Akeso PMA — Billing & Case Management Training Guide

On the left is the navigation sidebar: Dashboard, Patient Search, Account Search, Medical Aid Accounts and Reports. Top-right shows your role and site. The Quick Actions panel gives you Patient Search and Account Search buttons.

The tiles across the top of the Admissions panel are the billing pipeline — each number is a queue of patients at that stage:

• Admitted — currently in the facility (interim billing in progress).
• Discharged — left the facility; final billing can be completed.
• Awaiting Review — bill captured, waiting for a reviewer.
• Reviewed — reviewed and waiting to be released.
• Submitted — released to the scheme and invoiced.

Below the tiles, the list tabs — Admissions, Discharged, Awaiting Review, Reviewed, Submitted, Finalized — filter the patient list to that stage. Use the Filter box to search by name, and click View on a row to open that patient's billing profile.

Find the patient you need to bill from the dashboard list (or via Patient Search), then click View. In this guide we follow patient Mrs Susan Albertst.

At the top of the profile is the admission reference number (e.g. EAAL-2608-0001) and the customer number. Below it are four summary cards:

• Patient — identity and demographics.
• Admission Encounter — the admission itself, including the billing type (e.g. Inpatient | Local | Fee for Service | DAP).
• Account for Admission — the account and medical scheme (e.g. DISCOVERY).
• Account Holder for Admission — who is responsible for the account.

Click the expand icon (⤢) on any card to open its detailed view — for example the full encounter details, admission information and the clinical diagnosis (ICD).

Below the bill is the Event Log, a running history of everything done on this admission. The Encounter, Billing and Notes tabs filter what you see; the search and date filters help you find a specific event.

Click Add Note, type your note and save it. The note is stored against the admission and appears under the Notes tab of the event log.

Open the Patient card and click the edit (tick) icon top-right to reach the Update Patient screen. You can correct contact and next-of-kin details here.

Open the Admission Encounter card and edit it to reach the Update Admission screen. A case manager typically uses this to add the scheme authorisation number and the number of approved days, and to correct the diagnosis code (ICD) or the attending doctor. Save with Update.

After saving, the authorisation number and approved days show on the encounter, and the event log records an Approved Days Update and an Auth No. Update.

Before capturing, read the summary on the Admission Encounter card. It tells you the patient is, for example, an Inpatient, Local, Fee for Service patient. The billing type changes how the charge screen behaves — see Section 12 for what each type means.

Click Charges to open the Viewing Bill screen. If nothing has been captured yet the bill is empty. Click Add Item to open the charge-capture screen.

The charge screen has a collapsible Admission & Account Information summary at the top, then the fields you fill in for each line: the date of the charge, whether you are capturing a Tariff or Medications & Supplies, the Liability, the Billable setting, Quantity and price.

Pick what kind of charge this is. For daily interim billing you will usually capture Medications & Supplies. Tariffs (such as the bed rate) are covered in steps 11–12 below.

Liability is who pays for the item:

• Scheme — the medical aid pays. This is the default for a medical-aid patient.
• Member — the patient pays. Choose this for member-liable items even on a medical-aid patient.

Select where the item came from — Pharmacy or Ward. For pharmacy dispensing you can also mark Dispense as full pack.

Search for the medication or supply by code or name — the list is drawn from the stock system. Selecting an item pulls in its description and price automatically.

This decides whether the item shows on the patient's final statement:

• Billable — appears on the final statement.
• Non-Billable — does not appear on the statement; it is kept as supporting detail behind the scenes.

For a Fee-for-Service patient, all items are normally Billable because every item should appear on the statement.

Type the Quantity, check the total, and click Add to add the line to the bill. Repeat for each item, then Save.

Saved lines appear in the Billing Items table on the bill, with their code, description, quantity, liability and total. Repeat this whole process each day of the admission for interim billing.

Once the patient is discharged (Section 6), capture the remaining ward stock as Medications & Supplies with the Ward location — for example ID bands, swabs and blood-glucose strips.

Add the accommodation charge as a Tariff. Choose Tariff, set the pricing level (Medical Aid or Private), and search for the bed tariff — e.g. code 55004, General With Overnight. Selecting it looks up the price.

When an admission is created, the default bed tariff is added with Auto-compute until checkout switched on. This automatically increments the bed rate every half day until discharge, so you normally don't capture it by hand.

To set the quantity yourself, capture it manually and uncheck Auto-compute. This applies to other tariffs too — you choose per tariff whether it auto-increments each day.

With charges, ward stock and the bed rate captured, the full Fee-for-Service bill and all its line items can be reviewed on one screen.

The bill header shows three day counts, which should agree with each other:

• Total Days — length of stay, calculated from admission date to discharge date.
• Billed Days — how many days you have actually billed on the bed tariff.
• Approved Days — the days authorised by the scheme (from the authorisation you captured).

When you are happy with the captured bill, click Submit for Review at the top. The patient moves into the Awaiting Review queue for a reviewer to check.

Open the admission details and select Discharge. Choose the discharge date and confirm. In the demo the patient was admitted on 1 August and discharged on 4 August.

After discharge, the encounter shows the full admission period (e.g. 1 – 4 August) and the event log records an Administrative Discharge. The bill's Total Days now reflects the full stay.

On the dashboard, open the Awaiting Review tab. The patient whose bill was just submitted now sits here. Click View to open the bill.

Open Charges and read every line. The bill's status is Pending Review. If everything is correct you can go straight to marking it reviewed (step 5).

To correct a line — say three ID bands were used but only two were captured — click the edit icon on that line and change the quantity.

Enter a reason in Why is this charge being edited? and click Update. The overall bill total recalculates to reflect the change.

The corrected quantity and the new totals now show in the Billing Items table.

When satisfied, click Mark Reviewed. The bill's status becomes Reviewed and it is ready for releasing.

On the dashboard the patient now sits in the Reviewed queue — captured and reviewed, awaiting release.

From the Reviewed queue, open the patient and their Charges. Review all the items as the person responsible for releasing.

Tick the items to include. Use Select all scheme to select every scheme-liable line at once, then click Preview Bill.

The Bill evaluation trace opens. This shows how the scheme's tariff structure will evaluate the bill — the line items, the evaluation steps, the DPD (Decaying Per Diem) checks, the ICD codes considered, and the raw payloads.

In this example the system determines the bill is Decaying Per Diem eligible. Although it was captured as Fee for Service, the scheme and tariff structure mean it will be converted to a decaying per-diem rate on finalisation.

To show the difference: open Update Admission and add an exclusion diagnosis code — for example F10.2 (mental & behavioural disorders due to alcohol) — then update.

The new ICD shows on the main screen and in the event log.

Preview the bill again. Because an exclusion ICD is now present, the evaluation reports the bill is not eligible for Decaying Per Diem — so it stays as Fee for Service.

When the evaluation is correct, click Proceed with submit. This releases the bill, sends it to the scheme (the "switch") for payment, and finalises the invoice.

After submitting, the charges are converted to an invoice with an invoice number and a submission timestamp (e.g. INV-2026-AAL-16). The admission status shows Submitted.

The invoice shows what was billed on the final invoice at the top, and the original captured charges are kept below as Metadata — Original charges. For a converted decaying-per-diem bill you would see a single per-diem line at the top, with all the individual charges preserved as metadata below.

Click Invoice to download the invoice PDF, and Charge Item Details to download the detailed line items.

The Transactions / Encounters selector on the right lets you move between a patient's admissions. A patient with multiple admissions over time shows multiple rows here.

Click View Account to open the account and account holder. Here you see the outstanding balance, the scheme and patient balances, and the account transactions. A freshly submitted invoice shows as Unpaid until a payment is allocated.

Open the patient from the dashboard. The encounter shows Inpatient | Local | Fixed Rate / per Diem, and the account is a Cash Personal Account — a private patient.

As before, if the patient is still admitted, discharge them first — select Discharge, choose the date and confirm.

When you add a charge for a cash patient, only Member liability is available — the scheme option is disabled, because there is no medical aid.

Because this is a Fixed Rate / per Diem billing type, items default to Non-Billable — they sit behind the single fixed-rate line. Set the fixed-rate / residential item itself to Billable so it appears on the statement.

Capture the stay: the fixed-rate / residential line as Billable, and the General With Overnight, private allocation, ward stock and pharmacy items as Non-Billable. The bill now shows two tables — a Billable table (what reaches the statement) and a Non-Billable table (the supporting detail).

Submit the bill for review; the reviewer checks it and marks it reviewed, exactly as in Section 7.

Preview the bill. For a fixed-rate patient the evaluation shows a single line item on the final statement, with everything else carried as supporting data. Proceed with submit to release and invoice.

The invoice is produced (e.g. INV-2026-AAL-17). Opening View Account shows the invoiced amount — here R48,458.88 — with a status of Unpaid until payment is allocated.

Go to Reports and open Day End Reports. The register lists previously generated reports; Generate a report starts a new one.

There are two kinds of day-end report:

• Interim — shows what has been captured since the last day-end, without setting a new day-end. Use it to see the position before finalising the day.
• Final — sets the new day-end (closes the reporting period).

Select Interim, set the end date, and generate. The system compiles all billing captured since the last day-end. A message confirms generation has started.

Click the view icon to see the report: the non-released and final-released accounts, opening and closing balances, billing, revenue conversions, payments and adjustments. Download it as Excel or PDF for further analysis.

The Daily Audit Trail details every specific line captured. Like the day-end report, an interim audit trail does not set a new day-end. Download it as Excel, CSV or PDF.

The Bed Location Report (a ward report) shows every bed in the facility, which patient is in it, the ward and room, unit type, admission date, days in bed and attending doctor — useful for an at-a-glance view of who is where.