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Admission & Billing

Inpatient and Out-patient Sales

The purpose of this module is automating and controlling of the sales cycle starting from registering/ admitting patient, charging items/services to patient, insurance approval on non- covered items, auditing of sold items and rendered services, assignment of doctor fees and finally generating of invoice.

This module is integrated heavily with accounting and inventory modules, also is integrated with third party applications such as PDA’s that is used in the inpatient pharmacy. A special functionality is used to map G/L accounts with sales document types which enables automatic posting to accounting and affecting warehouse quantity balances.

In this module patient profile maintenance is took place, with ability of attaching (uploading) important ID’s. Patient profile is designed in a way that complies with HL7 standards. Similarly other sales master data is maintained in this system; this includes admission types, visit types, admission classes, diagnosis and procedure codes per ICD standard, package and related items is also defined in this module. Additionally Rooms, rooms’ classes, beds and isolation types are maintained also.

In this module also items and services are classified according to insurance coverage into three types: fully covered items / services (always covered), not covered items/ services (always not covered) and needs approval item/ services with a flexibility of changing the coverage status on approval/decline of the insurance company.

Different kind of discounts, pre invoice generation or post invoice generation, whether percentage or fixed amount are handled in this module according to the authorized employees and limits.

Settlement of credit invoices and payment of doctors’ fees also is handled in this module.

A special way of charging patient called “quick charging” is set up in this module which can be used to charge patient directly by doctor using portable devises.

Claim Management

The purpose of this module is to manage claims of corporate credit invoices according to the worked agreements between the organization and other external parties, payment of these claims and analyzing (reconciling) of claims. The reconciliation process can be automated with the agreement of external parties by exporting claims and importing paid claim file templated approved by both parties.

Point of Sales

This module is focused on handling sales done via point of sales i.e. Out- patient pharmacy, cafeteria and gifts shop. This module is highly integrated with accounting and inventory modules, so posting are done automatically to related revenue, cost of goods sold accounts and related warehouse balances.