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Billing refers to the creation, handling and processing of fees for services rendered and for costs incurred in the delivery of care. Billing may reside within the larger scope of accounting and financial management of a medical practice, and is distinct from, but may interact with, inventory and procurement.

GNUmed is not interested to fully develop billing, but is interested to support it. Billing is highly internationally and even regionally variable, and a project aiming to create an international-usable EMR could easily choke on full implementations of billing within the project. Anyone desiring to better-understand this might review BillingBackground.

In GNUmed, we are interested to help to identify, and in particular not to lose, the chance to identify events or items for which billing needs to be done. Additionally, GNUmed is interested to store the status of these items, once these have been created.

The types of items that GNUmed might track, for handing-over to billing software, would be all of those that may be patient-related, e.g.
  • clinical services (evaluative and therapeutic, procedural and non-procedural)
  • administrative services (forms completion, record copying & transfer)
  • miscellaneous charges to patients (missed appointments, other)

GNUmed has at present no plans to support, or at least no plans to manage
  • basic accounting, including payroll
  • charges for doctors' professional services when these would not be patient-related (medico legal, committee and other consulting work, typically billed to an organisation)


Much of the work performed by doctors occurs either during, or in consequence to, various types of encounters. Commonly, these would be the encounters involving physical interaction with the patient, but not always. Sometimes, consultations are performed (or advice is given) by telephone and this can be a service for which there can be a charge. Sometimes, a doctor's report must be generated from a review of the medical record without any interaction with the patient apart from their consent.

Encounters provide the structure and location for the recording of clinical data, but are not the structure in which to record billing-related codes, nor costs, nor any sales. These things belong, at minimum, in some other table which is to be the GNUmed "billables" table.

Encounters can be a marker for services and consumables that may be "billable". Consumables could be things like vaccines or tray fees for which charges may need to be issued. Eventually, consumables might be linked from some kind of inventory system.

Tasks, while not yet developed in GNUmed, might likewise guide the creation of billables. Tasks could be understood as things which must be done, either by the doctors or by the staff. As soon as GNUmed would support TaskTracking, tasks may likewise assist the creation of billable items.

Inserts could be programmatic, depending on values entered into fields in the encounter-type and yet-to-be tasks tables. Inserts could also be done programmatically where a canned query would poll the database to identify anything suspicious for missed charges, and inserting new records into "billables", complete with a suitable flag or pointer, for example an fk_clin_narrative foreign key. Lastly, billables would be able to be created manually, on whoever would be the active patient.

As soon as any user or widget would decide it is time to issue a claim or a billing, the widget may send a message with parameters {code:value, comment:text ...} via dispatcher. If you have a billing backend in place, it will get the message and act accordingly. If you have no billing backend or don't need the feature, the message will simply (automatically) be ignored.

These ideas are further developed in

Even without the above development, billing applications can already work side-by-side next to GNUmed. See the topic BillingSlaveMode.
Topic revision: 25 Jan 2012, KarstenHilbert
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