| | Description | | The module shall provide facilities necessary to invoice patients, perform all necessary amendments to patient’s account and provides comprehensive automatic follow-up of outstanding debts. The system should calculate resource usage for patient treatment where a free healthcare scheme is in operation. The module should include doctor’s fee management that takes care of all aspects of doctor’s involvement. The Billing Module should accommodate centralized and decentralized billing , and assist with every aspect of billing and collection. |
| 1 | | Provide facility to manage Patient Accounts on perpetual basis | | 2 | | Ability to Capture, store , and retrieve patient charge information | | 3 | | Ability to produce deposits, bills, statements, claim forms and logs | | 4 | | Ability to accept receipt, adjustment, and refund | | 5 | | Support posting of electronic remittances | | 6 | | Ability to deliver auto-proration capabilities | | 7 | | Ability to daily transfer of Billing data to General Ledger | | 8 | | Ability to transfer Patient refund data to Accounts Payable | | 9 | | Ability to pass procedure volumes to Cost Accounting for analyzing | | 10 | | Ability to Transfer Patient data to/from the Registration module ( inpatient , outpatient ) | | 11 | | Ability to support electronic third party billing, with multiple pricing and discounts | | 12 | | Allow grouping of financial classes for summary reporting | | 13 | | Accommodate Third Party contractual conditions and special negotiated pricing |
| 14 | | Provide online access to insurance data in admissions and other areas , to view pre-certification and entitlement requirements | | 15 | | Allow the Hospital to specify required registration and billing data by patient type and guarantor | | 16 | | Ability to edit and validate insurance verification data against insurance limitations and conditions | | 17 | | Provide ability to list non-covered services by insurance for different insurance companies and guarantors | | 18 | | Ability to include contract payment terms by service ( ex: emergency department, maternity ) in insurance portfolio | | 19 | | Provide charge master file that can be viewed online by patient account | | 20 | | Allow multiple prices for each line item in charge master ( by class and by insurance ) | | 21 | | Allow charging different rates for multiple insurance contracts, patient type of financial class ( first, second, ward, etc.. ) | | 22 | | Allow for automatic calculation of room and service charges on daily basis | | 23 | | Support percentage discounts and allowances for third party contracts | | 24 | | Allow overriding of charge master prices during charge entry | | 25 | | Support a variety of insurance contract billing requirements , such as sending separate bills to Social Security, MOH , various insurance companies | | 26 | | Provide coding and billing functions to support the Hospital ambulatory care system | | 27 | | Allow users to view previous outpatient visit discharge dates, site of service, and all ICD-10-CM diagnosis and CPT procedure codes | | 28 | | Ability to maintain and provide access to current and previous year’s ICD-10 coding tables and users’ tables to accommodate different third party | | 29 | | Support selectively or across the board price increases to charge master with effective dates | | 30 | | Provide audit trail of all charge master item additions, deletions, and updates with effective dates. | | 31 | | Ability to interface to order communications system for automatic posting of charges to patient accounts | | 32 | | Provide key data entry functions for posting charges in batch mode | | 33 | | Ability to validate entered charges for valid patient account numbers and charge code numbers | | 34 | | Allow individual charges on bill up to 15,000,000 Egyptian Pounds and total amount up to 100,000,000 E.P | | 35 | | Prohibit posting of batched charges if batch does not balance | | 36 | | Support the entry of price and description for miscellaneous charges | | 37 | | Allow posting of charges to patient accounts up to a user-defined cutoff period after discharge | | 38 | | Allow different late-charge cutoff periods for inpatient and outpatient bills | | 39 | | Allow posting of late charges to accounts ( after cutoff point ) and interface summary to general ledger system | | 40 | | Allow automatic transfer of outpatient and ER charges to inpatient account if admitted within user-defined time parameter | | 41 | | Produce daily late charge report by ancillary department | | 42 | | Produce monthly summary of late charge by department | | 43 | | Support billing for non-patient accounts ( ex: guest bed and meals charges ) | | 44 | | Provide comprehensive user defined front-end coding , revenue codes, bill type, etc.. | | 45 | | Allow for down payments , payments on account , partial billing , etc… | | 46 | | Support online cash posting by discharge cashiers as payments are received from patients | | 47 | | Allow assignment of primary and secondary financial class codes to patient accounts | | 48 | | Support proration of bill | | 49 | | Allow re-proration and rebilling | | 50 | | Automatically generate bill for second payor on remaining balance after first payor’s payment and eventually a third payor for same bills | | 51 | | Support rebilling for late charges and changes in financial class after final bill | | 52 | | Allow estimation of late or lost charges | | 53 | | Ability to perform series billing for recurring outpatients | | 54 | | Ability to maintain a series ( or recurring ) outpatient’s master record and reflect all changes in individual visit records | | 55 | | Support retroactive inpatient transfer from a financial class to another and allow recalculation of charges | | 56 | | Ability to report on conflicting situations resulting from transfer of patients and their financial impact | | 57 | | Ability to adjust accounting entries to reflect financial class transfers | | 58 | | Ability to automatically generate allowance amount when third party bill differs from Hospital price | | 59 | | Allow automatic change of patients’ financial class based on user-defined parameters | | 60 | | Ability to automatically update revenue statistics upon financial class changes in accounts | | 61 | | Provide third party log functions to track all payments, charges and adjustments for inpatients and outpatients | | 62 | | Support Retro billing for past event adjustments |
| >>> Instant Access and Update of pertinent information | | | | 63 | | Ability to grant Authorization to users, based on access restrictions, for data entry, edit, or view-only privileges | | 64 | | Support maintenance of complete guarantor, insurance and DRG data | | 65 | | Ability to maintain the pricing tables as legislated by the Ministry of Health ( MOH) | | 66 | | Ability to abide by the classification and coding of medical procedures issued by MOH | | 67 | | Provide capability to adopt to pricing of medications and medical classification pricing as established by MOH |
| >>> Contract Management ( and Guarantors ) | | Multiple contract management routines make it easy for the Hospital to govern managed care agreements and assist with negotiating and monitoring contracts with third party payors | | 68 | | Provide a contract dictionary that stores vital administrative information such as crucial dates , contract evaluation ( concurrent, retroactive ), contract terms, and notes taken during contract negotiation | | 69 | | Provide insurance identification routines for managing various insurance plans | | 70 | | Provide proration rules to calculate expected reimbursement to monitor managed care agreements | | 71 | | Produce various reports that help management determine if both parties are meeting predetermined managed care arrangements | | 72 | | Allow priorities in setting guarantors and self | | 73 | | Support group billing for multiple patients to an employer ( or other contract group ) account | | 74 | | Support family ( guarantor ) billing | | 75 | | Provide ability to edit guarantor data and reflect the changes in all related accounts |
| >>> Interim Billing | | Interim billing routines make it easier to track recurring and long-term accounts for billing and collection purposes | | 76 | | Capability of generating an unlimited number of bills based on how billing cycles are established | | 77 | | Provide facility to establish rules bringing groups of accounts through the billing cycle prior to a discharge date, allowing the Hospital to bill for charges incurred while the patient account is still active | | 78 | | Facility to assign a unique bill number for each billing cycle that is completed on a patient account | | 79 | | Ability to support resolution and tracking of claims | | 80 | | Ability to support secondary payors billing | | 81 | | Ability to support different interim billing methods by patient type and financial class | | 82 | | Ability to produce a single bill for patients transferring between divisions, without affecting divisional revenue reporting |
| 83 | | Provide for facility to establish proration rules for late charge bills in the event a payor requires different reimbursement | | 84 | | Provide for facility to report on charges posted after the final bill has been cutoff | | 85 | | Support estimation of late / lost charges in final billing process | | 86 | | Ability to automatically bill late charges any number of days after the final bill |
| >>> Other Billing Features | | | | 87 | | Facility to establish rules for final, interim, or late bill generation based on payor and/or account type | | 88 | | Ability to print or reprint Bills, claims, and statements , on demand by authorized users | | 89 | | Ability to track Patient charges throughout the Hospital, regardless of at which entity the costs were incurred | | 90 | | Provide one bill for all services rendered | | 91 | | Provide ability to identify mode of payment | | 92 | | Provide ability to calculate and record Tax and VAT | | 93 | | Maintain multiple ( up to four) insurance coverages for one account | | 94 | | Support proration and coordination of insurance coverage and billings and level of care changes proration in accordance with inlier-outlier status | | 95 | | Bill all payers and responsible parties simultaneously | | 96 | | Provide authorized members to view comprehensive patient account information online; print bills, statements, claim forms/logs; accept receipts; and provide account follow-up and management reports on demand | | 97 | | Ability to define billing procedures with one code and value based standard costs | | 98 | | Track Revenue and receivables separately for each facility | | 99 | | Track volume ( in dollars or LL ) of month-to-date and year-to-date charges | | 100 | | Track volume ( in approximate units of measurement) of month-to-date and year-to-date activity | | 101 | | Maintain and utilize service index table ( Fees Schedule ) :- Price | | 102 | | Maintain and utilize service index table ( Fees Schedule ) :- Alternative prices, based on patient type | | 103 | | Maintain and utilize service index table ( Fees Schedule ) :- Description | | 104 | | Maintain and utilize service index table ( Fees Schedule ) :- Statistical measurement ( RVU, CAP units , K Units , labs and operations units, etc..) | | 105 | | Maintain and utilize service index table ( Fees Schedule ) :- Date of last price updated | | 106 | | Maintain and utilize service index table ( Fees Schedule ) :- Ability to Automatically coordinate service index table with General Ledger codes | | 107 | | Maintain and utilize service index table ( Fees Schedule ) :- Cost per unit and date of last cost update | | 108 | | number of room charges by : Financial class | | 109 | | number of room charges by : Nursing unit | | 110 | | number of room charges by :Service unit | | 111 | | Ability to automatically determine service code information by accessing service index table for all hospital services: | | 112 | | Allow changing of multiple prices by inputting a single transaction ( ex: raise all room rates by 3%) | | 113 | | Allow user overrides of both description and price | | 114 | | Provide audit trail of manual price override | | 115 | | Allow immediate posting to accounts ( online ) | | 116 | | Provide transaction description on bills | | 117 | | Ability to summarize charges by type of service | | 118 | | Automatic retroactivity for Late charges | | 119 | | Automatic retroactivity for Late admissions | | 120 | | Automatic retroactivity for Late transfers | | 121 | | Automatic retroactivity for Change in form | | 122 | | Automatic retroactivity for Change in financial class | | 123 | | Automatic retroactivity for Erroneous discharge |
| 124 | | Ability to print bills in sorted order by inpatient, outpatient, and financial class | | 125 | | Allow separate bills for one patient visit | | 126 | | Ability to suspend bill printing until required data elements are present ( ex: diagnostic codes, insurance ) | | 127 | | Print suspended bills management report to track outstanding bills | | 128 | | Allow bills to be reprinted on demand ( using a unique number , or reprint sequence ) | | 129 | | Print ‘demand’ bills for inpatients at discharge and at point of service for ER and outpatients | | 130 | | Ability to generate summary of the Bill along with the itemized bill , by group of services | | 131 | | Print bills in different formats , and MOH billing forms ( and in Arabic ) | | 132 | | Allow bills to be reviewed and edited online before releasing for print or electronic billing | | 133 | | Print free-format text messages on all bills in a financial class | | 134 | | Print or display daily bill summary showing number of bills by financial class, amounts totals, for inpatient and outpatients | | 135 | | Ability to accept all charge information from patient care and communication system | | 136 | | Ability to produce a single bill for patients transferring between divisions, without affecting divisional revenue reporting | | 137 | | Print patient bills :- Patient name | | 138 | | Print patient bills :- Guarantor name and address | | 139 | | Print patient bills :- Date and type of bill ( interim or final) | | 140 | | Print patient bills :- Hospital service | | 141 | | Print patient bills :- Physician(s) | | 142 | | Print patient bills :- Financial class | | 143 | | Print patient bills :- Admit and discharge diagnosis | | 144 | | Print patient bills :- Visit diagnosis for outpatients including ICD10 code | | 145 | | Detail of charges:- Service code | | 146 | | Detail of charges:- Date | | 147 | | Detail of charges:- Description | | 148 | | Detail of charges:- Quantity | | 149 | | Detail of charges:- Amount | | 150 | | Detail of charges:- Total | | 151 | | Summary of charges by comprehensive groups | | 152 | | Comments ( at the hospital’s discretion) | | 153 | | Allow grouping of Medical Supplies below certain price, under one code and one set price | | 154 | | Ability to separate professional component from hospital portion of charges for separate billing; as required | | 155 | | Provide a sliding scale computation for outpatient charges | | 156 | | Ability to print interim bills for outpatients |
| 157 | | Provide collections management functions for hospital collections department | | 158 | | Provide online ‘tickler file’ function for scheduling follow-up collection actions | | 159 | | Support entry of online collections notes for individual accounts to track follow-up activities | | 160 | | Support automatic collection processing that routes account to specific follow-up steps per user-defined criteria ( ex: balance greater than 5,000,000 over 90 days ) | | 161 | | Print standard collection letters on demand to individual or groups of accounts ( ex: 30,60,90, 120 days ) | | 162 | | Print pre-list of accounts meeting hospital bad debt criteria before assigning to collections | | 163 | | Provide for Patient and guarantor collection | | 164 | | Provide for account look-ups by patient name and number, guarantor name and number, and medical record number | | 165 | | Ability to process reminders | | 166 | | Provide entry of free text and coded comments | | 167 | | Provide for unlimited generation of form letters for user-specified accounts ( in English and Arabic ) | | 168 | | Support reports that can be customized by the user | | 169 | | Elaborate security access that show and audit trail of who has posted transactions to an account |
| 170 | | Provide for a facility to check on all required information on a patient’s account prior to printing of the claim | | 171 | | Ability to online override facility in every field on the electronic claim form , to produce claims that meet payor’s specific requirements | | 172 | | Provide for claim establishment based on different insurance and account types such as mother/baby billing, inclusion/exclusion of professional components, ‘clean claim’ data checking, and exclusion of ‘cross over’ claims |
| 173 | | Provide online inquiry into billing data for current and past visits | | 174 | | Provide for detailed workstation displays and printouts by patient/guarantor demographics and account statuses, patient and insurance balances, transaction details, and follow-up statement histories | | 175 | | Maintain charge detail after billing for reference and inquiry for :- Inpatients | | 176 | | Maintain charge detail after billing for reference and inquiry for :- Outpatients | | 177 | | Maintain charge detail after billing for reference and inquiry for :- Transfer |
| 178 | | Print daily receipt log for ER and outpatient registration | | 179 | | Ability to generate cycle statements by either account or guarantor | | 180 | | Include an unlimited number of hospital-defined dunning messages | | 181 | | Operations summary, displaying all billing , A/R activity for a particular date or range of dates | | 182 | | Revenue reports: revenue summary, procedure revenue report, procedure period end comparison and patient revenue report | | 183 | | Charge exception, late charges, and general ledger reports | | 184 | | Collection reports such as biller and collector worklists | | 185 | | Collector performance reports | | 186 | | Patient and insurance receivable reports and third party logs | | 187 | | Late charge transaction report | | 188 | | Ability to identify, produce and report patient billing and account receivable ledger by division as well as combined | | 189 | | Inpatient in-house account report | | 190 | | Provide the flexibility for the user to determine which financial classes are to be broken out on the revenue reports | | 191 | | Ability to produce the following revenue and statistical reports | | 192 | | Produce patient census report by user defined criteria | | 193 | | Patient revenue for accounting period reports by :- Hospital charge | | 194 | | Patient revenue for accounting period reports by :- Sub-department totals | | 195 | | Patient revenue for accounting period reports by :- Department totals | | 196 | | Patient revenue for accounting period reports by :- Hospital service | | 197 | | Patient revenue for accounting period reports by :- Financial class | | 198 | | Patient revenue for accounting period reports by :- Accommodation | | 199 | | Patient revenue and usage statistics summaries with year-to-date figures by: type of service, third party | | 200 | | Daily income reports by: patient type, financial class, hospital service | | 201 | | Administrative operating summary showing aged Egyptian pounds totals by financial class for all accounts in the accounts receivable and bad debt files |
| 202 | | Accounts receivable module |
|
In this section you'll find a list of companies and organizations working in the healthcare IT sector in Egypt.