Process optimization in home care area

Though its close involvement with a home care provider in the market sector "enteral nutrition" Fresenius Netcare has gathered extensive know-how on the development and implementation of automated, efficient business processes for office staff. Here, medical care is also extended to patients in the out-patient area. The recipients of the medical care and nutritional products are the patients themselves or homes. Billing, however, is effected via the health insurers except in cases where the patients have private health insurance.

The changes in legislation in the healthcare sector and the varying requirements of the health insurers pose a great challenge when automating business processes. A high level of up-to-date, insider know-how is essential to implement the requirements of the health insurers.

The business processes can be summarized as follows:

• recording and supply of orders
• receipt of prescription
• creation of quotation
• billing the order/delivery on receipt of approval from the
  health insurer

• display and processing of orders: using the patient file, the orders can be adjusted so that the invoices that are created correspond with the requirements of the health insurers.
• clear overview of delivery notes, invoices and quotations for patients
• display and printing of filed records for patients
• maintenance of articles for which there is a long-term prescription:depending on the health insurer, certain articles can be billed immediately without a prescription. These articles are administered via the patient file and billed directly on delivery prior to the receipt of the prescription. display of the co-payment bills created for patients

• The co-payment amounts are calculated automatically by the system in accordance with the statutory provisions. Adjustments to the existing statutory provisions (e.g. minimum/ maximum co-payment amounts, changes in the indications that are included in the calculation, combination of product hierarchy group etc.) can be made quickly and easily by altering the master data. If necessary, the co-payment amounts can be changed manually.

• Determination of co-payments:
  the amounts of the co-payment invoices are determined on the basis of the invoices sent to the health insurers. The amounts that were deducted by the health insurers are charged to the patients in a separate invoice. The co-payment invoices for the patients are created automatically and printed together with a remittance form by an external service provider.

• which hospital uses which flat rate
• which article is allocated to a certain flat rate
• which flat rates are calculated on the basis of the number of calories per day
• which articles can be sold separately as individual articles