Hospital Glossary

Setting up A Debtor Status allows the Practice to display a preset-up warning on a Debtors' file. The warning will be displayed every time a booking is made. An icon will also display on the booking timeslot when a booking is made for a patient to whom the Practice has allocated a status. Statuses can be set up to suit the needs of the Practice. For example, a status can be added to indicate that the Debtor is a slow payer, the Patient has a payment arrangement, is eligible for discounts/special rates, pays on time or the Debtor's account has been handed over for collection. 

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Shifting amounts between the Patient and the Medical Aid involves adjusting which party is responsible for specific costs. This might be done to reflect accurate billing based on coverage details, eligibility, or changes in the Patient’s benefits plan. For example: Medical Aid Denials or Shortfalls: If a Medical Aid partially covers or denies a claim, the outstanding balance may need to be shifted to the Patient. If the Medical Aid didn't pre-authorise a particular service, the amount may initially be billed to the Patient. Once authorisation is granted, the amount could be shifted back to the Medical Aid.

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This means the Rand value associated with the total Rand value of a Case (minus
Carve Out costs) that could be converted to FF/PD – if this rand value is exceeded
then the claim will remain FFS.

Submitting a claim to the Medical Aid is the process of sending the case's invoices to the Debtor/Patient's Medical Aid for payment of the account. Upon a Patient's admission to a Hospital, multiple invoices may arise. Each Surgeon and the Hospital will bill the Patient independently. In instances where the Hospital invoices daily for Facility usage, Materials, Meals, etc., it is preferable to consolidate the charges and send a single bill to the Medical Aid or Patient, rather than issuing multiple invoices. Submitting a claim to the Medical Aid is the process of sending the case's invoices to the Debtor/Patient's Medical Aid for payment of the account. 

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Desktop App:

Configuration of the Hospital allows users to set up and define various preferences and settings that align with the unique needs and operational processes of the Hospital. Users can set up Statement Codes, Per Diem Profiles and indicate who the Facility's Case Manager is.

System Options is the configuration of how the system operates and allow the user to set up the system to suit the needs of the Practice and activates/deactivates certain functions in the system. 

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