a set of medical activities for a patient encounter. |
| Manage Medical Activity In | Read Medical Activity | To read the detailed information of an instance of the Medical Activity business object. |
| Manage Medical Activity In | Maintain Medical Activity based on Medical Activity Collection Notification | To maintain a medical activity (or medical activities) based on a notification from a third-party system |
| Query Medical Activity In | Find Medical Activity by Elements | To find a list of instances of the Medical Activity business object, using element values as the search criteria. |
How to Use This ES Bundle
The Medical Activities, Patient Billing and Invoicing ES bundle service-enables the SAP Patient Management service and provides connectivity to Clinical systems, lab systems and other systems in a hospital.
Instead of going the manually way or using SAP Patient Management Business APIs the process may now be integrated by this Bundle, including the following services:
- Find Medical Activity by Elements
- Read Medical Activity
- Maintain Medical Activity
- Check Patient Bad Debt Party
- Read Patient Private Information
- Calculate Accruals
Use Case 1: Capture charges
A nurse working with a clinical system wants to document medical activities (this is the business object) that have been performed for a given patient. She enters them in her Clinical System which then sends it to the SAP Patient Management system. There the service rules in place will be executed and check if the entered services are correct, have dependencies with other services (inclusion, exclusions) and return this information to the nurse. She then can adjust her entries.
The following table summarizes these steps and the associated enterprise services:
Step | Enterprise Service Invoked |
|---|---|
Step 1: Nurse enters the documentation UI for a given patient and views all already documented medical activities for this patient | Find Medical Activity by Elements |
Step 2: The nurse wants to have a detailed look at one of the displayed medical activities | Read Medical Activity |
Step 3: The nurse enters additional medical activities | Maintain Medical Activity (sync) or Maintain Medical Activity based on Medical Activity Collection Notification (async) |
Use Case 2: Check patient insurance status within planning process
A hospital scheduling clerk receives telephone calls from patients asking for outpatient appointments. He asks each patient whether he or she as already been at this hospital before. If yes, he searches for the existing patient record otherwise he creates a temporary patient record and enters the patient insurance status in additional to the patient's name and birth date.
When he actually searches for a free time slot in the outpatient clinic, the information on the patient's insurance status will be considered. For already existing patients this information will be displayed with the help of an enterprise service.
The following table summarizes these steps and the associated enterprise services:
Step | Enterprise Service Invoked |
|---|---|
Step 1: Search for an existing patient record or create a new patient record | Find Patient by Basic Data or Create Patient |
Step 2: Search for free time slots in the scheduling application | No service from Patient Management needed for this |
Step 3: Determine the patient's insurance status | Read Patient Private Information |
Step 4: Schedule the appointment in the scheduling application | No service from Patient Management needed for this |
Use Case 3: Check bad debt party within the admission process of an existing patient
A patient arrives at the hospital's central admission with his referral documents and asks to be admitted. The admission clerk searches in the hospital information system for a patient with the name and birth date he is given.
The following table summarizes these steps and the associated enterprise services:
Step | Enterprise Service Invoked |
|---|---|
Step 1: Search for patient record | Find Patient by Basic Data |
Step 2: Information on the bad debt status of the patient is returned by the SAP Patient Management system | Check Patient Bad Debt Party |
Step 3: The admission clerk can, knowing that the patient is a bad debt party, ask him for a down payment | No service from Patient Management needed for this |
Use Case 4: Check expected revenues
During medical documentation, a physician wants to compare already spent costs of a patient with the expected revenues. In case there are medically equivalent treatment alternatives, the physician might be able to make a decision based on these figures.
The following table summarizes these steps and the associated enterprise services:
Step | Enterprise Service Invoked |
|---|---|
Step 1: Search for patient record and Billing Patient Encounter Group | No service from Patient Management needed for this. Search in local system (e.g. Clinical System). |
Step 2: Information on the expected revenues is calculated and displayed | Calculate Accruals |
System Requirements
- SAP NetWeaver Process Integration (formerly XI)
- SAP ERP 6.0
- SAP Patient Management as part of 6.0 (Enhancement Package 4 or 5 depending on the required service)
Related ES Bundles
- Patient Administration
- Resource Planning and Scheduling
- Resource and Supply Chain Planning for Healthcare Providers