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Admission, Discharge, Transfer & Billing

Admission, Discharge and Transfer is the administrative management systems in hospitals, and should have main features included such as:

• Providing patient registration and disposition.
• Providing patient advance search with duplication prevention mechanism.
• Providing patient data merge when duplication happen.
• Tracks patient movements during inpatient stays.
• Provide up-to-date patient information.
• Generates numerous managerial and statistical reports.
• Performs patient data consistency checks.
• Supports the flagging and monitoring of patient records deemed to the sensitive.
• Compliance to International standards.

Item Master
Foundation of Connection

• Item master is the foundation of all aspects where inventory, locations, customer and supplier along with tariff, cost, and account journal are integrated throughout the system.
• Item master can be classified as stocked-item or service-item and can be situated together in the material bill.
• Item Types are used to differentiate the items based on the normal functions such as Service, Medication, Medical Supply, Laboratory, Imaging, Other Exam, Logistic, Package and Others.
• Item Groups are used to breakdown the item types, example "Service", it is grouped to Room Charge, Administration Charge, Physician Charge, and so forth.
• Item Types and Item Groups are used to define the accounting group code to predefined the accounts for journal generations.

Bill of Material
Packages to Simplified and Winning the Business Competition

• BOM is a comprehensive list of items, assemblies required to build or manufacture a product/package.
• BOM is usually in a hierarchical format, with the top-most level showing the end product/package, and the bottom level displaying individual's items number, unit of measurement, quantity per parent item, manufacturing/purchase lead-time, cost components and the parent item number itself. When it rollup from bottom to top level can give an estimation of total lead-time and total cost.
• The accuracy target for BOM is even higher than on inventory minimum 98 percent.

Tariff Management
Control Tariffs and Eliminate Charging Errors

• The Tariffs have to be accurate. Streamlines and centralizes all tariff strategy and execution, creating a single source of truth so that can manage and enforce tariff policies.
• In the environment of "cross-subsidiaries" method the tariff setting are more complex and deal with one-item with different tariff related with patient sources, program, charge class and payer (see contract management) to prevent from charging errors.
• Any changes of tariff should follow documented workflow such as:
  • Create and segment tariffs.
  • Assigning ownerships.
  • Set tariff strategy.
  • Secure approval.

Cost Management
Cost and Budget

• Cost management is a process of planning and controlling the budget that allows predicting of expenditures.
• Cost management consist of 2 points as follows:
  1. Cost Component consist of:
     • Material Cost.
     • Overhead Cost.
     • Labor Cost.
     • Burden/Service Cost.
     • Sub Contract Cost.
  2. Costing Methods (combination of):
     • Periodic Weighted Average.
     • Standard Costing.
• At the end of the fiscal period, the system will be converted into the ACTUAL based costing.

Contract Management
Business Partners Pricing Management

• Typical medium-size hospital deals with almost 100-business partners and the figures are still growing. Business partners derive from insurances, BUMN, BUMD, private company, without any support from a strong and capable system; hospitals can potentially be chaotic, creating errors within billing.
• The contract itself should be able to manage schemes such as;
  • Coverage
    • Tariff negotiated with business partners can be different with hospital standard tariff and coverage of items can be limited, out of the coverage become member's burden.
  • Co-Sharing
    • This scheme is usually used by private companies, in which they cover certain percentages and the rest should be charged directly to members.
  • Plafond
    • Since the system is not yet connected with other insurance company and the limit per member is vary. To settle this the system at the point of discharge to generate the pro-forma invoice and send to business partner to get final approval the items / amount accepted and the rest become the member responsibility.

Patient Management
Inpatient, Outpatient, Emergency, Walk-in, Medical Checkup to Hospital Facilities

• Hospitals are a healthcare institution that provides patients treatments with specialized staff, equipment and facilities. Patient management focuses on manages the patient for inpatient, outpatient, and emergency plus manage the walk-in patient to ancillaries support, one-day care and medical check up (personal or corporate).

Bed Management
Bed Management Eliminate the Revenue Opportunity

• Bed Management has long been a problem for hospitals to accurately manage the communication and updates to the status of the beds easily by system and it can provide feedback to the front office up-to-date, which can eliminate any risk of rejection.
• Bed management benefits to significantly improved bed utilization, improved patient outcomes, improved infectious diseases control.

Infectious Diseases Control Management
Bed and Infectious Diseases Control

• To protect and prevent patients from health, safety and security threats especially infectious diseases that should be acknowledged by the system to care provider to avoid the risks of contamination.

Deposits
Down Payment

• In some hospitals, they normally request the patients pay a certain amount as down payment or deposit. The deposit could be topped-up from time-to-time to cover the hospital's bills.

Billing and Charges
Deposits, Physician Discount, Billing, Charges, Global Discount, Payment

• The billing and charges process includes submitting charges to the patients and third-party payers (based on contract management), posting patient transactions journal (auto journal generated on accrual based), and follow-up on outstanding accounts by producing "interim bill" to adding the patient deposits and or any discount from physician.
• The role of hospital billing is quite complex because of the variations in payer schemes. Oftentimes, they are unable to avoid the eventual change of payers, which requires the system to recalculate and synchronize with the back-office.

Interim Bills
Avoid Patient Lag or Bad Debt

• Periodically, the system can generate interim bills for inpatient when the total outstanding is greater than the limit allowed and any additional payment will treat as additional deposits.

Recapitulation Transaction
Discharge and Apply Administration Charges

• Recapitulation of transaction, when the patient plans to discharge and review all transactions (no more open order), the system will generate administration charges and generate the invoice.

Pro-forma Invoice
Business Partners Amount Approval

• Typically, when the hospital deals with business partners who prefers to use the plafond scheme and don't have the capability for direct connections, they prefer the hospital to send by email or by fax the pro-forma invoice for evaluation, and the final confirmation of the amount accepted. The remainder from the bill will be charged to the patients.

Invoicing
Pro-forma, Personal, Corporate

• Pro-forma invoice can be generated periodically for interim bill to notify patients to top-up their deposit in order to cover their outstanding bill or pro-forma invoice can be use for payer with "plafond" scheme to get the amount covered.
• After recapitulation, cashier/billing can generate the invoice for patient's personal use and if business partners cover the patients, finance can periodically generate corporate invoice as one or multi-patients.

Revenue Sharing
Physician Revenue Sharing and Progressive Taxation

• Revenue sharing is a deal between hospital and physician in term of percentage or nominal for their services.
• Two methods can be chosen to calculate the revenue sharing and in the same time as hospital responsible to collect and pay the tax in accordance with Indonesian law.

Remunerations
Remuneration for Nurses, Radiographer, ...

• Remunerations can be calculated periodically for individuals or groups of people for the services given to the patients.

CPOE Selection and Execution
CPOE: Medication, Laboratory, Imaging, Vital Signs, and ...

• Orders given by the physician will be selected and executed by respective service unit, this is the point of integration with other system though HL7 protocol.
• Execution of CPOE's, which is stock-item, will affect the inventory and billing, in which the system will update and generate an auto log (accrual based method) for back-office.

CPOE Integration
HL7 to Pharmacy, Laboratory, Imaging

• CPOE can pass through other sub-system such Pharmacy Information System, Laboratory Information System and Radiology Information system via HL7 (Health Level Seven) International Standards to provide the standard of exchange, integration, sharing and retrieval of health data.

Inventory Control
Stocked-Item

• Inventory controls are used to monitor stocked-item inventory balances, perform stocktaking, review inventory transaction history.
• Stocked-items located at warehouse/location and should be a person in charge to manage and responsible the flow of inventory.
• Mechanism of Inventory transfer between the locations or sites will use "Good in Transit" location/site to accommodate time to delivery and also to ensure the physically stock is correct of both locations or sites especially when stocktaking process or inventory balance query.
• Some other functions related with inventory such as:
  • Transfer Order is used to manage transfers between locations in the same site.
  • Site Transfer Order is used to manage transfers between sites.
  • Material Receipt Unplanned is used to manage items as a gift or donation with no price and should be part of the inventory as stock-in.
  • Material Issue Unplanned is opposite of MRU, it is used to take the inventory out for reasons such as stock-out.
  • Direct Purchase used for emergencies in the event that the pharmacy run out of stock and restocks from the nearest pharmacy.
  • Stock Adjustment

Inventory Accuracy
Inventory is the ROOT of the problems

• Inventory Accuracy is a method to measure on how closely official inventory match with the physical inventory.
• Based on research, a lot of industries are falling to the same problem, when inventory accuracy below 60%, it means the confidence levels of inventory are considered low and will potentially cause shortages or overstock.
• Inventory Accuracy is very crucial especially when the material planning in place. According with Oliver Wight, the inventory accuracy should be at least 95%.
• Two methods normally used to improve inventory accuracy are as follows;
  • Physical Inventory
    • PI are usually used by the auditors to perform stocktaking while freezing the stock, suspending any transactions during the process and operated once or twice a year.
    • For other non-healthcare industries, this is not a big issue, because they perform PI during the year-end holidays, their activities can be suspended, but for hospitals, they are unable to suspend their activities for this process. Hence the other method called Cycle Count is preferable.
  • Cycle Count
    • CC is another method for stocktaking; the difference is that it is not necessary to freeze stock, transaction and operations, as they can function as normal. Hospitals can define their own strategies for periodic cycle count to make sure the Inventory Accuracy improves until it achieves the target of at least above 95% accuracy.

Procurements Management
Request for Proposal, Purchase Order, Material Request, Purchase Order Receipts, Return to Supplier

• Procurement Management deals with all activities related to the purchase of goods and services from external suppliers and the corresponding reports.
• Due to its complexity and different roles involved it is convenient to split into:
  • Procurement Processes:
    • Convert Planned Order into Request for Proposal
    • Convert Planned Order into Purchase Order
    • Material Request into Purchase Order
    • Manual Purchase Order
    • Service Order / Asset Order
  • Order Receive Process:
    • Purchase Order Receipt
    • Service Order / Asset Order Receipt
  • Return to Supplier Process:
    • Return to Supplier for Replacement
    • Return to Supplier for Credit Note