113036 - Is-H SGCHCA Payment Distribution and Pricing

SAP Note

 

  113036 - IS-H SG/CH/CA: Payment distribution and pricing Version   3     Validity: 20.02.2002 - active  

 

Language   English

Header Data Released On 20.02.2002 13:53:14 Release Status Released for Customer Component IS-H-PA Patient Accounting Priority Recommendations / Additional Info Category Consulting

Symptom This note firstly contains an explanation of the preconditions for a correct pricing when using payment distribution. And secondly, a description of the payment distribution flow and the special features resulting from it.

Other Terms Conditions, taxes, gross, net, consulting, pricing

Reason and Prerequisites This note is relevant as of Release 4.01B. It is only valid for the country versions Switzerland, Singapore, and Canada. During payment distribution, the system assigns services or parts of a service for the insurance verification to the repective insurance providers. The prices for services are determined in a pricing before payment distribution. At this point the assignment of services to insurance providers is not yet known. Therefore, pricing for individual services cannot be carried out with the insurance providers which are to take over these services later on. As a result, some special features arise concerning the following points: l

Insurance provider-dependent settings in pricing

l

Division of conditions

l

Determination of taxes

l

Gross and net values in the contract types and the payment distribution

Solution This note first illustrates the necessary settings in Customizing. There then follows a description of the settlement flow, with special consideration of pricing and payment distribution. The special features that arise here are then explained individually in more detail including examples. 1. Overview of the necessary settings in Customizing                        You must carry out the settings described here in Customizing so that the payment distribution can work correctly. These settings are not optional. a) Document flow ¡

In the Hospital Implementation Guide, select 'Patient billing -> Billing -> Billing -> Define document flow'.

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Choose the action 'Copying Control: Sales Document to Billing Document'.

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Branch to the item data of billing type NF01.

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Maintain the value G 'Copy pricing elements unchanged and redetermine taxes' for the pricing type field. b) Taxes in the pricing procedure

                       The tax conditions must always be specified last in pricing procedures.                        Exception: If you have defined your prices in the service master as gross prices, you need a condition which calculates the net value of the service (for example the condition type NETW) in the pricing procedure in addition to your tax condition. This condition is the only exception. It is influenced by tax and must be specified therefore in the pricing procedure according to the tax condition. c) Gross/net values setting in payment distribution

                       As of Release 4.02A: In the Hospital Implementation Guide, under 'Patient Accounting -> Billing-> Set up billing parameters', you can set whether gross or net values should form the basis for payment distribution. Also read the section 'Gross/net values in payment distribution' for more information in this note.                        Release 4.01B:                        In Release 4.01B this setting can only be made by means of a program change. Read Note 115172 for information on this. 2. Settlement flow (pricing and payment distribution) a) Determination of service prices               A pricing is carried out before payment distribution for determining the service prices. At this point the assignment of services to insurance providers is not yet known. Therefore the prices of the services cannot be determined in dependency on the respective relevant insurance providers. In order that insurance provider-dependent settings can nevertheless be used, a certain insurance relationship is used for this basic pricing. This is either the insurance relationship that is marked as main insurance relationship, or the insurance relationship with the highest rank. b) Payment distribution               Depending on the settings made in the system for payment distribution, either the gross values or the net values of services are distributed to the participating insurance relationships. The rules for this distribution are anchored in the contract types which you have previously assigned to the insurance relationships.               The payment distribution includes the determination of the amounts which must be taken over by the respective insurance relationships and the corresponding division of the conditions (read the section 'Division of the conditions' in this note for more information on this). c) Tax calculation               An invoice is created for each participating insurance relationship with the results of payment distribution. So that the tax can be displayed correctly for each invoice, the tax amounts are determined again for each invoice. 3. Insurance provider-dependent settings in pricing               Using different billing types for different insurance providers or insurance provider types, you can set up an insurance provider-dependent pricing procedure determination in IS-H. In addition, you can define insurance provider-dependent prices, discounts or surcharges in the conditions. However, note for payment distribution that only the settings which refer to the actual insurance provider which is used for pricing become effective.                              Example:                        Condition type ZPRS, condition records:                        Service   Insurance provider Price                        ------------------------------------                       ABC      A                  50.ABC      B                  30.                       Insurance relationships for the case:                        1. Insurance provider A, rank 1, contract type: 10% of service ABC 2. Insurance provider B, rank 2, contract type: 90% of service ABC                        If the insurance relationship with the highest rank is used for pricing, the price of 50.- arises for service ABC. After carryng out payment distribution, insurance provider A will take over the amount of 5.- from service ABC, insurance provider B the amount of 45.-. The condition record for insurance provider B is unimportant in this example since it refers to a insurance provider who is not relevant for pricing. 4. Division of the conditions               In the course of payment distribution, the gross or net amounts of the services are distributed to the individual insurance providers. In order that a condition analysis can be carried out later for the individual invoices, the corresponding condition values must be determined for each insurance provider. To that end, the relationship from the amount to be taken over by an insurance relationship to the total amount of the invoice is transferred to the conditions determined in pricing. In the course of this process (see example) it is ensured that the condition values for an insurance relationship in the total result in the amount to be taken over determined previously. However, the total within a condition type must no longer match the amount determined previously (pricing) in the cross-section covering all insurance relationships.                        Example:                        Condition values after pricing GP00 (basis Price) 50.ZSUR (Surcharge) 10.                       Total 60.-

                       Insurance relationships IV1 takes over 20.IV2 takes over 20.IV3 takes over 20.                       The condition values for the first insurance relationship IV1 are determined first. The relationship from amount to be taken over to total amount is transferred to all conditions. The factor for insurance relationship IV1 results in 0.33 (20 / 60).                        First step (first approximation: Multiplication with factor)                                                            IV1 GP00 (Basis Price)    50.- * 0.33    16.50 ZSUR (Surcharge)      10.- * 0.33     3.33                        Total                60.- * 0.33    19.83                        The total for the insurance relationship IV1 does not however yet match the specifications from the contract types. For this reason a second step follows in which the total is corrected. In the step, the condition value with the greatest amount (in this example GP00) is changed correspondingly.                        Second step (determination of the final condition values)                                                            IV1 GP00 (Basis Price)    50.-           16.67 ZSUR (Surcharge)      10.-            3.33                        Total                60.-           20.                                               The procedure for the two following insurance relationships is identical. The condition values for the three insurance relationships then look as follows:                                                            IV1        IV2         IV3 GP00 (Basis Price)    50.-          16.67      16.67      16.67 ZSUR (Surcharge)      10.-          3.33        3.33       3.33                        Total                 60.-          20.-        20.-      20.                       The total for the individual insurance relationships matches the specifications in the contract types. Each insurance relationship takes over 20.-. Note that the total within the individual condition types does not need to match the original total anymore. Both condition types are affected in this example. For GP00 for example, a value of 50.- was determined originally. However, a value 50.01 results in the total after division. 5. Taxes               Several invoices are created during billing. So that the tax amount for each single invoice can be specified correctly from the accounting point of view, the taxes must be calculated again after payment distribution has been carried out. It is possible that the total of taxes from the single invoices does not correspond to the tax amount which results from tax calculation of the overall invoice (see example).               Example:               Through the division of an overall invoice of 9.71 (net) to three different invoices (see table), the total tax amount changes.                                          Net    Tax (3%)    Gross Overall invoice   9.71    0.29         10.                       Single invoices Invoice 1        3.24    0.10         3.34 Invoice 2        3.24    0.10         3.34 Invoice 3        3.23    0.10         3.33                6. Gross/net values in payment distribution               You can determine in the settlement parameters for your institution whether payment distribution should work with gross values or with net values. Note the following for the respective procedure: a) Net procedure                        The service prices in the service master must be defined as net prices. For determining the taxes, define your tax condition as a condition type with calculation type A (in percent).                        During payment distribution, the net amounts of services are distributed to the insurance relationships. The amounts in the contract types are evaluated correspondingly as net values.                        Example:                        Service  Net    Gross A        100.-  103.-

B         200.-  206.                       Insurance relationships:                        IV1: Contract type: 60.- for service A, 100.- for service B IV2: Self-payer (without contract type)                        Payment distribution:                        Service  Overall IV1    IV2 A        100.-  60.-   40.B         200.-  100.-  100.                       Total     300.-  160.-  140.                       The following invoices are created:                        IV1: 164.80 (160.- + 3% tax) IV2: 144.20 (140.- + 3% tax)                         b) Gross procedure                        The gross procedure can only be selected if all insurance providers are similarly subject to tax. There must not be any difference in the tax record between the individual insurance providers.                        The service prices in the service master must be defined as gross prices. For determining taxes, define your tax condition as a condition type with calculation type H (in percent). In addition, you need a condition which calculates the net value of a service (for example the condition type NETW).                        During payment distribution, the gross amounts of services are distributed to the insurance relationships. The amounts in the contract types are evaluated correspondingly as gross values.                        Example:                        Service  Net    Gross A        100.-  103.B         200.-  206.                       Insurance relationships:                        IV1: Contract type: 60.- for service A, 100.- for service B IV2: Self-payer (without contract type)                        Payment distribution:                        Service  Overall IV1    IV2 A        103.-  60.-   43.B         206.-  100.-  106.                       Total     309.-  160.-  149.                       The following invoices are created:                        IV1: 160.- (including 3% taxes) IV2: 149.- (including 3% taxes)

Other Attributes Transaction codes

HIER ZSUR

Validity This document is not restricted to a software component or software component version

References This document refers to: SAP Notes 132226   IS-H SG/CH: Incorrect conditions distribution 115172   IS-H SG/CH: Gross/net setting in pymt. distribution

This document is referenced by: SAP Notes (2) 132226   IS-H SG/CH: Incorrect conditions distribution 115172   IS-H SG/CH: Gross/net setting in pymt. distribution