Casemaster
The Casemaster takes data from a patient or case file (Dossier) with already defined sessions / patient contacts as input and applies the definition of outpatient treatments in accordance with Appendix B of the tariff structure agreement. The Casemaster is mostly independent of specific tariff versions. However it relies on a version-specific Capitulum assignment classification system which is used to group diagnoses of sessions. The JSON file containing the Capitulum assignment is provided together with the tariff files. The use of Casemaster is voluntary, provided that the definition of outpatient treatment is already implemented in the service provider’s case management.
The Casemaster is applied before grouping and mapping a patient case. A patient is a collection of sessions / patient contacts within a given time frame treated by a given service provider and the patient’s master data (birth date, sex, PID). Each session has one diagnosis, multiple services coded with LKAAT codes and may have additional tariff positions (tarpos) from other tariffs (drugs, laboratory, materials, etc.). The output of the Casemaster is a list of errors and a list of generated patient cases / outpatient treatments.
Sessions and patient contacts are considered identical in the context of the Casemaster. The Casemaster does not differentiate between sessions and patient contacts as this differentiation is not relevant after having defined sessions and patient contacts.
Multiple diagnoses
If multiple sessions with different diagnoses (but the same capitulum) are grouped into the same outpatient treatment, the Casemaster assigns the diagnosis of the first session to the outpatient treatment. The order of the sessions is determined by the order they are stored / inserted in the Patient by Patient.addSession() or Patient.setSessions(), (not ordereb by date) and hence this choice can be influenced. This simplification may require human intervention depending on the use of the grouped patient cases. However this choice will not have an impact on the grouping and the mapping process as all diagnoses are in the same capitulum and grouping logic uses the diagnosis only for Capitulum assignment (ATM).
Implemented rules of Appendix B of the tariff structure agreement
Appendix B of the tariff structure agreement
Rules regarding the definition of outpatient treatments (section 5 of appendix B, rules 1,2,3,6 and 8) are implemented.
Rule 4 of section 5 of appendix B is in the process of clarification: Mitternachtszensus
Section 7 (Age / Altersangaben) is implemented in the Mapper
Section 8 rule 1: The age of a patient case is set to the age during the first session excluding radiation planning sessions.
Section 8 rule 3: apply the grouper in order to comply with this rule
Unimplemented rules of Appendix B of the tariff structure agreement
Differentation of inpatient and outpatient treatments (section 1 of appendix B and rule 5 of section 5 of appendix B)
Rules regarding the service provider (section 2 of appendix B and rule 7 of section 5 of appendix B)
Rules regarding the session (section 3 of appendix B). The session is expected to be already defined in the input data.
Rules regarding the patient contact (section 4 of appendix B). The patient contact is expected to be already defined in the input data.
Rules regarding billing (section 6 of appendix B).
Section 8 rules 2 (not possible as sex is usually only stored in the patient’s master data), 4 and 5