98 APPENDIX The Application of HCM on the Basis of a Clinical Case
✔✔ Inspection of data by the patient with HCM
Frank has received a QR code from the hospital that he can use to register
at the patient portal. The HCM system fed all necessary information into
the portal via an XDS transaction. Based on the QR code and defined permissions
in the system, Frank only has access to his own data.
If Frank wasn’t so progressive and IT-savvy, he could of course also have received
a storage medium or paper documents.
The patient case is billed
After Frank’s discharge, the surgery and the associated stay in the hospital are
billed.
An employee in medical accounting uses all information and data of the
case stored in the HIS and in the case file of the HCM system. First he checks
whether the data is complete, then he creates an appropriate invoice based on it.
✔✔Billing with HCM
The medical accounting employee also has access to the multi-format viewer
via the HIS and can verify all data in the context of the case. The HCM system
thus supports him in verifying the completeness of the case file. Once the
health insurance company has received the bill for Frank’s hospital stay, it is
passed on to the medical review board of an NHI. The medical review board
of the NHI notifies the medical accountant of the hospital that the patient
case has to be inspected to confirm the bill. This means that Frank’s billing-
relevant data must be available within a certain period of time.
The medical review boards of the NHI perform their reviews in different
ways: a review can take place on site or at the reviewers’ premises.
In the latter case, the files must be made available to the auditor
in digital or paper-based form. In any case, data should be at hand
quickly and comprehensively.
✔✔Medical review board of the NHI inspection with HCM
In order to prepare for the medical review board of the NHI inspection, the
medical accounting employee selects all documents, individual pages,
images and studies in the multi-format viewer that he or she would like to
make available to the medical review board. If the medical review board requests
the data in paper-based form, it can be printed out directly from