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Invoicing for an MSME company refers to the process of issuing invoices for the goods or services sold, essential for the financial and tax management of these companies (Barreix and Zambrano, 2018). In this sense, the study explores the technical, operational and human factors that affect the billing in commercial MSMEs, in the service stations category, in the city of Pilar in the year 2023. The research methodology is descriptive with a non-experimental design. with a quantitative approach. The survey was used as a data collection technique in a probabilistic sample of MSME accountants in the sector chosen for the analysis. The results allow the identification of key factors that contribute to billing efficiency, as well as the development of recommendations and strategies to address these challenges., La facturación para una empresa MiPymes se refiere al proceso de emisión de facturas por los bienes o servicios vendidos, fundamental para la gestión financiera y tributaria de estas empresas (Barreix y Zambrano, 2018). En este sentido, el estudio explora los factores técnicos, operativos y humanos que inciden la facturación en MiPymes comerciales, del rubro estaciones de servicios, de la ciudad de Pilar en el año 2023. La metodología de investigación es de tipo descriptiva de diseño no experimental con enfoque cuantitativo. Se empleó como técnica de recolección de datos la encuesta en una muestra probabilística de contadores de MiPymes del rubro elegido para el análisis. Los resultados permiten identificar los factores clave que contribuyen a la eficiencia en la facturación, así como el desarrollo de recomendaciones y estrategias para abordar estos desafíos.

Billing models which can easily adapt with emerging market opportunities is essential in long term survival of any business. Accounting and billing is also one of the few processes which has wide impact on legal and regulatory compliance, revenue lines as well as customer retention models of all businesses. In the era of rapid technology shifts, with emergence of Fog and Edge deployment models, and marriage of IoT and cloud which promises smart-everything everywhere, it is paramount to understand what new challenges must be addressed within any billing framework. In this paper we list several emerging challenges which should be overcome in architecting any future-ready billing platform. We also present briefly an analysis of few technologies which could be used in prototyping such a solution. We present our proof of concept experiment along with initial results highlighting the feasibility of our proposed architecture towards a scalable billing framework for massively distributed IoT applications at the edge.

The objective of this research was based on analyzing the billing quality audit of health services, from external providers of the Rural Social Security, and how this affects payments during the period 2021-2022. A methodology with a non-experimental design was applied with a type of field research, at a explanatory level, and supported by a documentary investigation, the sample used and to whom the survey was applied were the area personnel of external providers of the coordination of the SSC of Manabí and the financial-accounting department corresponding to the department of external health providers (14 workers), and the external health providers of the Comprehensive Public Health Network and Private Complementary Network (62 providers). In the same way, it was complemented with comparative images on debt payments and liquidations to external providers in the year 2021 and 2022. In the results obtained, it is concluded that it is necessary to optimize and standardize the processes of Billing quality Audit to improve settlement times, debt payment to external providers, who need these resources to improve and timely serve IESS affiliates, especially those of the SSC. Likewise, it was observed that the training of the personnel in charge of this audit must be constant and the computer systems must be verified in order to avoid fraud in the collection of invoices by external health providers., El objetivo de esta investigación se basó en analizar la auditoria de calidad de facturación de servicios de salud de los prestadores externos del Seguro Social Campesino, y como esto incide en los pagos durante el período 2021-2022. Se aplicó una metodología con diseño no experimental con un tipo de investigación de campo, de nivel explicativo, y apoyada en una investigación documental, la muestra utilizada y a quien se les aplico encuesta fueron el personal de área de prestadores externos de la coordinación del SSC de Manabí y al departamento financiero-contable correspondiente al departamento de prestadores externos de salud (14 funcionarios), y los prestadores externos de salud de la Red Pública Integral de Salud y Red Complementaria Privada (62 prestadores). De igual manera, se complementó con imágenes comparativos sobre pagos de deuda y liquidaciones a prestadores externos en el año 2021 y 2022. En los resultados obtenidos se concluye que es necesario que se optimicen y estandaricen los procesos de Auditoria de la Calidad de Facturación para mejorar los tiempos de liquidación, de pago de deuda a los prestadores externos, quienes necesitan de estos recursos para mejorar y atender oportunamente a los afiliados al IESS en especial a los del SSC. Asimismo, se observó que la capacitación del personal encargado de esta Auditoría debe ser constante y los sistemas informáticos deben ser verificados con el propósito de evitar fraudes en los cobros de facturas por parte de los prestadores externos de salud.

Introduction: Recent reports suggest rising intensity of emergency department (ED) billing practices, sparking concerns that this may represent up-coding. However, it may reflect increasing severity and complexity of care in the ED population. We hypothesize that this in part may be reflected in more severe manifestations of illness as indicated by vital sign abnormalities.Methods: Using 18 years of data from the National Hospital Ambulatory Medical Care Survey, we conducted a retrospective secondary analysis of adults (>18 years). We assessed standard vital signs using weighted descriptive statistics (heart rate, oxygen saturation, temperature, and systolic blood pressure [SBP]), as well as hypotension and tachycardia. Finally, we evaluated for differing effects stratifying by subpopulations of interest, including age (<65 vs ≥65), payer type, arrival by ambulance, and high-risk diagnoses.Results: In total there were 418,849 observations representing 1,745,368,303 ED visits. We found only minimal variations in vital signs over the study period: heart rate (median 85, interquartile range [IQR] 74-97); oxygen saturation (median 98, IQR 97-99); temperature (median 98.1, IQR 97.6-98.6); and SBP (median 134, IQR 120-149). Similar results were found among the subpopulations tested. The proportion of visits with hypotension decreased (first/last year difference 0.5% [95% CI 0.2%-0.7%]) while there was no difference in the proportion of patients with tachycardia.Conclusions: Arrival vital signs in the ED have largely remained unchanged or improved over the most recent 18 years of nationally representative data, even for key subpopulations. Greater intensity in ED billing practices is not explained by changes in arrival vital signs.

By sharing common assets such as the power grid, prosumers are closely interrelated by their actions and interests. Game theory provides powerful tools for increased coordination among the prosumers to optimize the energy resources. However, depending on the prosumer profiles and the market rules, the individual bills may notably differ and prove to be unfair. In this work, we analyze the outcomes of three relevant game-theoretical billing methods, which are innovatively transposed to the day-ahead scheduling of energy exchange within a liberalized residential community dominated by distributed energy resources. The first two approaches rely on a (static) daily billing scheme, while the third considers a multi-temporal (continuous) billing. The Nash equilibria are computed using distributed algorithms, hence ensuring individual decision-making and avoiding third-party dependencies. The cost distributions are assessed using both a qualitative and a quantitative comparison based on various prosumer profiles in a modern smart grid. It is shown that, depending on the billing option, either the contribution towards the entity (i.e., the ability to improve the global solution) or the individual empowerment (i.e., the ability to bargain) can be preferentially incentivized.

The payroll and billing management of the Zonal Coordination 4 of the Ministry of Public Health that performs the Ecuadorian Institute of Social Security Portoviejo for medical care in 2019 directly impacts its economy, so the purpose of this research is to analyze the impact management and measure efficiency in payroll and billing through management indicators. The method applied is descriptive, explanatory, non-experimental, transactional, a documentary analysis of the entire payroll and billing process for the year 2019 was carried out with statistical data; the population of this study was: an official in charge of opening files, two medical auditors, two payroll officials and a collection official. The main results found in 2019 was 0% management and a loss of more than one million dollars was obtained, which was assumed in that fiscal year by the Ministry of Public Health. It is concluded that the payroll and billing management had a negative impact by not charging for the medical service, due to the lack of application of management indicators and for not following the management process of the current regulations, in addition to the professionals in charge of the management. and execution are doctors who do not have professional training in Business Administration or related and highly valued resources are being wasted. It is recommended to carry out research after the year under study, to correlate the impact after applying the recommended strategies., La gestión de planillaje y facturación de la Coordinación Zonal 4 del Ministerio de Salud Pública que realiza al Instituto Ecuatoriano de Seguridad Social Portoviejo por atención médica en el año 2019 impacta directamente en su economía, por lo que el propósito de esta investigación es analizar el impacto de la gestión y medir a través de indicadores de gestión la eficacia en el planillaje y facturación. El método aplicado es descriptivo explicativo de tipo no experimental, transeccional se realizó un análisis documental de todo el proceso de planillaje y facturación del año 2019 con datos estadísticos; la población de este estudio fue: un funcionario encargado de apertura de expedientes, dos médicos auditores, dos funcionarios planilladores y un funcionario de cobros. Los principales resultados encontrados en el año 2019 fue el 0% de gestión y se obtuvo una pérdida de más de un millón de dólares que fue asumida en ese año fiscal por el Ministerio de Salud Pública. Se concluye que la gestión de planillaje y facturación tuvo un impacto negativo al no cobrar por el servicio médico, por falta de aplicación de indicadores de gestión y por no seguir el proceso de gestión de la normativa vigente, además los profesionales a cargo de la dirección y ejecución son médicos que no tienen una formación profesional en Administración de Empresas o afines y se está desperdiciando recursos altamente valorados. Se recomienda realizar investigaciones posteriores al año en estudio, para correlacionar el impacto después de aplicar las estrategias recomendadas.

The study focused on determining the internal control strategies that allow improvement in billing management in commercial and artisanal microenterprises in the Portoviejo canton in order to carry out an analysis based on the results obtained. Due to this, methods were applied through non-experimental research with a mixed approach (qualitative/quantitative); For this, data collection tools such as the survey and the semi-structured interview were applied; the resulting sample for its implementation was made up of a total of 68 microentrepreneurs. The results showed the main internal control strategies adopted by commercial and craft microenterprises, among which are billing processes, Enterprise Resource Planning System (ERP) and process control., El estudio se concentró en determinar las estrategias de control interno que permiten la mejora en la gestión de facturación en microempresas comerciales y artesanales en el cantón Portoviejo con la finalidad de realizar un análisis con base a los resultados obtenidos. Debido a esto, se aplicaron métodos por medio de una investigación no experimental con un enfoque mixto (cualitativo/cuantitativo); para ello, se aplicaron herramientas de recolección de datos como la encuesta y la entrevista semiestructurada; la muestra resultante para su implementación estuvo conformada por un total de 68 microempresarios. Los resultados mostraron las principales estrategias de control interno adoptadas por las microempresas comerciales y artesanales entre las cuales se encuentran procesos de facturación, sistema de planificación de recursos empresariales (ERP) y control de procesos.

El presente trabajo hace un análisis de la estructuración del proceso de facturación de los servicios de salud que presta la Clínica de Ortopedia y Fracturas TRAUMEDICAL S.A.S, teniendo en cuenta que de su ejecución depende el sostenimiento financiero de la empresa, su liquidez y su rentabilidad; así como la toma de decisiones de puesta en marcha de proyectos para su crecimiento, prestación de nuevos servicios de salud, y el avance a otro nivel de complejidad dentro del Sistema de Salud en Colombia. Se parte de realizar un diagnóstico del proceso de facturación, su desarrollo y resultados. Posteriormente, se propone un rediseño del proceso de facturación mediante el uso de la aplicación de la herramienta de análisis Business Process Management (BPM), como la metodología que permite la optimización de los procesos empresariales, a través de la contextualización de los principales problemas que influyen en la obtención de un producto final, que en este caso en concreto, se denomina factura de venta. Este rediseño contempla cambios en la ejecución de procedimientos críticos que contribuyen a minimizar especialmente los riesgos financieros que se presentan cuando la factura tienen errores en su elaboración, generando objeciones representadas en glosas o devoluciones detectadas en los procesos de auditoría, adelantados por el responsable del pago, llámese Empresa Prestadora de Servicios de Salud (EPS) o empresa aseguradora, en los casos de accidentes de tránsito, accidentes laborales, entre otros., This manuscript analyses the structuring of the health services billing process provided by the Orthopedics and Fractures Clinic TRAUMEDICAL S.A.S, considering that the company’s financial support, is dependent on its liquidity, and profitability, as well as the decision-making for the implementation of projects for their growth, provision of new health services, and advancement to another level of complexity within the Health System in Colombia. Initially, there is a diagnosis of the billing process, with its development and results. Then, applying the Business Process Management (BPM) analysis tool, as the methodology that allows the optimization of business processes, and through the contextualization of the main problems that influence the obtaining of a final product, that in this case is called a sales invoice, a redesign of the current billing process is proposed. This redesign contemplates changes in the execution of critical procedures that contribute to minimizing, especially, the financial risks that arise when the invoice has errors in its elaboration, generating objections represented in glosses or returns detected in the audit processes carried out by the ones responsible for the payment, be it the Health Services Provider Company (EPS) or insurance company, in cases of traffic accidents, occupational accidents in among others.

El presente trabajo de grado tiene como objetivo proponer un plan de mejoramiento para el proceso de facturación del acueducto de la vereda Zanjones, ubicado en la zona rural del municipio de Pitalito, en el Departamento del Huila, el cual está operando desde el año 2012, bajo la gestión de La Junta Administradora del acueducto, una entidad legalmente constituida con forma jurídica sin ánimo de lucro, dedicada a la captación, tratamiento y distribución del agua, actualmente cuenta con 105 usuarios y una proyección de crecimiento poblacional del 10% anual en un futuro cercano a 5 años. Teniendo en cuenta el crecimiento poblacional de la vereda, el área de facturación requiere la implementación de un plan de mejoramiento que proporcione la capacidad operativa y esté preparado para el cubrimiento del servicio en cada vivienda que solicite un punto de agua. Para esto se requiere un cambio en la forma en que se lleva a cabo el registro manual de facturas, con los datos personales de cada usuario, la medición y cobro del consumo del servicio de agua mensual. Este proceso actualmente toma un tiempo de 3 días teniendo en cuenta el desplazamiento por el terreno escarpado, la distancia entre las viviendas y las actividades relacionadas en el proceso como: la recolecta de información de los medidores en cada predio, el diligenciamiento de las planillas, y el cálculo del valor a pagar junto al registro manual de los recibos de pago y entrega de las facturas en el predio. Para optimizar los tiempos y movimientos y evitar cometer errores de cálculo del actual proceso de facturación, se proponen unas actividades partir de los principios y estructura de la Guía de los fundamentos para la dirección de proyectos, PMBOK (7°ed.,2021), diseñando la planificación 10 ejecución, monitoreo y control del proceso que permitirá apoyar la gestión administrativa, logrando que la operación se reduzca en cuanto al tiempo dedicado a ejercer las actividades, proponiendo la necesidad de implementar h, The objective of this degree work is to propose an improvement plan for the billing process of the Zanjones aqueduct, located in the rural area of the municipality of Pinalite, in the Department of Huila, which is operating since 2012, under the management of the Administrative Board of the aqueduct, a legally constituted non-profit entity, dedicated to the collection, treatment and distribution of water, currently has 105 users and a projected population growth of 10% per year in the near future to 5 years. The population growth of the district, the billing area requires the implementation of an improvement plan that provides operational capacity and is prepared to cover the service in every home that requests a water point. This requires a change in the way in which the manual registration of invoices is carried out, with the personal data of each user, the measurement and collection of the monthly water service consumption. This process currently takes 3 days, considering the travel time due to the steep terrain, the distance between houses and the activities related to the process, such as: the collection of information from the micro-meters in each property, the filling out of the forms, and the calculation of the amount to be paid together with the manual registration of the payment receipts and delivery of the invoices to the property. In order to optimize the time and movements and avoid making errors in the calculation of the current invoicing process, some activities are proposed based on the principles and structure of the PMBOK (7th edition, 2021), designing the planning, execution and management of the project. ), designing the planning, execution, monitoring and control of the process that will support the administrative management, achieving that the operation is reduced in terms of time spent on activities, proposing the need to implement technological tools to analyze statistical and accounting data to strengthen the financial statements, decision m

ALOS Constructores, es una empresa de ingeniería civil conformada por diferentes áreas interdisciplinarias, pero conforme se suman nuevos retos, se ve inmersa en dificultades administrativas que no le permite tener un buen flujo de caja. Por tal motivo, la junta directiva, solicita a los directores de las diferentes áreas, que trabajen mancomunadamente para realizar un proyecto y generan un procedimiento interno el cual les permita determinar y mejorar el flujo de caja haciéndolo un proceso más ágil ante las entidades contratantes., ALOS Constructores is a civil engineering company that it finds itself immersed in administrative difficulties that do not allow it to have a good cash flow. For this reason, the board of directors’ requests that the directors of the areas work together to prepare a report to determine the weak link that does not allow the projects to quickly invoice the contracting entities. After the area directors pass the report to the board of directors, they agree that there are several factors that influence the late invoicing, since the monthly advance minutes leave the field, their management by the company, audit approval and even its collection; process that can take up to 3 months; much more than expected by the financial team.

[ES] Este proyecto consiste en el diseño de una aplicación web para permitir a las empresas, tanto grandes como pequeñas, realizar un seguimiento de los costes y progresos de sus proyectos. La aplicación dispone de un sistema, basado en formularios, para recopilar datos de la organización y sus integrantes, necesarios para previamente poder generar un reporte sobe la ruta de trabajo del personal. Asimismo, la aplicación dispone de funcionalidad para la organización y seguimiento de los diversos proyectos que la empresa tenga en activo, así como de cada uno de los empleados y la labor que ejercen dentro de uno o más de estos proyectos a los que se les ha asignado. Para ello se ha utilizado una herramienta de desarrollo conocida como OutSystems, un software de desarrollo low code, es decir, programación de alto nivel, que facilita al desarrollador las labores de diseño y de implementación lógica de la aplicación de esta manera conseguir aplicaciones de calidad en un tiempo reducido. El objetivo del proyecto es obtener un producto final que sea sencillo de utilizar por el consumidor, aunque no esté familiarizado con aplicaciones informáticas, práctico y cómodo de utilizar., [EN] This project consists of the design of a web application to enable companies, both large and small, to track the costs and progress of their projects. The application includes a system based on forms, to collect data from the organization and its members, necessary to previously generate a staff work route. In addition, the app has functionality for the organization and monitoring of the various projects that the company has active, as well as each ofthe employees and the role they carry out within one or more of these projects to which they have been assigned. For this purpose, a development tool known as OutSystems have been used. This is a low-code development software, in other words, based on high-level programming, which facilitates the developer's work in the design and logical implementation of the application in order to achieve quality applications in a reduced time. The aim of the project is to obtain a final product that is easy to use by the consumer, even if he/she is not familiar with computer applications, practical and comfortable to use.

[ES] Desarrollo de una aplicación basada en tecnologías web para el uso cotidiano en la administración de un taller mecánico basado en la simplificación de algunas herramientas comerciales actuales. El proyecto entero se programará mediante el lenguaje TypeScript para mantener un único lenguaje por parte del programador. El diseño del proyecto estará en constante retroalimentación por parte de un usuario de la aplicación. Las principales funcionalidades del proyecto serán la previsión de pagos y la gestión de facturas tanto emitidas como de proveedores del taller, aunque también mantendrá una base de datos de vehículos y sus clientes asociados. Respecto a la especificación técnica, se utilizará una base de datos no relacional y un framework destinado al front-end. Además, la aplicación se desarrollará bajo el stack MEAN (MongoDB, Express, Angular, NodeJS) debido al uso nativo de TypeScript por Angular y la capacidad de TypeScript de ser compilado a JavaScript., EN] Developement of a web based application for the daily use in a garage’s managing based on simplification of some current paid tools. The whole project will be programmed in TypeScript in order to maintain a unique language for the programmer. The project’s design will be in constant feedback by an end user. The principal features of the project will be payment forecasting and bills management but it will also contain a vehicle database with its associated customers. Regarding technical specification it will use a non-relational database and a frontend framework. The application will also be developed by the MEAN stack (MongoDB, Express, Angular, NodeJS) thanks to the native support of TypeScript by Angular and the capability from TypeScript to be compiled into JavaScript code., [CA] Desenvolupament d’una aplicació basada en tecnologíes web per a l’ús cotidià en la administració d’un taller mecànic basat en la simplificació d’algunes eines comercials actuals. El projecte es programarà completament mitjançant el llenguatje TypeScript per a mantenir un únic llenguatge per part del programador. El disseny del projecte estarà en constant retroalimentació per part d’un usuari de l’aplicació. Les principals funcionalitats del projecte seràn la previsió de pagaments i la gestió de factures emitides i de proveedors del taller, encara que també es mantindrà una base de dades de vehicles i els seus clients associats. Quant a l’especificació técnica, s0utilitzarà una base de dades no relacional i un framework destinat al frontend. A més, l’aplicació es desenvoluparà en l’stack MEAN (MongoDB, Express, Angular, NodeJS) degut a l’ús natiu de TypeScript per Angular i la capacitat de TypeScript de ser compilat a JavaScript.

Cloud computing constant evolution requires dynamic adjustments to service pricing and billing terms, considering provider infrastructures, customer requirements, and discount policies, among others. In this context, Customer Agreements (CA) are used to regulate the service provision including, among other information, the agreed service level in SLAs, pricing, and billing terms. Although many existing proposals and industrial tools support the definition of pricing and billing of cloud services, there is a lack in terms of customisation and automated monitoring tools integrated with the billing process. In this article, we provide a flexible billing proposal supporting CA that considers not only SLA terms but also customisable pricing and billing terms, possibly including compensations (i.e. discounts or overcharges) that apply when specified conditions are met. In addition, we developed an automated monitoring and analysis tool that we validate in a real-world industrial scenario. Moreover, we analyse and compare more than 50 existing industrial tools with our proposal, highlighting the advantages of its rule-based approach.

Throughout this presentation, in order to promote debate, the legal problems that have arisen around the Covid with direct repercussions on public health services are formulated in a summarized way, grouped into four thematic blocks, all of them with a common denominator: the COVID pandemic and associated legal uncertainty., A lo largo de presente exposición, con la finalidad de propiciar el debate, se formulan de forma resumida las problemáticas jurídicas surgidas en torno al Covid con repercusión directa en los servicios públicos de salud, agrupadas en cuatro bloques temáticos, todos ellos con un común denominador: la pandemia COVID y la incertidumbre jurídica asociada.

[ES] A causa de los avances tecnológicos de los últimos años, las administraciones públicas de todo el mundo requieren que los empresarios realicen sus gestiones online, con el objetivo de ahorrar tanto costes como tiempo, esto ha generado en grandes corporaciones la necesidad de realizar procesos que hagan las gestiones de la forma más rápida posible sin tener que cambiar sus sistemas a causa de los costes que aquello generaría. El proyecto se basa en el desarrollo de una aplicación que pueda satisfacer las necesidades anteriormente mencionadas a las grandes empresas, ofreciendo la posibilidad de gestionar grandes volúmenes de facturas, en el caso concreto del proyecto, las facturas electrónicas de crédito de Argentina. Para ello se ofrecen multitud de funciones mediante las cuales realizar todas las gestiones que requiera la administración pública de Argentina, entre las cuales destacan: consulta de facturas, información de pagos, autenticación con certificado electrónico y aceptación o cancelación de facturas. Para la correcta ejecución de las funciones se utilizan frameworks como Spring o Apache CXF con la finalidad de facilitar el desarrollo de las partes del proyecto que realicen las comunicaciones con los servicios web oficiales, que están basados en el estándar de seguridad mediante certificado TLS 1.2 y el estándar para los mensajes SOAP. El proyecto se basa principalmente en el desarrollo del back-end del módulo, cuya arquitectura se basa en dividir las diferentes máquinas en clientes o servidores, pudiendo distribuir la carga total y reducir el impacto que puede sufrir cada máquina. Con el fin de optimizar al máximo la aplicación y con la finalidad de evitar conexiones o consultas innecesarias se utiliza el IMDG que ofrece el framework HazelCast, el cuál ofrece la posibilidad de crear una memoria compartida en tiempo real entre varios servidores formando una red. Consiguiendo así tener en todo momento la información necesaria en cualquier máquina y evitan, [EN] Because of the technological advances in the last years, the public administrations around the world have started to require to the businessmen to perform their managements online, in order to save both costs and time, this has generated in the big corporations the need to develop processes that can perform their managements in the fastest way possible without having to change their internal sistems because of the costs that this would generate. The project is based on the development of an application that could satisfy the needs mentioned above to the big corporations, offering the possibility to manage huge amount of invoices and electronic documents, in the specific case of this project, the electronic credit invoices of Argentina. The application will offer multitude of functionalities through which the users can perform all the managements required by the administration of Argentina, among wich stand out: invoice consultation, payments information, authentications with electronic certificate and invoice acceptance or cancellation. For the correct execution of the functionalities, in the project are used frameworks like Spring or Apache CXF, aiming to ease the development oof the parts in the project that perform the connections with the official services, that are based on the security standard by certificate TLS 1.2 and the messages standart SOAP. The project is based mainly in the development of the back-end of the module, which architecture is based on dividing the different machines in clients or servers, being able to distribute the total work and reduce the impact that can suffer the machines. In order to optimize the application and aiming to avoid the innecessary connexions or queries, the projects also uses the IMDG that offers the HazelCast framework, offering the possibility to create a real time shared memory between several servers forming a network. Thanks to that, all the time every machine has the necessary information that needs and can a, [CA] A causa dels avenços tecnològics del últims anys, les administracions públiques de tot el món requereixen que els empresaris realitzen les seves gestions online, amb l’objectiu d’estalviar tant en costos com en temps, això ha generat en les grans corporacions la necessitat de realitzar procesos que facin les gestions de la forma més rápida posible sense tenir que canviar els seus sistemes a causa dels costos que això generaría. El projecte es basa en el desenvolupament d’una aplicació que pugui satisfer les necessitats esmentades anteriorment a les grans empreses, oferint la possibilitat de gestionar grans volums de factures, en el cas concret del projecte, les factures electróniques de crédit d’Argentina. Per a això s’ofereixen multitud de funciones mitjançant les quals realitzar totes les gestions que requereixi l’administració pública d’Argentina, entre les quals destaquen: consulta de factures, informació dels pagaments, autenticació amb certificat electrónic y aceptació o cancelació de factures. Per a la correcta execució de les funcions s’utilitzen frameworks com Spring o Apache CXF amb la finalitat de facilitar el desenvolupament de les parts del projecte que realitzen les comunicaciones amb els serveis oficials, que estan basats en l’estàndard de seguretat mitjançant certificat TLS 1.2 y l’estàndard per als missatges SOAP. El projecte es basa principalment en el desenvolupament del back-end del mòdul, la arquitectura del qual es basa en dividir les diferents màquines en clients o servidors, podent distribuir la carga total y reduir l’impacte que pot sufrir cada màquina. Amb la finalitat d’optimitzar al màxim l’aplicació y evita connexions o consultes innecessàries s’utilitza el IMDG que ofereix el framework HazelCast, mitjançant el qual es pot crear una memòria compartida en temps real entre diversos servidors formant una xarxa. Aconseguint gràcies a això tenir en tot moment l’informació necessària en qualsevol màquina y evitant crear noves peticions re

[EN] The project intends to assess the technical and economic performance of a Danish household characterized by several domestic (1-phase) appliances and a 5.4 kW (3-phase) photovoltaic (PV) plant. The PV installation consists in 18 solar panels (300W). Besides, there is a three-phase inverter (6kW) which produces in a balanced way over the three phases. The thesis quantified the amount of photovoltaic production and domestic consumption on each phase. To do that, an analysis of the amount that was self-consumed was developed, depending on the metering mode. One method consisted of measuring the 3 phases together, while the other measured them individually. With the second procedure energy imports and exports could occur simultaneously in two different phases, whereas with the 3-phase method imports and exports were mutually exclusive quantities. These two methods were applied monthly, considering the energy over: every second, every five minutes, every hour and every day. In the end, with the different results obtained, a quantification of the production and consumption depending on the scenario was conducted. Once the quantification over the months was done for the different periods, based on typical values of energy selling and purchasing, an economic study was conducted to determine in which months and scenarios the household obtained profits. In addition, a study in the voltage quality of the photovoltaic supply was done taking as reference the European Standard EN 50160. Furthermore, for the results obtained, it was assessed how much photovoltaic production could be used to charge an electric vehicle, instead of being injected to the grid, considering realistic driving patterns. The analysis was based on the fact that in maximum production hours (noon) the car cannot be charged as is being used (not at home) attending to the typical usage of a vehicle for a labour timetable. The data used in this study for both photovoltaic installation production and househo, [ES] El proyecto intenta evaluar el comportamiento técnico y económico de una casa danesa caracterizada por un cierto número de dispositivos domésticos (monofásicos) y una planta fotovoltaica de 5.4kW (trifásica). La instalación consiste en 18 paneles solares (300W). Además hay un inversor trifásico (6kW) que equilibra la producción de cada fase. El trabajo consiste en cuantificar la producción fotovoltaica y el consumo doméstico de cada fase. Se desarrollará un doble análisis de la cantidad que es autoconsumida dependiendo del modo de medida. Un método consistirá en medir las tres fases juntas mientras que el otro medirá las fases individuales. Con el segundo procedimiento consumo y producción pueden darse simultáneamente en dos fases diferentes mientras que con el método de las tres fases el resultado será el balance entre las tres. Estos dos métodos serán aplicados cada mes, considerando la energía: cada 5 minutos, cada hora y cada día (24 horas). Al final, con los diferentes resultados obtenidos, se realizará una cuantificación de la producción/consumo dependiendo del escenario. Los datos utilizados para este estudio tanto para la producción fotovoltaica como para el consumo se han obtenido con una resolución de 5 minutos empezando en Septiembre de 2019 y hasta el final del proyecto. La herramienta seleccionada para trabajar con todos estos datos será MATLAB. Finalmente, para perfiles históricos dados, se evaluará cuánta producción puede ser destinada para cargar un vehículo eléctrico, en vez de ser inyectada a la red, considerando perfiles realistas de conducción. El análisis investigará en el hecho de que en las horas de máxima producción (mediodía) el vehículo no se puede cargar ya que está siendo usado (no está en casa) atendiendo al típico uso de un vehículo para un horario laboral.

Background: Health policy knowledge is critical in today's healthcare environment; efforts to understand dermatology residents' health policy literacy and education on policy reforms pertaining to dermatology practice are limited. Methods: A 25-question electronic survey was administered to current U.S. dermatology residents in ACGME-accredited residencies to assess health policy education/experiences, career goals, and familiarity with current issues in health policy and dermatology. Results: There were 46 respondents of equal gender and training stage distribution. Of these, 67% and 30% reported health policy instruction in medical school and residency, respectively; 17% reported no prior instruction. Additionally, 50% and 31% intended to pursue academic medicine and private practice, respectively. Although most believed dermatology careers to be compatible with non-clinical endeavors (organized medicine leadership, policy reform, political/legislative advocacy, elected office), few intended to pursue such endeavors. Fewer than 50% of respondents reported familiarity with health legislation, reimbursement models, and the American Academy of Dermatology Association's 2018 advocacy priorities. Conclusions: Although some dermatology residents have prior health policy education and/or receive training in residency, there remain gaps in their knowledge and preparation to face current healthcare issues. Medical schools and residencies should address such gaps and provide health policy opportunities to ensure trainees' future success.

This study presents the analysis of energy revenue and electrical power losses in distribution network, aimed to determine the energy losses on power distribution system. The 11kV power transmission line at Ujokuen community feeding to Benson Idahosa University was investigated. The following data were obtained as follow: energy delivered, energy billing, total cash amount, billed collected and correspond percentage. From the research work various technical power losses associated with power distribution network were determined and their effect on energy delivered and energy billing and corresponding difference under the area of investigation. It was observed that energy delivered is not constant or linear for the year 2013. The comparison of energy delivered and energy billed for various years were determined. It was observed that there is decreased in energy delivered and energy billed from 2013 to 2015 and the system witnessed a slightly increase of energy delivered and energy billed from 2016 to 2018. The energy level differentials are due to copper losses, energy theft and core loss.

Recently, California (CA) pharmacists' scope of practice has expanded to include independently prescribing self-administered hormonal contraceptives, nicotine replacement therapy medications, travel health medications, routine vaccinations, naloxone hydrochloride, and HIV preexposure and postexposure prophylaxis. However, previous reports indicate that practicing within this expanded scope has remained limited. Therefore, a 26-item, web-based survey was emailed to CA community pharmacists to assess pharmacists' knowledge, intent, and barriers to prescribing and billing for these patient care services. A total of 216 chain, supermarket-based, independent, mass merchant, and health-system outpatient pharmacists were included. The primary services provided and medications prescribed are for vaccinations and naloxone. Most pharmacists agree that engagement in and implementation of new strategies to enhance patients' access to care is important. Common barriers include patient unawareness of pharmacist-provided services, lack of payment for services, and difficulty incorporating services within pharmacy workflow. Pharmacists are confident in their ability to provide patient care services but are less knowledgeable and confident about billing for them. Enhancing promotion of pharmacist-provided services to patients, developing strategies to efficiently incorporate them into the workflow, and payment models can help overcome barriers to providing these services.

El presente documento analiza los procesos de facturación y cuentas médicas de la Empresa Social del Estado (ESE) Hospital Local de Arjona, Colombia, mediante la aplicación de instrumentos de captura de información al personal del área de contabilidad. Se utiliza el diagnóstico organizacional como herramienta de evaluación de la gestión de estos dos procesos, considerados críticos en las organizaciones dedicadas a la prestación de servicios de salud. La problemática estriba en que con mucha frecuencia se presentan objeciones o “glosas”, atribuibles a inconsistencias e irregularidades en los procesos de facturación y presentación de las cuentas médicas. Lo anterior conduce a que no se haga el pago de la cuenta y con ello se desencadena un problema que amenaza la sostenibilidad y la calidad de la prestación de los servicios de salud en las organizaciones dedicadas a este sector. Se encontró que la presencia de inconsistencias y deficiencias en el proceso de facturación y cuentas médicas son atribuibles a la ausencia de control en la facturación y debilidades en los procesos de radicación, auditoría y respuesta oportuna de glosas. Se concluye que el problema de sostenibilidad financiera que exhibe la institución es el mismo que ha ahondado la crisis que padece el sector a nivel nacional asociado con el desconocimiento de la normativa para la presentación y estructuración de las cuentas médicas y unificación de criterios en estos procesos., This document analyzes the billing and medical bills processes of the state-owned hospital of Arjona, Colombia. Organizational assessment is used as a tool for evaluating these two processes, both considered as critical points in organizations dedicated to the provision of health services, in particular state-owned hospitals. The problem is that objections are frequently presented, as outcomes of inconsistencies and irregularities in billing practices and medical bill presentation. This leads to the non-payment of bills, and consequently emerges a serious problem that threatens the sustainability and quality of the provision of health services. It was found that the presence of inconsistencies and deficiencies are consequences of the lack of control in the billing process and to the weaknesses in the processes of filing, auditing and timely response. It is concluded that the problem of financial sustainability exhibited by the institution is associated with the lack of knowledge of sectoral regulations for the presentation and structuring of medical bills and unification of criteria in these processes. These are the same aspects that has deepened the crisis in the Colombian health sector at the national level.

Medicare guidelines specifically with regard to PATH rules ( Physicians At Teaching Hospitals). Specific Documentation is a requirement for reimbursement under Medicare, Medicaid, and any 3rd party payers who refer to Medicare guidelines. Resident participation & documentation is incorporated by the Teaching Physicians (TP).

Cloud service providers offer to their customers a variety of pricing policies, which range from the simple, yet widely used pay-as-you-go schema to complex discounted models. When executing the billing process, stakeholders have to consider usage metrics and service level objectives in order to obtain the correct billing and conform to the service level agreement in place. The more metrics, discount and compensations rules are added to the pricing schema, the more complex the billing generation results. In this paper we present a monitoring-based solution that enables the dynamically definition of both service level objectives and discount rules, so that providers can customise the billing generation process in terms of the service level agreement they offer. We validate our proposal in a real-world scenario, introducing a micro-service based software solution deployed in a Kubernetes cluster.

The purpose of this academic article is to make a revenue control model for the company INGENIERÍA Y LOGÍSTICA MARÍTIMA S.A. INLOGMAR located in the city of Guayaquil. n the company under investigation INGENIERIA Y LOGISTICA MARITIMA S.A. INLOGMAR, the income is recognized when the risks and advantages of the service provided have been transferred, through the issuance of reports of management performed; that is, the company has no control over the service provided, the billing process is daily and for considerable amounts, carried out manually for its issuance, used block of invoices authorized by the Internal Revenue Service. In the absence of a manual of procedures and control when evaluating the service delivered, consider that there is a recurrence in errors and omissions regarding the values billed to customers, which is transferred to the accounts of the financial statements, presented results with unreasonable values, which affects profitability and limits the decision making of its top managers. For the aforementioned, as a solution to the problem raised, a manual of policies and procedures for the billing process and for the application of IFRS 15 in the accounting of the company was designed. This manual aimed to reduce the rate of errors or omissions in such a way that it can protect the financial health of the company, El presente artículo académico tiene como propósito realizar un modelo de control de ingresos para le empresa INGENIERÍA Y LOGÍSTICA MARÍTIMA S.A. INLOGMAR ubicada en la ciudad de Guayaquil. En la empresa objeto de investigación INGENIERIA Y LOGISTICA MARITIMA S.A. INLOGMAR, los ingresos son reconocidos cuando se han trasladado los riesgos y ventajas del servicio prestado, a través de la emisión de informes de maniobras realizadas; es decir, la empresa no guarda control alguno sobre el servicio prestado, el proceso de facturación es diario y por montos considerables, realizado de forma manual para su emisión, utilizan block de facturas autorizadas por el Servicio de Rentas Internas. Ante la falta de manual de procedimientos y control al momento de evaluar el servicio entregado, se considera que existe recurrencia en errores y omisiones en cuanto a los valores facturados a los clientes, lo que se traslada a las cuentas de los estados financieros, presentado resultados con valores no razonables, lo que afecta la rentabilidad y limita la toma de decisiones de sus altos directivos. Por lo antes mencionado, como solución a la problemática planteada, se diseñó un manual de políticas y procedimientos para el proceso de facturación y para la aplicación de La NIIF 15 en la contabilidad de la empresa. Este manual tuvo como objetivo disminuir el índice de errores u omisiones de tal manera que se pueda proteger la salud financiera de la empresa.

According to (SARMIENTO, 2015) Enterprise Resource Planning (ERP) systems are basically management information systems that integrate and manage many of the businesses related to production or manufacturing, distribution, storage, and different activities required for the delivery of goods or services. The purchase of an Enterprise Planning System (ERP) by organizations has been promoted as the solution to survive in this economy based on electronic commerce. ERP systems have been the solution to integrate the different departments of the company with the promise of improving the efficiency and productivity of them as a whole. ERP systems are integral management systems for the company. They are characterized by being composed of different parts integrated in a single application. These parts are of different use, for example: production, sales, purchasing, logistics, accounting (of various types), project management, GIS (geographic information system), inventories and warehouse control, orders, payrolls, etc. We can only define an ERP as the integration of all these parts. The opposite would be like considering a simple billing program as an ERP for the simple fact that a company integrates only that part. This is the fundamental difference between an ERP and another management application. The ERP integrates everything necessary for the operation of the business processes of the company. We cannot talk about ERP at the moment that only one or a small part of the business processes is integrated. The very definition of ERP indicates the need for "Availability of all information for everyone at all times"., Según (SARMIENTO, 2015) Los sistemas de planificación de recursos empresariales (ERP por sus siglas en inglés) son básicamente sistemas de información gerenciales que integran y manejan muchos de los negocios relacionados con la producción o fabricación, distribución, almacenamiento, y distintas actividades necesarias para la entrega de bienes o servicios. La compra de un Sistema de planificación empresarial (ERP) por las organizaciones ha sido promocionada como la solución para sobrevivir en esta economía basada en el comercio electrónico. Los sistemas ERP han sido la solución para integrar los distintos departamentos de la empresa con la promesa de mejorar la eficiencia y la productividad de los mismos como un todo. Los sistemas ERP son sistemas integrales de gestión para la empresa. Se caracterizan por estar compuestos por diferentes partes integradas en una única aplicación. Estas partes son de diferente uso, por ejemplo: producción, ventas, compras, logística, contabilidad (de varios tipos), gestión de proyectos, GIS (sistema de información geográfica), inventarios y control de almacenes, pedidos, nóminas, etc. Sólo podemos definir un ERP como la integración de todas estas partes. Lo contrario sería como considerar un simple programa de facturación como un ERP por el simple hecho de que una empresa integre únicamente esa parte. Ésta es la diferencia fundamental entre un ERP y otra aplicación de gestión. El ERP integra todo lo necesario para el funcionamiento de los procesos de negocio de la empresa. No podemos hablar de ERP en el momento que tan sólo se integra uno o una pequeña parte de los procesos de negocio. La propia definición de ERP indica la necesidad de “Disponibilidad de toda la información para todo el mundo todo el tiempo”.

Rating, Charging, Billing (RCB) is the fundamental activity that enables a business to generate revenue stream depending on the resource consumption by their consumers. Traditionally, telecom operators have used custom designed, vertically integrated solution for RCB which often results in a complex system that is difficult to adapt to new service offerings. With telecom operator’s desire to capitalize on cloud computing by using their vast amount of infrastructure, the need for a RCB solution that serves the needs of cloudified telcos is needed. In this paper we present an approach to implement a generic rating, charging, and billing engine that serves the business and technical needs of both cloudified telecom services and those of cloud service providers. Key to this is a generic accounting process to drive the design of the generic RCB architecture. We show how RCB as a service can be offered catering to not only traditional telco services, the new cloud services they wish and will offer, but packaged cloudified services to the consumers and application developers as well. Finally, we detail how our architecture can be distributed and key services replicated to ensure high-availability. The end result of this paper is a solution that can enable telecom service providers to leverage the rapidly growing and accelerating cloud service market.

Objective: to analyze technical disallowances in a surgical center of a private general hospital. Methods: retrospective documentary study with a sample of 383 medical records with disallowed hospital accounts in which the percentages of disallowances were evaluated through Generalized Estimating Equation models. Results: 1,373 items were disallowed, 82.1% corresponded to nursing professionals and 17.9% to anesthesiologist physicians. The “materials” and “medicines” accounting groups presented the greater number of items disallowed: 67.7% and 13.2%, respectively. The highest amount of disallowed items was generated by nursing professionals, however the highest percentage corresponded to anesthetist physicians. Conclusion: the analysis of hospital accounts allowed the calculation of the number of technical disallowances, with a total of 1,373 items. Nursing professionals were responsible for most of the disallowed items, and the “materials” accounting group predominated, contributing to the search for alternatives that increase billing in the surgical center studied., Objetivo: analisar glosas técnicas geradas em centro cirúrgico de hospital geral privado. Métodos: pesquisa documental retrospectiva, cuja amostra constituiu-se de 383 prontuários com contas hospitalares glosadas, nas quais foram avaliadas as porcentagens de glosa, por intermédio de modelos de Equações de Estimação Generalizadas. Resultados: foram glosados 1.373 itens, 82,1% correspondentes aos profissionais de enfermagem e 17,9% aos médicos anestesistas. Os grupos contábeis “materiais” e “medicamentos” apresentaram os itens mais glosados, 67,7% e 13,2%, respectivamente. A maior quantidade de itens glosados foi gerada por profissionais de enfermagem, contudo a porcentagem mais elevada correspondeu aos médicos anestesistas. Conclusão: a análise das contas hospitalares subsidiou o cálculo do número de glosas técnicas, com total de 1.373 itens, sendo os profissionais de enfermagem responsáveis pela maioria dos itens glosados e com predominância do grupo contábil “materiais”, contribuindo para busca de alternativas que incrementem o faturamento no centro cirúrgico pesquisado.

Clinical genetic testing has incredible promise due to its clinical utility and proven cost effectiveness when ordered and performed appropriately. However, the relationships amongst healthcare providers, insurance companies, and genetic testing laboratories are complicated and evolving quickly. In the field of clinical genetics, the responsibility of coordinating billing for genetic testing often falls on the genetic counselor—a person who usually does not have formal training in this area. Having a person who is not formally trained in insurance and billing coordinating this aspect of the process may be reducing productivity or quality of care. With this study, we surveyed clinical genetic counselors to evaluate trends in their interactions with insurance companies and their confidence in how they manage insurance and billing. We also included in the survey questions about training that the participants received. Free-response questions about health insurance terms were included to determine the level of understanding of health insurance. The survey responses were analyzed based on demographic factors and data about clinical practice, including subspecialty and other professional and institutional characteristics. The results of the study demonstrated that training provided in graduate school and by employers was significantly correlated with preparedness and confidence level in the insurance and billing processes. Additionally, respondents’ decision making with respect to insurance and billing in clinical scenarios was correlated with certain institutional and professional characteristics. This study highlights the importance of the relationship between genetic counselors and health insurance and underscores the need to educate genetic counselors about insurance and billing.

The study has a purpose designed to investigate within which framework automation of accounting and billing systems processes is possible through machine learning, as a result of providing guidance for when and where an implementation is relevant in the systems. For the study, a data collection has been carried out on a company that offers accounting and billing systems and works within the machine learning area. Interviews have been made at the company conducted to capture relevant empirical results. Aspects categorized from collected data are presented in possibilities, implementation, ethics and alternative approaches. Together with literature studies, the empirical categories have been analyzed and four frameworks identified. The frameworks identified are: competitiveness, technical factors, knowledge and skills as well as impact on occupational groups.Each frame contains information and examples of factors that should be considered. Companies can investigate important aspects of when and where an implementation of machine learning is possible and relevant in accounting and billing systems., Studien har ett utformat syfte som handlar om att undersöka inom vilka ramar automatisering av processer inom bokförings- och faktureringssystem är möjligt med hjälp av maskininlärning, med anledning av att skapa en vägledning för när och var en implementation är relevant i systemen. För studien har en datainsamling utförts på ett företag som erbjuder bokförings- och faktureringssystem samt arbetar med maskininlärning för området. Hos verksamheten har intervjuer utförts för att fånga in relevant empiri som resultat. Aspekter som kategoriserats från insamlad data presenteras i möjligheter, implementering, etik och alternativa tillvägagångssätt. Tillsammans med litteraturstudier har kategorierna ur empirin analyserats och fyra ramar identifierats. Ramarna som identifierats är följande: konkurrenskraft, tekniska faktorer, kunskap och kompetens samt påverkan på yrkesgrupper.Varje ram innehåller information och exempel på faktorer som bör beaktas. Företag kan med hjälp av ramarna utreda viktiga aspekter gällande när och var en implementation av maskininlärning är möjlig och relevant i bokförings- och faktureringssystem.

Des de sempre ha sigut important portar un control dels processos en les empreses. I a partir de l'auge dels Sistemes d'Informació es va fer més evident que era un factor clau per aconseguir avantatges competitius. Avui en dia totes (o quasi totes) les grans empreses ja tenen algun tipus de software, It has always been important to keep track of processes in companies. Star- ting with the Information Systems boom it has become even more obvious that it's a key factor in having competitive advantages. Today, most large com- panies already have some type of software to control their internal proce

BackgroundHealth care delivery in the United States has evolved in many ways over the past century, including the development of the specialty of Emergency Medicine (EM). With the creation of this specialty, many positive changes have occurred within hospital emergency departments (EDs) to improve access and quality of care of the nation's de facto "safety net." The specialty of EM has been further defined and held to high standards with regard to board certification, sub-specialization, maintenance of skills, and research. Despite these advances, problems remain.ObjectiveThis review discusses the history and evolution of for-profit corporate influence on EM, emergency physicians, finance, and demise of democratic group practice. The review also explores federal and state health care financing issues pertinent to EM and discusses potential solutions.DiscussionThe monopolistic growth of large corporate contract management groups and hospital ownership of vertically integrated physician groups has resulted in the elimination of many local democratic emergency physician groups. Potential downsides of this trend include unfair or unlawful termination of emergency physicians, restrictive covenants, quotas for productivity, admissions, testing, patient satisfaction, and the rising cost of health care. Other problems impact the financial outlook for EM and include falling federal, state, and private insurance reimbursement for emergency care, balance-billing, up-coding, unnecessary testing, and admissions.ConclusionsEmergency physicians should be aware of the many changes happening to the specialty and practice of EM resulting from corporate control, influence, and changing federal and state health care financing issues.

O estudo de caso aqui desenvolvido compara dois momentos dentro de uma mesma instituição de Saúde Hospitalar, observando a evolução e os resultados na redução de glosas hospitalares após a implantação do conceito de qualidade total ao grupo executor da atividade de faturamento. Trata-se de um estudo quali-quantitativo, exploratório, documental, desenvolvido através de um estudo de caso em hospital localizado no estado de São Paulo. Para atender ao objetivo destacado neste trabalho, como base para a coleta e análise de dados buscou-se a montagem de um banco de informações gerenciado capaz de fornecer conhecimento sobre a distribuição das glosas hospitalares quanto a local de ocorrência, incidência, e tipologia. As variáveis foram descritas por médias ± desvios padrão e frequências. As médias foram comparadas utilizando-se o teste t-Student, com nível de significância de cinco por cento. Ao mesmo tempo, buscou-se avaliar o papel e a importância da aplicação prática do conceito de qualidade total na gestão hospitalar. Como resultado, conclui-se que técnicas de qualidade total culminaram em melhores resultados no aspecto da redução de glosas hospitalares., The case study developed here compares two times within the same Hospital Health institution, by watching the progress and results in the reduction of hospital glosses after the implementation of the concept of total quality to the executor group's billing activity. It is a qualitative and quantitative, exploratory and documental study, developed through a case study in a hospital located in the State of São Paulo. To meet the goal highlighted in this work, as the basis for data collection and analysis, the assembly of a managed information bank was sought after so as to provide knowledge about the distribution of hospital glosses according to occurrence place, incidence and type. The variables were described as means ± standard deviations and frequencies. Means were compared using the Student t test, with a five percent significance level. At the same time, we sought to evaluate the role and the importance of practical application of the concept of total quality management in the hospital. As a result it is concluded that overall quality techniques resulted in better results as regards the reduction of hospital glosses.

Communication agencies are companies that are in contact with public relations, advertising, mediaand journalism ndustries. These companies should be leadersin the use of new communication tools. In this article we will study if the communication agencies with the largest turnover in Spain make a good use of new communication tools, especially social networks. We have discovered these companies should have more activity in social networks and in the online world in general. They do not create specific contents for their different networks and get little feedback of from their followers. However, all of them have a profile on Facebook,Twitter and blogs., Las agencias de comunicación son empresas que se mueven en el terreno de las relaciones públicas, la publicidad, la comunicación audiovisual y el periodismo. Estas empresas deberían ser líderes en el uso de las nuevas herramientas de comunicación con las que contamos, como las redes sociales, ya que son empresas que se dedican a elaborar planes de comunicación, estrategias de comunicación para sus clientes y si ellas mismas no incluyen en sus estrategias el uso de herramientas sociales de comunicación de acuerdo a los tiempos en que vivimos, no están transmitiendo una buena imagen a sus clientes, ya que deben predicar con el ejemplo y contar con estrategias de comunicación completas en las que se tengan en cuenta las redes sociales y demás herramientas online. En este artículo estudiaremos a las agencias de comunicación que más facturan en España para comprobar si, efectivamente, hacen un buen uso de las nuevas herramientas de comunicación, especialmente de las redes sociales y en el mundo online en general. No crean contenidos específicos para sus diferentes redes, consiguen poco feedback por parte de sus seguidores, si bien es cierto que todas tienen perfiles en Facebook, Twitter, además de blogs.

Introduction: The business activity of tourist intermediation, based on bringing consumers and users of travel services to the operated in this economy sector companies, is an essential tourist activity, which the Law reserves to particular companies: travel agencies, tour operators and booking companies, mainly.Purpose: Like any other economic activity, the transactions carried out by travel agencies is strongly affected by its indirect taxation (VAT), as it impacts the final price offered, as well as the management of their bills. The VAT taxation of such companies has recently been modified in accordance with a legislative reform of November 2014, as a result of the Superior Court of Justice of the European Union sentence’s in 2013, which condemns Spain for a violation of the EU rules. This paper aims to expose the effects of the reform of its indirect taxation at the intermediation activities.Methodology: For this purpose, it will be used an own methodology of legal science. In particular, it will be analyzes the applicable legal texts, jurisprudence and literature.Conclusions: Travel agents will have to adapt to the new indirect taxation imposed by the European Union. They will have to carry out the calculation of their taxable income (expense recognition and benefits) differently than the hitherto used, with reflected incidence in the way of making their bills., Introducción: La actividad empresarial de intermediación turística, consistente en acercar a los consumidores y usuarios de servicios turísticos con los empresarios de este sector, supone una actividad turística fundamental que la Ley reserva a unas determinadas empresas: las agencias de viaje, los operadores turísticos y las centrales de reserva, fundamentalmente.Objetivo: Como cualquier otra actividad económica, la desarrollada por las agencias de viaje se encuentra muy afectada por su tributación indirecta (IVA), puesto que incide en el precio final ofertado, así como en la gestión de sus facturas. La tributación por IVA de tales empresas se ha visto recientemente modificada en virtud de una reforma legislativa de noviembre de 2014, como consecuencia de una Sentencia del Tribunal Superior de Justicia de la Unión europea de 2013 que condena a España por la vulneración de la normativa comunitaria. El presente trabajo pretende exponer la incidencia del impuesto del valor añadido en la actividad de intermediación turística.Metodología: A tal fin, se utilizará una metodología propia de las ciencias jurídicas: el análisis de los textos legales, la jurisprudencia y la literatura.Conclusiones: Las agencias de viaje han de adaptarse a la nueva tributación impuesta por la Unión Europea, esto es, deberán realizar el cálculo de su base imponible (imputación de gastos y beneficios) de forma distinta a la hasta ahora acostumbrada, con incidencia refleja en la forma de emitir facturas.

Introduction: Documentation and billing for laceration repair involves a description of wound length. We designed this study to test the hypothesis that emergency department (ED) personnel can accurately estimate wound lengths without the aid of a measuring device.Methods: This was a single-center prospective observational study performed in an academic ED. Seven wounds of varying lengths were simulated by creating lacerations on purchased pigs’ ears and feet. We asked healthcare providers, defined as nurses and physicians working in the ED, to estimate the length of each wound by visual inspection. Length estimates were given in centimeters (cm) and inches. Estimated lengths were considered correct if the estimate was within 0.5 cm or 0.2 inches of the actual length. We calculated the differences between estimated and actual laceration lengths for each laceration and compared the accuracy of physicians to nurses using an unpaired t-test.Results: Thirty-two physicians (nine faculty and 23 residents) and 16 nurses participated. All subjects tended to overestimate in cm and inches. Physicians were able to estimate laceration length within 0.5 cm 36% of the time and within 0.2 inches 29% of the time. Physicians were more accurate at estimating wound lengths than nurses in both cm and inches. Both physicians and nurses were more accurate at estimating shorter lengths (<5.0 cm) than longer (>5.0 cm).Conclusion: ED personnel are often unable to accurately estimate wound length in either cm or inches and tend to overestimate laceration lengths when based solely on visual inspection. Abstract [West J Emerg Med. 2014;15(7):–0.]

[ES] Actualmente, todas las prestaciones sanitarias y farmacéuticas facilitadas en España a personal desplazado de la Unión Europea y de países con los que España tenga convenios bilaterales son facturables. Esta facturación se realiza a través del Instituto Nacional de la Seguridad Social (INSS) mediante medios telemáticos. El INSS tramita de forma conjunta la compensación de la facturación de los servicios prestados por los departamentos de salud autonómicos con la facturación que realizan las instituciones extranjeras por la asistencia sanitaria prestada a los españoles en el extranjero. La recaudación derivada de esta facturación se repartirá entre las distintas comunidades autónomas según los criterios establecidos reglamentariamente. No obstante, se debe distinguir según se trate de asegurados en otros Estado miembros que se trasladen para fijar su residencia en otro Estado miembro distinto de aquel en el que están asegurados, cuya facturación irá mediante una cuota global (CG), de aquellos asegurados extranjeros que se encuentran en estancia temporal, cuya facturación irá por el llamado Fondo de Cohesión Sanitaria (FCS) En este trabajo se presta especial atención a la facturación sanitaria a extranjeros en la Comunitat Valenciana, territorio eminentemente turístico. Una vez analizados los procesos y tratados los datos de facturación en un periodo concreto, 2002-2011, se realiza una propuesta de mejora basada en la alineación de la gestión de los recursos humanos de la organización con los objetivos de la dirección basada en la mejora de la formación del personal que gestiona la facturación., [EN] Currently, all sanitary and ph armaceutical benefits provided in Spain staff displaced from the EU and countries with which Spain has bilateral agreements are chargeable. This billing is done through the National Institute of Social Security (INSS) through electronic means. INSS transacts jointly compensation for the billing of services rendered by health departments regional billing that foreign institutions for health assistance to the Spanish abroad. Fundraising for this turnover shall be apportioned between the different autonomous communities according to the criteria established by regulation. However, must be differentiated according to whether policyholders in other States members which move to take up residence in another Member State other than that in which they are insured, whose billing will go through a global quota (CG), of those foreign insured persons who are in temporary stay, whose billing will go for the so-called Fund for health Cohesion (FCS). This work gives special attention to foreigners in the region of Valencia, eminently tourist territory health billing. Once analyzed the processes and treaties data turnover in a given period, 2002-2011, is a proposal for improvement based on the alignment of the management of human resources of the organization with the object ives of the address is based on the improvement of the training of the staff that handles the billing.

BackgroundThe purpose of this study was to propose a new crosswalk using the resource-based relative value system (RBRVS) that preserves the time unit component of the anesthesia service and disaggregates anesthesia billing into component parts (preoperative evaluation, intraoperative management, and postoperative evaluation). The study was designed as an observational chart and billing data review of current and proposed payments, in the setting of a preoperative holing area, intraoperative suite, and post anesthesia care unit. In total, 1,195 charts of American Society of Anesthesiology (ASA) physical status 1 through 5 patients were reviewed. No direct patient interventions were undertaken.ResultsSpearman correlations between the proposed RBRVS billing matrix payments and the current ASA relative value guide methodology payments were strong (r=0.94-0.96, P<0.001 for training, test, and overall). The proposed RBRVS-based billing matrix yielded payments that were 3.0%±1.34% less than would have been expected from commercial insurers, using standard rates for commercial ASA relative value units and RBRVS relative value units. Compared with current Medicare reimbursement under the ASA relative value guide, reimbursement would almost double when converting to an RBRVS billing model. The greatest increases in Medicare reimbursement between the current system and proposed billing model occurred as anesthetic management complexity increased.ConclusionThe new crosswalk correlates with existing evaluation and management and intensive care medicine codes in an essentially revenue neutral manner when applied to the market-based rates of commercial insurers. The new system more highly values delivery of care to more complex patients undergoing more complex surgery and better represents the true value of anesthetic case management.

Computing infrastructures offer remote access to computing power that can be employed, e.g., to solve complex mathematical problems or to host computational services that need to be online and accessible at all times. From the perspective of the infrastructure provider, large amounts of distributed and often heterogeneous computer resources need to be united into a coherent platform that is then made accessible to and usable by potential users. Grid computing and cloud computing are two paradigms that can be used to form such unified computational infrastructures. Resources from several independent infrastructure providers can be joined to form large-scale decentralized infrastructures. The primary advantage of doing this is that it increases the scale of the available resources, making it possible to address more complex problems or to run a greater number of services on the infrastructures. In addition, there are advantages in terms of factors such as fault-tolerance and geographical dispersion. Such multi-domain infrastructures require sophisticated management processes to mitigate the complications of executing computations and services across resources from different administrative domains. This thesis contributes to the development of management processes for distributed infrastructures that are designed to support multi-domain environments. It describes investigations into how fundamental management processes such as scheduling and accounting are affected by the barriers imposed by multi-domain deployments, which include technical heterogeneity, decentralized and (domain-wise) self-centric decision making, and a lack of information on the state and availability of remote resources. Four enabling technologies or approaches are explored and developed within this work: (I) The use of explicit definitions of cloud service structure as inputs for placement and management processes to ensure that the resulting placements respect the internal relationships between d, Note that the author changed surname from Henriksson to Espling in 2011

From the review on health law and rates, is proposed through a review and adaptation, broadcast speech therapists in the community, an administrative technical tool that allows them to know what and how to check the activities and procedures developed in speech language pathology actions.A review of Colombian law that exists from the year 1996 until the year 2013. We found that despite the major changes has been the Colombian Health System, although there is no equality between acts of general and specialized audiologist defined in the latest update of POS (Compulsory HealthPlan) and the rates currently used manuals. We concluded that in Colombia, has not yet declared a manual single tariff, which is why they are used and the manual rate SOAT ISS. These books are not set values for all activities arising speech language pathologist updating POS both serving IPSof speech language pathology may by order internal and ratemaking procedures and assign codes to take as reference rates established in the draft Decree Tariff Single Manual defined in 2006., A partir de la revisión acerca de la legislación en salud y sus tarifas, se propone a través de una crítica y adaptación, difundir en la comunidad de Fonoaudiólogos, una herramienta técnico administrativa que les permita conocer qué y cómo facturar las actividades y procedimientos desarrollados en las acciones fonoaudiológica. Se realizó una revisión de la normatividad colombiana que existe desde el año de 1.996 hasta el año 2.013. Se encontró que pese a las grandes transformaciones que ha tenidoel Sistema de Salud Colombiano, aun no existe igualdad entre las intervenciones del Fonoaudiólogo general y especializado definidas en la última actualización del POS (Plan Obligatorio de Salud)y los manuales de tarifas utilizados actualmente. Se pudo concluir que en Colombia, aún no se ha decretado un manual único tarifario, razón por la cual son utilizados el manual tarifario ISS y SOAT. En estos manuales no están definidos los valores para todas las actividades Fonoaudiológicas planteadas en la actualización del POS, por tanto las IPS que prestan servicios de Fonoaudiología, pueden mediante resolución interna, crear tarifas y asignar códigos a procedimientos y tomar como referencia tarifas establecidas en el Decreto borrador del Manual Único Tarifario definido en el año 2006.

The Defense Base Act (DBA) of 1941, as amended, requires federal government prime contractors and subcontractors to provide workers' compensation insurance for their employees who work overseas. DBA insurance carriers provide disability and medical benefits to employees for work-related injuries and death benefits to eligible survivors for work-related deaths. The U.S. government reimburses contractors for the cost of their DBA premiums. As of December 2010, the number of DBA cases for Afghanistan totaled 10,600. Since 2005, the U.S. Army Corps of Engineers (USACE) has contracted with Continental Insurance Company (CNA) to serve as the single DBA provider for all USACE contracts. In 2008, U.S. Central Command Joint Theater Support Contracting Command (C-JTSCC) contracts were added to the USACE DBA program. CNA has collected approximately $225 million in premiums for these contracts. SIGAR initiated this audit to (1) determine the extent to which DBA premium rates were set at appropriate levels, (2) assess USACE and C-JTSCC's internal controls for ensuring that prime contractors and subcontractors obtain insurance in compliance with the DBA, and (3) evaluate the process for billing and reimbursing contractors for their DBA costs. We conducted our work in Washington, D.C.; Winchester, VA; Chicago, IL; and Kabul and Kandahar, Afghanistan from February 2011 through July 2011, in accordance with generally accepted government auditing standards.

Grid computing and cloud computing are two related paradigms used to access and use vast amounts of computational resources. The resources are often owned and managed by a third party, relieving the users from the costs and burdens of acquiring and managing a considerably large infrastructure themselves. Commonly, the resources are either contributed by different stakeholders participating in shared projects (grids), or owned and managed by a single entity and made available to its users with charging based on actual resource consumption (clouds). Individual grid or cloud sites can form collaborations with other sites, giving each site access to more resources that can be used to execute tasks submitted by users. There are several different models of collaborations between sites, each suitable for different scenarios and each posing additional requirements on the underlying technologies. Metadata concerning the status and resource consumption of tasks are created during the execution of the task on the infrastructure. This metadata is used as the primary input in many core management processes, e.g., as a base for accounting and billing, as input when prioritizing and placing incoming task, and as a base for managing the amount of resources allocated to different tasks. Focusing on management and utilization of metadata, this thesis contributes to a better understanding of the requirements and challenges imposed by different collaboration models in both grids and clouds. The underlying design criteria and resulting architectures of several software systems are presented in detail. Each system addresses different challenges imposed by cross-site grid and cloud architectures: The LUTSfed approach provides a lean and optional mechanism for filtering and management of usage data between grid or cloud sites. An accounting and billing system natively designed to support cross-site clouds demonstrates usage data management despite unknown placement and dynamic task resourc

Objective: The healthcare chart is becoming ever more complex, serving clinicians, patients, third party payers, regulators, and even medicolegal parties. The purpose of this study was to identify our emergency medicine (EM) resident and attending physicians’ current knowledge and attitudes about billing and documentation practices. We hypothesized that resident and attending physicians would identify billing and documentation as an area in which residents need further education.Methods: We gave a 15-question Likert survey to resident and attending physicians regarding charting practices, knowledge of billing and documentation, and opinions regarding need for further education.Results: We achieved a 100% response rate, with 47% (16/34) of resident physicians disagreeing or strongly disagreeing that they have adequate training in billing and documentation, while 91% (31/34) of residents and 95% (21/22) of attending physicians identified this skill as important to a resident’s future practice. Eighty-two percent (28/34) of resident physicians and 100% of attending physicians recommended further education for residents.Conclusion: Residents in this academic EM department identified a need for further education in billing and documentation practices. [West J Emerg Med. 2010;11(2): 116-119.]

As of today, contractual agreements govern the terms of interaction between users and providers as well as between interoperating providers. Such contracts indicate usable services and resources, tariffs, payment methods, etc. Typically, these terms are negotiated once before the contract is signed and are seldom changed thereafter, such that contracts are rather static and inflexible. Furthermore, establishing such a contract requires human involvement. As a consequence, it is difficult for small content or access providers to reach users and to find interoperation partners amongst the large operators. In addition, providers in general lack flexibility with respect to charging according to demand, and users are unable to easily change their preferred access and service conditions depending on their current life situation and location. Supporting automated and dynamic negotiation of contractual agreements as well as implementing these agreements in an automated, ad hoc fashion are therefore key requirements for compensation systems in future mobile networks. In this paper we propose a functional compensation architecture that meets these key requirements. The architecture is furthermore designed to be able to operate atop of current compensation systems and thus protects and even leverages prior investments. Finally, the architecture allows for the integration of different legacy and non-legacy compensation-related components and thus supports heterogeneous systems. The description of the conceptual architecture in this work is complemented by presenting a prototype including first performance indicators.

Emerging Cloud computing infrastructures provide computing resources on demand based on postpaid principles. For example, the RESERVOIR project develops an infrastructure capable of delivering elastic capacity that can automatically be increased or decreased in order to cost-efficiently fulfill established Service Level Agreements. This infrastructure also makes it possible for a data center to extend its total capacity by subcontracting additional resources from collaborating data centers, making the infrastructure a federation of Clouds. For accounting and billing, such infrastructures call for novel approaches to perform accounting for capacity that varies over time and for services (or more precisely virtual machines) that migrate between physical machines or even between data centers. For billing, needs arise for new approaches to simultaneously manage postpaid and prepaid payment schemes for capacity that varies over time in response to user needs. In this paper, we outline usage scenarios and a set of requirements for such infrastructures, and propose an accounting and billing architecture to be used within RESERVOIR. Even though the primary focus for this architecture is accounting and billing between resource consumers and infrastructure provides, future support for inter-site billing is also taken into account., Daniel Henriksson Se även Daniel Esping

Background: Physician reimbursement laws for diagnostic interpretive services require that only those services provided contemporaneously and /or contribute directly to patient care can be billed for. Despite these regulations, cardiologists and radiologists in many hospitals continue to bill for ECG and plain film diagnostic services performed in the emergency department (ED). The reimbursement value of this care, which is disconnected in time and place from the ED patient encounter, is unknown. In a California community ED with a 32,000 annual census, the emergency physicians (EPs) alone, by contract, bill for all ECG readings and plain film interpretations when the radiologists are not available to provide contemporaneous readings.Objectives: To determine the impact of this billing practice on actual EP reimbursement we undertook an analysis that allows calculation of physician reimbursement from billing data.Methods: An IRB-approved analysis of 12 months of billing data cleansed of all patient identifiers was undertaken for 2003. From the data we created a descriptive study with itemized breakdown of reimbursement for radiograph and ECG interpretive services (procedures) and the gross resultant physician income.Results: In 2003 EPs at this hospital treated patients during 32,690 ED visits. Total group income in 2003 for radiographs was $173,555 and $91,025 for ECGs, or $19/EP hour and $6/EP hour respectively. For the average full-time EP, the combined total is $2537/month or $30,444 per annum, per EP. This is $8/ED visit (averaged across all patients).Conclusion: As EP-reimbursement is challenged by rising malpractice premiums, uninsured patients, HMO contracts, unfunded government mandates and state budgetary shortfalls, EPs are seeking to preserve their patient services and resultant income. They should also be reimbursed for those services and the liability that they incur. The reimbursement value of ECGs and plain film interpretations to the practicing EP is

We evaluated the controls for billing customers and collecting revenue at Corpus Christi Army Depot (CCAD) and the Defense Finance and Accounting Service (DFAS) Rock Island. The controls at CCAD did not ensure that it properly billed customers for direct labor and materials. Specifically: 1) Personnel did not always record employee direct labor correctly or have adequate documentation to support it. 2) Supervisors did not always segregate the timekeeping duties. 3) Employees did not certify the time they worked on projects. 4) Supervisors did not always have adequate oversight of contract labor hours, which personnel did not always record correctly. 5) Production controllers did not track material usage and did not consistently order material against the correct projects. 6) Parts managers did not consistently review orders with a Depot Overhaul Factor of 0.00000 for accuracy. 7) Journal voucher preparers did not always have adequate or clearly identified documentation to support cost transfers between projects.

Fourth Generation (4G) wireless networks allow ubiquitous pervasive data and voice connections for mobile users. Users will no longer have a single relationship with one access provider, but a relationship with a Biller or Agent which enables them access to the 4G world. The role of the Biller is to negotiate with providers that users have requested a service from. This situation gives rise to a number of security and trust issues between the 4G participants. The contribution of this paper is the proposal of a security architecture that provides informed consent for users and providers, per unit billing and per use billing with non-repudiation.We provide an informal analysis of the performance and security of this new architecture.