This article introduces the main business processes supported by the new country version France of SAP Patient Mangement. It also highlights a new billing feature required by France, but available for SAP Patient Management in general.
SAP Patient Management for France - what's in it
The SAP Patient Management country version France aims at supporting the country-specific requirements linked to patient administration and billing in public and private hospitals in France. Many of these requirements are legal requirements and they include electronic data interchange with external players, such as the French statutory health insurance or the Technical Hospitalisation Information Agency (ATIH)
Here is a rough overview of the enhancements made to meet the France-specific requirements:
Data collection at outpatient and inpatient admission
- Electronic reading of the French healthcare smartcard "Carte vitale" or manual entry of replacement documents on insurance coverage
- Data on coordinated care path compliance
- Entry of statutory health insurance information including reasons for exemption from patient contribution, for example.
- Entry of complementary health insurance data also the covering the specific complementary insurance schemes CMUC and AMEC and including complementary contract schemes defining the patient's benefits.
Medical activity documentation and reporting ("PMSI")
- Entry of services with the relevant attributes that need to be provided for the various service categories such as technical services (CCAM or NGAP) , lab services (NABM), drugs and medical products (UCD and LPP services).
- Support of PMSI processes including the entry of diagnoses, creation of the standardized discharge summary (RSS) and interface to the grouper program for acute hospital care.
- Creation of standardized preparation summaries (RSP) for radiotherapy cases.
- Electronic data interchange for DRG reporting (T2A) as legally required including the legally stipulated reports RSS, VID-HOSP, RSP, RSFACE, FICHCOMP for UCD and LPP.
Payment distribution, invoicing and electronic data interchange (EDI) for invoices and payment information
The system is able to support both the billing rules applicable to private hospitals and the billing rules applicable to public hospitals in France. It just needs a different customizing of the system settings to set up the required billing rules.
French public hospitals are moving from a general budget to direct billing ("T2A"). The SAP system is ready to switch the billing rules to direct billing when this becomes legally mandatory.
Here is an overview of the most important France-specific billing rules that are part of the SAP Patient Management country version France:
- Pricing and invoicing based on rules defined by the Coordinated Care Path Program ("Parcours de soins coordonné")
- Private patient billing ("Activité libérale")
- Calculation of the patient contribution based on per diem fees (relevant for public hospitals)
- Billing of the daily hospital rate ("forfait journalier")
- Calculation of service surcharges and discounts
- Creation of the electronic invoice B2 (CP standard)
- Import and display of electronic payment messages (NOEMIE)
- Posting of revenue notes (actual receivables in FI)
Individual Payment Distribution - a new feature generally available!
In France (but not only in France) health insurance providers offer very many different health insurance contracts. The vast number of contract schemes makes it difficult to keep them as master data in the system.
However, when you create a bill for a patient's treatment, you need to apply the terms of the insurance contracts of the various insurance providers.
In order to make this task easier, the billing work station was enhanced with a new function called Individual Payment Distribution. This function allows you to perform payment distribution based on the contract schemes which are assigned to the insurance providers of the case and to manually adapt the result.
This way, you can predefine the most common contract schemes in your system and use them when entering insurance coverage information at patient admission. If required, you can still modify the contract scheme assigned to the case and finally use Individual Payment Distribution to tweak the coverage amounts as needed.
This new functionality is available in SAP Patient Management in general for all countries where billing is carried out using Payment Distribution.
Below you can see a screenshot of this new functionality.
Want to learn more?
The French country version of SAP Patient Management is part of Enhancement Pack 4 for SAP ERP 6.0. It entered the Ramp-up program on November 21, 2008. Ramp-up completion is targeted for Q2 2009.
If you are interested in learning more about new functionality available with SAP ERP 6.0 EHP4 in general and with SAP Patient Management Country Version France in particular, please have a look at the Release Notes available at the SAP Service Marketplace.