Inpatient Final Bill Generation - hmislk/hmis GitHub Wiki

Inpatient — Final Bill Generation

The final bill consolidates all charges accumulated during the admission into a single billable document. It is generated after nursing discharge is confirmed and must be settled before the admission is fully closed.

Page: Admission Profile → Billing panel → Final Bill (shown after discharge), or via menu search
XHTML: /inward/inward_bill_final.xhtml (generation), /inward/inward_bill_final_break_down.xhtml (breakdown)
Controller: BhtSummeryController / InwardBeanController
Privilege: InwardBilling to reach the billing screens; InwardSettleFinalBill to settle the bill

What the Final Bill Includes

Some final bill aggregates samples are given below:

Charge Category Examples
Room charges Room rent, guardian room rent
Timed services Oxygen, IV fluids, nursing procedures
Services & investigations Lab tests, radiology, physiotherapy
Outside charges External provider fees
Pharmacy issues Medicines dispensed to the BHT
Professional fees Consultant and specialist fees
Surgery fees Theatre and surgery charges
Admission items Auto-charged items configured on the admission type

Medicine that was cancelled or returned during the stay is not shown as a separate line — its value is already netted into the Medicine total, so the Medicine line reflects what was actually charged after cancellations/returns.

Bill Generation Steps

  1. Open the Final Bill page for the discharged BHT — from the admission's Interim Bill, click Create Final Bill.
  2. Click Process — the system calculates all charges and updates totals.
  3. Review the line items in the bill breakdown panel.
  4. Optionally adjust line items (if permitted).
  5. Click Save Final Bill — this settles the bill and moves on to payment collection. The button is disabled until the figures have been processed, and requires the InwardSettleFinalBill privilege.

Depending on configuration, additional options appear:

  • Show an Intermediate Bill on Final Bill Edit — if enabled, Process shows a preliminary printable bill before Settle

Provisional bills are no longer saved from this page; see Provisional Bill Search to find and work with them.

Bill Breakdown

The breakdown view (inward_bill_final_break_down.xhtml) shows charges grouped by category with subtotals. This view is useful for:

  • Itemised review before settlement
  • Printing a pre-settlement itemised statement for the patient or their insurance company

Adjusting Category Totals

Each charge category row has an Adjusted Total field. By default it is editable for most categories, but locked for Room Charges, MO Charges, Maintain Charges, Nursing Charges, Linen Charges, Medical Care (ICU), Administration Charge, and Professional Charge — these are driven by other configured rules and are not meant to be hand-edited. Whether this lock applies is a per-institution setting; some institutions allow every category's Adjusted Total to be edited freely.

If the sum of the category totals doesn't match the sum of the adjusted totals, Settle can be blocked with "There is a difference between actual and adjusted values. Please Adjust category amount correctly." — also a per-institution setting; some institutions don't enforce this check.

See Application-Level Configuration for the keys that control both.

Professional Fees on the Final Bill

A doctor is named on the bill only when the fee was entered through Add Professional Fee. The Profesionall Fee panel below the charge types lists one row per doctor, with that doctor's total and an Adjusted Value.

Professional charges can also arrive a second way: through a service item whose charge type is Professional Charge — for example an MRI "REPORTING - Dr ..." item billed by the Diagnostic Centre, where the radiologist's fee is bundled into the service. Those are not listed per doctor. They are added together and printed as a single Other Professional Charges line under Professional Charge, and the panel shows the same figure as a note under the table.

So there are two ways to bill an MRI for an inpatient, and they print differently:

How it is set up What the bill shows
An MRI item without a professional component, plus the radiologist's fee entered through Add Professional Fee The MRI under its own charge type (e.g. Scanning Charges) and the doctor named under Professional Charge
An MRI item with the professional fee bundled into it The bundled part under Professional Charge as Other Professional Charges, with no doctor name

Final bill print where the MRI is a Scanning Charge and the radiologist is named under Professional Charge

MRI billed without a professional component: Scanning Charges 3,000.00 on its own line, and the 2,500.00 professional fee named under Professional Charge. Doctor name replaced; amounts are local test data.

Final bill print where the bundled MRI reporting fee prints as Other Professional Charges

The same doctor, billed both ways on one admission: her 5,000.00 of entered professional fees is named, while the 500.00 bundled into the MRI reporting item prints as Other Professional Charges. The two add up to the 5,500.00 Professional Charge total.

If a hospital wants a doctor named on the bill, the fee has to be entered through Add Professional Fee. If that doctor's charge keeps arriving bundled inside a service item, ask an administrator for a version of that service without the professional component, and enter the doctor's fee separately.

The label of the line can be changed with the application option Inward Final Bill - Label For Other Professional Charges (default "Other Professional Charges").

Adjusting a doctor's fee changes the Professional Charge adjusted total only by the amount you changed — charges that came in through service items stay in the total. For example, lowering a 2,000.00 fee to 1,500.00 on a 4,000.00 Professional Charge gives an adjusted total of 3,500.00. As with any category, Save Final Bill is blocked while adjusted and actual totals differ, if that check is switched on (see above).

Free-of-charge consultations

A doctor who saw the patient without charging is still named on the final bill. Enter the fee through Add Professional Fee with the FOC (free of charge) switch turned on and the Fee Amount left at 0.00. On the final bill:

  • The doctor is listed under Professional Charges with Free of Charge in place of an amount.
  • The Professional Charges line still prints when free doctors are the only professional fees; its total stays 0.00.
  • Bill totals do not change.
  • A free fee whose professional bill was cancelled is not listed, the same as any cancelled fee.

Custom Bill 3 print listing a free-of-charge consultant under Consultant Fee

Custom Bill 3: the consultant entered with FOC is listed as "Free of Charge". The Consultant Fee line reads 0.00 and the Total is unchanged. Doctor name redacted; amounts are local test data.

The wording can be changed with the application option Inward Final Bill - Label For Free Professional Fee (default "Free of Charge"). The same label is used on every final bill print format and on the Professional Bill print.

This applies to final bills saved after the change. A final bill saved earlier is not rebuilt when it is reprinted, so a free doctor stays missing from it.

Price Matrix Value (Service Charge Margin)

If any of the admission's charge categories are covered by a configured Price Matrix, the markup the matrix applied is already folded into that category's Total — it isn't billed separately. To let billing staff see how a category's Total was arrived at, the Charges Overview panel and the Charge Types grid both show a Service Charge (Margin) figure alongside Total:

  • Charges Overview (top-right panel): Gross Total (before any matrix markup) and Service Charge (Margin) (the matrix markup), which together add up to Total Charges.
  • Charge Types grid: a Service Charge (Margin) column next to Total, per charge category — covers Room Charges, Maintain Charges, MO Charges, Nursing Charges, Linen Charges, Medical Care (ICU), Administration Charge, Professional Charge, and matrix-priced services/investigations.

Charges Overview and Charge Types showing Service Charge (Margin)

Both figures are informational only — editing Adjusted Total still works the same way described above.

Credit Company Allocation (Credit Admissions)

For an admission with Payment Method = Credit, clicking Process also splits the net due between the credit company(ies) recorded on the admission and the patient's own co-payment. See Insurance Allocation on the Final Bill for how the split is calculated and how to override it before settling.

If the credit company + patient allocation rows don't add up to the net due amount, Settle can be blocked with "Total allocation (...) must equal the net due amount (...)." — this is also a per-institution setting; see Application-Level Configuration.

Discounts

Discounts can be applied to the final bill through the Discount Matrix configuration. See Admin — Inpatient Discount Matrix.

Price Adjustments

Price adjustments are the hospital's service-charge margin, configured as a matrix for services, investigations, pharmacy, store items and room facility charges. The margin is resolved when each item is billed and is already inside the category totals shown here — it is not something applied on this screen, and it increases rather than reduces the bill. See Inward Price Adjustment Matrix and Admin — Inpatient Price Adjustments.

After Settlement

Once Save Final Bill is clicked:

  • patientEncounter.paymentFinalized = true
  • The final bill is locked — no further charges can be added
  • The Admission Profile Billing panel switches from "Interim Bill" to "Final Bill"
  • Proceed to Inpatient — Final Bill Payment

Interim Bill (During Admission)

Before discharge, an Interim Bill (running total) is available from the Admission Profile at any time. It shows the current total without finalising anything. See also the Estimated Bill which includes professional fee estimates.

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