KV Solutions - Software für Kassenärztliche Vereinigungen

KV.net is designed for processing and monitoring (format, data, content/figure work) the quarterly invoices from medical care service providers. Other functions include reporting, extended tests and the issue of information material to authorised third parties.

Whereas the basic logic behind the processing of invoices in all ASHIPs is comparable, the concrete methods and stages vary considerably from one ASHIP to another. For this reason, KV.net processes are configured exactly to customer requirements.

The path from import to export of the invoices is accompanied by short-term processes which handle the amounts and, when necessary, transfer them to the next stage. The programs which realise these short-term processes are normally supplied with the KV.net system. These include, for instance, the dialogue program, guidelines and the rule maintenance program. Another option is the generation of ASHIP-specific programs which can be introduced into the system control in the same way as the pre-configured programs.

The ASHIPs not only check the data structure of individual invoices from healthcare providers and verify the content and calculations, but also the overall fee of the healthcare providers. There are, of course, various regulations and contractual stipulations which must be taken into consideration – such as specialist subdivisions, practice composition, budgeting, reductions, standard service volumes, point values, healthcare groups, additional contractual agreements, etc.

The basis in this case is the Fee Allocation Criteria (FAC). Alongside the actual calculation of amounts to be paid to the individual healthcare providers, it is the reporting of these complex invoices which plays an important role. A range of information packs in graphic and written form must be prepared for the healthcare providers, health insurance companies, ASHIPs and others.

KV.net 2 is very flexible – the workflow can be adapted and configured to individual needs, allowing optimum integration of the software into the work processes of each health insurance company. In KV.net 2 no manual changes are necessary, apart from the individual adjustments for accounting activities and reports. Basically, a “Part 2” invoice could be started - and implemented - with one click.

The program is based on the billing procedure of KV.net, only that data between the physician’s practice and the Association of Statutory Health Insurance Physicians* (KV) is exchanged via a web interface.

A connection is set up between the physician’s practice, or the computer system at the practice, and the server of the ASHIP*. Data is exchanged via this server. Encrypted data packets, xkm files, are transferred from the practice/physician to the ASHIP. XKM is a tool provided by the National Association of Statutory Health Insurance Physicians (KBV) that enables invoices to be encrypted and decrypted.

Further processing of the data is carried by the ASHIP with components of the KV.net program. A feedback file is generated for each step, which is then saved on the database server. The physician/practice can access information via this file about the status of any bills that he or his practice have submitted. KVOnline.net is composed of the following components:

- 1 -

V OnlineWebclient & Host (consisting of the gradient online portal, incl. service for collecting bills/eDocumentation with BatchCryptomodule and as a host for the service to connect the practice management system, or another portal)

- 2 -

AdminTool3: management and research program

- 3 -

D2DAdmin management program and Windows service for the collection and processing of D2D messages and sending feedback

- 4 -

OneClickAdmin management program and Windows service for processing OneClick bills

- 5 -

LoaderAdmin management program and Windows service for processing bills und eDocumentation that exist as files

- 6 -

Connection to esQlab.online

*ASHIP (Association of Statutory Health Insurance Physicians

Ais.net is a modern system for doctors’ registers, documentation and information. It was geared towards the special requirements of those ASHIPs participating in the project and will continue to be developed further.

In addition to a high level of variability regarding the mapping of all imaginable constellations in terms of legal principles, such as social welfare legislation, organisation of further education, the Medical Association’s professional code of conduct, or the licensing of doctors, a history is to be included. What is particularly worthy of note is the central importance of AIS.net in combination with further applications in the field of quality assurance, assessment of services in terms of fee allocation contract regulations, with the application of the quarterly invoices and finally administrative accounting.

All these important environment functions access the entries in AIS.net.

The Akon.net program is used for the administration of a doctor’s contacts, enabling the user round-theclock access to correspondence and calls with doctors and businesses, dispensing with the troublesome search in documents and files and allowing a speedy response to enquiries.

Invoices received, even those requesting further information, can be documented, as well as queries regarding invoices and general enquiries. With Akon.net, recorded contacts can be allocated to a specific person to be dealt with or clarified by email. Notes can be entered, which can also be forwarded by email to an employee. It is also possible to define tasks which must be completed. The option to generate a number of letters is also available.

@xka is distinguished by its ultimate flexibility and enormous extension potential. It is a software system for processing doctors’ invoices for their fees, or the so-called ”invoice part 2”.

The user benefits from the state-of the-art interface design, simple interfaces and a high level of system compatibility. To a large extent @xka is based on XML format, facilitating the transfer of results to an individual HTML presentation and enabling data to be displayed with the help of web browsers, i.e. also on the internet.

The data language DSP is at the heart of this invoicing software for processing doctors' invoices. The principle of DSP is to meet the requirements of any invoice and not to represent a specific invoice. In this way DSP can react flexibly to any changes in doctors’ invoices.

Das EBM-Stamm Pflegeprogramm dient der Haltung und Aktualisierung des zentralen EBM (Einheitlicher Bewertungsmaßstab). Darüber hinaus werden alle gesetzlich geforderten und auch für weitere KVSolutions speziell modifizierte Datenformate (Exporte) unterstützt.

Wie auch alle anderen KV-Solution-Produkte kann EBM.net flexibel auf Besonderheiten der KVStrukturen angepasst werden und findet an der Basis der Stammdaten seinen Platz.

Somit ist nicht nur gewährleistet, dass alle notwendigen Informationen der Gebührenordnungspositionen an die KBV, die Arztpraxen oder Kassen gelangen, sondern dass auch für alle internen Programme, Prüfungen, Berechnungen und Regelwerke die Stammdaten zur Verfügung stehen. Gebührenordnungspositionen können bearbeitet, hinzugefügt, erweitert, beendet, gekennzeichnet, kopiert und modifiziert werden. Stammdateien der KBV können importiert, weiterverarbeitet und exportiert werden und auch das Reporting spielt eine große Rolle.

Aufgrund des modernes Designs, der schlanken Bedienoberfläche und der klaren Struktur findet man sich hier als Benutzer umgehend zurecht.

eDoku.net with a configuration program currently supports the preparation and processing of the following
types of documentation:
• Early diagnosis coloscopy
• Skin cancer screening
• Cervix cytology (quality assurance of cytological examinations of the cervix in the form of annual statistics)

Further types of documentation are also possible. For each type of documentation there is a separate program interface – the structure and method are very similar.

The documents checked for plausibility are exported to the National ASHIP or to the Central Institute of the National ASHIP and separately to the ASHIP in different formats (.xml, .zip). In this way the data is available for further processing (e.g. KVnet).

The advantages of eDoku.net by gradient.Systemintegration GmbH are, above all, the electronic testing process and central data administration, which for example, allows data evaluations to be carried out for statistical purposes.

esQlab.net has facilitated the automatic data collection of doctors' invoices with the ASHIPs since 1999. In Germany approximately 95% of these bills are processed with our esQlab system.

In a first step the bills are scanned with a throughput of up to 8,000 bills per hour. Document type, bill type, data for services provided etc. are automatically collected and sorted. Recognition of handwriting is also very reliable. All scanned, recognised and - if necessary – corrected bills are then archived. The online archive with up to eight settlement quarters can be accessed by research-client and web-browser.

esQlab.online from gradient.Systemintegration GmbH provides you with a browser-based billing system.

The principle is quick and simple: After data is entered into the computer at the surgery, it is automatically verified and corrected, and securely transmitted to the server of the Association of Statutory Health Insurance Physicians (ASHIP). Various security mechanisms protect the sensitive data - for example, encrypted transmission via HTTPS and server and client certificates.

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