[Weekly overview] Ggz setting Geriant monitors with software the accuracy of declarations. This week the designated institution received a certification. Eline van der Wal, finance manager Geriant, explains the software and tells what the certification Geriant
.
The software takes the rules for claims in the eye.
Why is the certification required?
“The certification of the financial module in our EPD Synapse (Topicus) contributes to the approval of our annual production and direction accountant and health insurers. In the software we work with validation rules that control or the DBC meets the rules of the Dutch Healthcare Authority and DBC Maintenance. This should ensure that we send wrong claims to insurers. These validation rules we had in our system, but the certification, we can prove to the outside world that the validation rules are correct. That makes the job of the auditor easier and we notice that health insurers as well to questions.
What do these validation rules exactly?
“It’s A total of 140 validation rules when a claim is assessed. There are simple rules that look at mandatory fields as the customer’s name, date of birth or the reason for closing the DBC. Additionally, there are more complicated rules see if there is a diagnosis is made and whether the DBC no longer than 365 days open. When the dbc after 366 days is closed, we do not get paid. When Geriant early 2014 began working with the EPD, we have tested in every way, a substantial task. Turned out about 80 validation rules error prone. Validation rules, however, change yearly. By repeating the certification of the validation rules do not need these tests.
Ensures that a reduction in the administrative burden?
Indeed . By preventing administrative errors, you reduce the administrative burden of secretariats and caregivers. Administration is not exactly a hobby of caregivers. They may charge a storage rate of 30 percent provided care per hour for administrative tasks and related issues. That sounds a lot, but in practice it really tight. In recent years, the amount of work per client has increased such that the rate previously around 40 to 50 percent range. But we have storage to date do not increase: if you must care organization does not want. We try to bring that percentage down so that the main practitioner can devote his time to the clients. The installation of controls and certification of the EPD can help. By declarations in good time to file, you do not correct afterwards. “
What’s the next step?
” We prefer would the rules for insurers also bring. We are still working with many lists, but that is proving difficult. Namely all the insurers apply different rules. We treat geriatric patients. When someone in the hospital is diagnosed with dementia, the hospital can refer to us. However, not every insurance company accepts the hospital as referral; We have for example a referral from a general practitioner. If we forget that, the declaration is not right and we do not get paid. Another example is that not every health care provider accepts the specialist in geriatric medicine as hoofdbehandelaar. Some only accept a psychiatrist. There are differences between the health insurers that may cause errors in the declarations.
Each insurer uses different rules so?
“It goes even further . Except that with VGZ, Silver Cross, Menzis, Multi Care, DSW and CZ make separate agreements, there are also several appointments per contract year. There are also differences in terms between basic and specialized mental health services. Actually, we have twelve contracts to be reckoned with and that takes a lot of time to test it all. And then I let the wijkverpleging- and WMO contracts only out of consideration. The most annoying is that our workers should apply separate rules for each client: which should you actually do not want. By automating the invoice control, we want to make sure that our people can only do well. Now we carry many periodic checks. That goes, but it is the route of most of the work.
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