This master's thesis is focused on developement of billing system with the options of monitoring individual calls for software exchange Asterisk. Billing of calls is adaptible with the help of group of individual rules, consisting of tariff impulses, numerical prefix, with help of outgoing trunk and cost of the billed unit. The first part of this work is focused on instalation, configuration and preparation of individual components of the billing system. In this work is explained the architecture of the billing system and highlighted the purpose of work of the model database. Next we focused on the purpose and the principal system invidual function of the system including solution. At last there is a simple manual to operate the system with the help of created web interface.

Background: To efficiently capture evaluation and management (E&M) and procedural billing in our surgical intensive care unit (SICU), we have developed an electronic billing system that links to the electronic medical record (EMR). In this system, only notes electronically signed and coded by an attending generate billing charges. We hypothesized that capture of missed billing during nighttime and weekends might be sufficient to subsidize 24/7 in-house attending coverage. Methods: A retrospective chart EMR review was performed of the EMRs for all SICU patients during a 2-month period. Note type, date, time, attending signature, and coding were analyzed. Notes without attending signature, diagnosis, or current procedural terminology (CPT) code were considered incomplete and identified as "missed billing." Results: Four hundred and forty-three patients had 465 admissions generating 2,896 notes. Overall, 76% of notes were signed and coded by an attending and billed. Incomplete (not billed) notes represented an overall missed billing opportunity of $159,138 for the 2-month time period (∼$954,000 annually). Unbilled E&M encounters during weekdays totaled $54,758, whereas unbilled E&M and procedures from weeknights and weekends totaled $88,408 ($44,566 and $43,842, respectively). Missed billing after-hours thus represents ∼$530K annually, extrapolating to ∼$220K in collections from our payer mix. Surprisingly, missed E&M and procedural billing during weekdays totaled $70,730 (∼$425K billing, ∼$170K collections annually), and typically represented patients seen, but transferred from the SICU before attending documentation was completed. Conclusions: Capture of nighttime and weekend ICU collections alone may be insufficient to add faculty or incentivize in-house coverage, but could certainly complement other in-house derived revenues to such ends. In addition, missed daytime billing in busy modern ICUs can be substantial, and use of an EMR to identify missed billing opportunities can help create solutions to recover these revenues.

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O Setor Elétrico Brasileiro tem sofrido nos últimos anos profundas transformações, principalmente nas questões voltadas à comercialização de energia. A criação do mercado, introduzindo o modelo competitivo, com a lei das concessões (Lei 8.987/95), a instituição do livre acesso, criação do produtor independente, consumidor livre e rede básica (Lei 9.074/95), criação da ANEEL (Lei 9.427/96), regulamentação do Mercado Atacadista de Energia (MAE, atual CCEE - Câmara de Comercialização de Energia Elétrica) e definição das regras de organização do Operador Nacional do Sistema (ONS), Lei 9.648/98, resultando na criação dos agentes de geração, transmissão, distribuição e comercialização. O objetivo da criação do mercado foi desonerar o poder público dos investimentos em infra-estrutura, por meio da atração do capital privado, estimulando a livre concorrência, aumentando-se assim a competitividade. Dentro deste novo arcabouço regulatório, considerando-se então o ambiente competitivo, surgem os aspectos referentes à medição de energia elétrica, cujas bases técnicas atuais vigentes estão fundamentadas nas recomendações oriundas de especialistas que integraram a Força Tarefa Medição no âmbito do Grupo RESEB (Projeto de Reestruturação do Setor Elétrico Brasileiro) requisitos técnicos estes que norteiam os processos de especificação, implantação e manutenção dos Sistemas de Medição para Faturamento do SIN (Sistema Interligado Nacional). No presente trabalho apresenta-se uma avaliação crítica dos aspectos relativos à adequação/instalação dos Sistemas de Medição para Faturamento no que diz respeito à Regulação, Especificação Técnica e discussões atuais existentes entre os Agentes de Mercado. Para permitir solucionar eventuais entraves nos processos, são apresentadas contribuições, no sentido de indicar alternativas que visam consolidar as operações do mercado de energia no Brasil, que passam sem dúvida pela implantação dos Sistemas de Medição para Faturamento, bem como é abordado o tema Custos, que mediante simulações, procura-se identificar aos elegíveis futuros Consumidores Livres e Especiais a viabilidade de migrar para o Ambiente de Livre Contratação frente aos custos da medição. / The Brazilian electric sector has undergone profound changes in recent years mainly focused on issues the marketing of energy. The establishment of the market entering the competitive model, with the concessions law (Law 8.987/95), the institution of free access, creation of the independent producer, consumer and core network free (Law 9.074/95), creation of ANEEL (Law 9427 / 96), regulation of the Wholesale Energy Market (MAE, today CCEE - Electric Power Commercialization Chamber) and defining the arrangements for the National System Operator (ONS), Law 9.648/98, resulting in the creation of agents of generation, transmission, distribution and commercialization. The objective of establishing the market was able to relieve the public of investments in infrastructure, through the attraction of private capital, encouraging free competition by increasing the competitiveness. Within this new regulatory framework, considering the competitive environment then there are aspects related to the measurement of electrical energy, whose bases are existing techniques based on current recommendations from experts who joined the Task Force - Measurement Group under the RE-SEB (Project for Restructuring of the Brazilian energy sector), these technical requirements that guide the process of specification, deployment and maintenance of Measurement Systems for Billing of SIN National Interconnected System. In this work presents a critical evaluation of aspects concerning the adequacy / installation of the Measurement Systems for Billing with regard to regulation, technical specification and current conflicts between the agents of the market. To allow any obstacles in resolving cases, contributions are made to indicate alternatives aimed at consolidating the operations of the energy market in Brazil that are without doubt the deployment of Measurement Systems for Billing and is dealt with the issue that cost through simulations seeks to identify eligible for future free consumers and the viability of Special to the Environment migrate Free Recruitment front the costs of measurement.

O Setor Elétrico Brasileiro tem sofrido nos últimos anos profundas transformações, principalmente nas questões voltadas à comercialização de energia. A criação do mercado, introduzindo o modelo competitivo, com a lei das concessões (Lei 8.987/95), a instituição do livre acesso, criação do produtor independente, consumidor livre e rede básica (Lei 9.074/95), criação da ANEEL (Lei 9.427/96), regulamentação do Mercado Atacadista de Energia (MAE, atual CCEE - Câmara de Comercialização de Energia Elétrica) e definição das regras de organização do Operador Nacional do Sistema (ONS), Lei 9.648/98, resultando na criação dos agentes de geração, transmissão, distribuição e comercialização. O objetivo da criação do mercado foi desonerar o poder público dos investimentos em infra-estrutura, por meio da atração do capital privado, estimulando a livre concorrência, aumentando-se assim a competitividade. Dentro deste novo arcabouço regulatório, considerando-se então o ambiente competitivo, surgem os aspectos referentes à medição de energia elétrica, cujas bases técnicas atuais vigentes estão fundamentadas nas recomendações oriundas de especialistas que integraram a Força Tarefa Medição no âmbito do Grupo RESEB (Projeto de Reestruturação do Setor Elétrico Brasileiro) requisitos técnicos estes que norteiam os processos de especificação, implantação e manutenção dos Sistemas de Medição para Faturamento do SIN (Sistema Interligado Nacional). No presente trabalho apresenta-se uma avaliação crítica dos aspectos relativos à adequação/instalação dos Sistemas de Medição para Faturamento no que diz respeito à Regulação, Especificação Técnica e discussões atuais existentes entre os Agentes de Mercado. Para permitir solucionar eventuais entraves nos processos, são apresentadas contribuições, no sentido de indicar alternativas que visam consolidar as operações do mercado de energia no Brasil, que passam sem dúvida pela implantação dos Sistemas de Medição para Faturamento, bem como é abordado o tema Custos, que mediante simulações, procura-se identificar aos elegíveis futuros Consumidores Livres e Especiais a viabilidade de migrar para o Ambiente de Livre Contratação frente aos custos da medição. / The Brazilian electric sector has undergone profound changes in recent years mainly focused on issues the marketing of energy. The establishment of the market entering the competitive model, with the concessions law (Law 8.987/95), the institution of free access, creation of the independent producer, consumer and core network free (Law 9.074/95), creation of ANEEL (Law 9427 / 96), regulation of the Wholesale Energy Market (MAE, today CCEE - Electric Power Commercialization Chamber) and defining the arrangements for the National System Operator (ONS), Law 9.648/98, resulting in the creation of agents of generation, transmission, distribution and commercialization. The objective of establishing the market was able to relieve the public of investments in infrastructure, through the attraction of private capital, encouraging free competition by increasing the competitiveness. Within this new regulatory framework, considering the competitive environment then there are aspects related to the measurement of electrical energy, whose bases are existing techniques based on current recommendations from experts who joined the Task Force - Measurement Group under the RE-SEB (Project for Restructuring of the Brazilian energy sector), these technical requirements that guide the process of specification, deployment and maintenance of Measurement Systems for Billing of SIN National Interconnected System. In this work presents a critical evaluation of aspects concerning the adequacy / installation of the Measurement Systems for Billing with regard to regulation, technical specification and current conflicts between the agents of the market. To allow any obstacles in resolving cases, contributions are made to indicate alternatives aimed at consolidating the operations of the energy market in Brazil that are without doubt the deployment of Measurement Systems for Billing and is dealt with the issue that cost through simulations seeks to identify eligible for future free consumers and the viability of Special to the Environment migrate Free Recruitment front the costs of measurement.

Este trabalho estuda a possibilidade de se adicionar funções de detecção e registro de eventos, que afetam a qualidade de energia elétrica, aos medidores eletrônicos de faturamento. A presença destes medidores na grande maioria dos consumidores ligados à média tensão transforma este recurso em uma poderosa ferramenta de análise. A existência de canais de comunicação remota nestes medidores facilita a coleta dos dados e seu armazenamento. Estes dados transferidos para sistemas com alta capacidade de processamento permitem uma análise mais precisa dos eventos que ocorrem em toda a rede. Foram consideradas as limitações dos medidores de faturamento quanto à sua capacidade de processamento, memória e taxa de amostragem. Os eventos que podem ser detectados com estes medidores ficam restritos a variações de tensão de curta duração (VTCDs) e transitórios oscilatórios de baixa freqüência. As funções criadas para registro de eventos podem ser usadas para registro de sinais em regime permanente, aumentando a capacidade de diagnóstico e análise da qualidade da energia elétrica em locais da rede. São utilizadas como técnicas de detecção de eventos: as variações dos valores eficazes, a decomposição de sinais, a Norma Euclidiana Instantânea (NEI) e a transformada wavelet (TW). / This work shows the possibility to add new functions for detection and registration of disturbances that affect power quality to electronic billing meters. The widespread installation of these meters in the power network makes this resource a powerful analysis tool. Remote communication channels in these meters create an easy way for reading and registering such power quality events. Data transferred to powerful processing systems allow accurate analysis of events occurring in the power grid. The limitations on billing meters, namely processing resources, memory availability and sampling rate, were taken into account. Despite these limitations, the electronic meters can handle short duration voltage events and low-frequency oscillatory transients. Those new functions can also be used for registering steady state phenomena, extending the ability to diagnose power quality problems throughout the power network. Techniques like RMS variations, signal decomposition, instantaneous Euclidian norm and wavelet transform were used for detection of the considered power quality events.

Este trabalho estuda a possibilidade de se adicionar funções de detecção e registro de eventos, que afetam a qualidade de energia elétrica, aos medidores eletrônicos de faturamento. A presença destes medidores na grande maioria dos consumidores ligados à média tensão transforma este recurso em uma poderosa ferramenta de análise. A existência de canais de comunicação remota nestes medidores facilita a coleta dos dados e seu armazenamento. Estes dados transferidos para sistemas com alta capacidade de processamento permitem uma análise mais precisa dos eventos que ocorrem em toda a rede. Foram consideradas as limitações dos medidores de faturamento quanto à sua capacidade de processamento, memória e taxa de amostragem. Os eventos que podem ser detectados com estes medidores ficam restritos a variações de tensão de curta duração (VTCDs) e transitórios oscilatórios de baixa freqüência. As funções criadas para registro de eventos podem ser usadas para registro de sinais em regime permanente, aumentando a capacidade de diagnóstico e análise da qualidade da energia elétrica em locais da rede. São utilizadas como técnicas de detecção de eventos: as variações dos valores eficazes, a decomposição de sinais, a Norma Euclidiana Instantânea (NEI) e a transformada wavelet (TW). / This work shows the possibility to add new functions for detection and registration of disturbances that affect power quality to electronic billing meters. The widespread installation of these meters in the power network makes this resource a powerful analysis tool. Remote communication channels in these meters create an easy way for reading and registering such power quality events. Data transferred to powerful processing systems allow accurate analysis of events occurring in the power grid. The limitations on billing meters, namely processing resources, memory availability and sampling rate, were taken into account. Despite these limitations, the electronic meters can handle short duration voltage events and low-frequency oscillatory transients. Those new functions can also be used for registering steady state phenomena, extending the ability to diagnose power quality problems throughout the power network. Techniques like RMS variations, signal decomposition, instantaneous Euclidian norm and wavelet transform were used for detection of the considered power quality events.

<p>We have 3G on the doorstep but nothing seems to attract ordinary people to this technology. To attract the mass market the telecom industry must show something beyond high bit rates. They must show how ordinary people can take advantage of this new technology. This is done by showing the possibilities of the new technology and by demonstrating applications that it will handle. The telecom industry must convince the telecom operators to invest in this technology and the only thing that matters to them is how much revenue they can make by adopting the upcoming technology. </p><p>To convince the operators industry must show how the operators can charge for the new types of applications that will be introduced soon. This is the main reason why this Master's Thesis has been conducted. The purpose of this thesis is to provide a demonstration to Ericsson's 3G lab in Katrineholm in the form of an IP application with a billing solution. This thesis describes the migration from 1G to 3G and examines existing and future billing strategies as well. </p><p>The IP application is an application that uses progressive streaming in order to stream multimedia content to a PDA connected to a 3G phone. This application is platform independent because it is placed on leading Web servers, Apache and IIS. </p><p>The billing application consists of a number of steps. The first step is logging, which is performed by the Web server on which the streaming application is placed. The second step, processing and billing, is performed in the BGw, which is Ericsson's mediation tool, and the SQL server.The third step is displaying the bill, which is done by using ASP to create an active HTML page.</p>

We have 3G on the doorstep but nothing seems to attract ordinary people to this technology. To attract the mass market the telecom industry must show something beyond high bit rates. They must show how ordinary people can take advantage of this new technology. This is done by showing the possibilities of the new technology and by demonstrating applications that it will handle. The telecom industry must convince the telecom operators to invest in this technology and the only thing that matters to them is how much revenue they can make by adopting the upcoming technology. To convince the operators industry must show how the operators can charge for the new types of applications that will be introduced soon. This is the main reason why this Master's Thesis has been conducted. The purpose of this thesis is to provide a demonstration to Ericsson's 3G lab in Katrineholm in the form of an IP application with a billing solution. This thesis describes the migration from 1G to 3G and examines existing and future billing strategies as well. The IP application is an application that uses progressive streaming in order to stream multimedia content to a PDA connected to a 3G phone. This application is platform independent because it is placed on leading Web servers, Apache and IIS. The billing application consists of a number of steps. The first step is logging, which is performed by the Web server on which the streaming application is placed. The second step, processing and billing, is performed in the BGw, which is Ericsson's mediation tool, and the SQL server.The third step is displaying the bill, which is done by using ASP to create an active HTML page.

Introdução: A ocorrência de glosas nas contas hospitalares impacta no adequado faturamento assistencial, especialmente em unidades de maior faturamento como o Centro Cirúrgico (CC), requerendo estratégias para sua minimização. Objetivos: mapear, descrever e validar o processo de auditoria e faturamento de contas em um hospital geral, de grande porte, privado; calcular a percentagem das glosas técnicas geradas por profissionais de enfermagem e médicos anestesistas no CC; verificar qual(is) item(ns) foi(ou foram) mais glosado(s) por grupo contábil; identificar as facilidades e dificuldades relativas ao registro de materiais, medicamentos, equipamentos, gases, taxas e ao lançamento de débitos e propor uma ação educativa, com foco no faturamento assistencial, direcionada aos profissionais da equipe cirúrgica do CC. Método: Trata-se de pesquisa quantitativa, exploratória, descritiva, retrospectiva, documental, na modalidade de estudo de caso único. Foram realizadas visitas aos Setores de Auditoria Interna e de Recurso de Glosas visando o mapeamento dos processos desenvolvidos, os dados obtidos foram documentados descritivamente e ilustrados na forma de fluxogramas. Concomitantemente foram coletados dados de 383 prontuários de pacientes atendidos no CC, relativos a três meses típicos, para o cálculo e a análise das glosas técnicas. Na sequência, realizou-se o recrutamento de integrantes da equipe de colaboradores do CC, por amostragem não probabilística, que responderam a um questionário para identificação das facilidades e dificuldades quanto ao registro da assistência prestada e obtenção de subsídios para proposição de ação educativa. Resultados: Os processos de auditoria e faturamento e de recurso de glosas, vigentes na instituição, foram mapeados e validados por especialistas da área de auditoria de contas hospitalares internos e externos ao hospital. O faturamento relativo ao atendimento dos 383 pacientes totalizou R$5.623.968,17 (100%), sendo R$164.892,29 (2,93%) referentes às glosas técnicas, 2,01% relacionado à categoria profissionais de enfermagem e 0,92% a categoria médico anestesista. O valor médio glosado correspondeu a R$ 430,53 (DP= R$ 573,07) e a porcentagem média de valor glosado a 3,56% (DP=4,55). Os itens do grupo contábil materiais foram os mais glosados (67,7%) seguidos pelos grupos contábeis medicamentos (13,2%), equipamentos (8,1%), gases (4,2%) e taxas (6,8%). Quanto aos itens glosados com maior impacto no grupo contábil materiais destacou-se o avental descartável (12,7%); no grupo medicamentos o item solução (38,7%); no grupo equipamentos o item capnógrafo (31,3%); no grupo gases o item oxigênio (75,9%) e no grupo taxas o item antissepsia (44,1%). A maior porcentagem de itens glosados no grupo contábil materiais, 74,0%, foi gerada pela categoria profissionais de enfermagem sendo superior a porcentagem da categoria médico anestesista (38,4%). Nos grupos contábeis medicamentos, equipamentos e gases a categoria médico anestesista apresentou mais itens glosados em comparação a categoria profissionais de enfermagem: 35,9% e 8,2%, 18% e 6,0% e 7,8% e 3,5%, respectivamente. A categoria profissionais de enfermagem foi responsável por 82,15% dos itens glosados e a categoria médicos anestesistas por 17,85% que, por sua vez, apresentou a maior porcentagem de itens glosados por paciente (1,83%) comparada à categoria profissionais de enfermagem (0,81%). A maioria dos enfermeiros e dos auxiliares/técnicos respondeu saber o que era faturamento assistencial e conhecer sua atuação neste processo; a totalidade dos médicos anestesistas respondeu desconhecer o que era faturamento assistencial. Para melhorar o processo de faturamento da assistência as propostas dos médicos anestesistas centraram-se na realização da conferência da Ficha de Anestesia ao final do ato cirúrgico e aprimoramento deste impresso. Entre as propostas dos enfermeiros destacaram-se a informatização da documentação e o registro dos materiais, usados durante o procedimento cirúrgico, por meio de leitura ótica. Além dessas sugestões auxiliares/técnicos de enfermagem indicaram o uso de um impresso gerado pela farmácia do hospital contendo os materiais disponíveis na sala cirúrgica, sendo registradas apenas as quantidades utilizadas. O conhecimento das dificuldades e facilidades no processo de documentação da assistência prestada, evidenciadas por componentes da equipe cirúrgica, subsidiou a proposição de uma ação educativa, com ênfase no processo de faturamento assistencial, a fim de diminuir a ocorrência de glosas técnicas nas contas hospitalares do CC. Conclusão: Os resultados obtidos favorecerão a busca de alternativas que permitam a diminuição da ocorrência de glosas técnicas e, consequentemente, melhoria do processo de faturamento assistencial no CC. Entretanto, os profissionais precisam estar sensibilizados e comprometidos com a adequação da documentação da assistência prestada, compreendendo que a inadequação dos seus registros incorrerá em perdas financeiras para a organização de saúde que podem atingi-los direta ou indiretamente. / Introduction: The occurrence of glosses in hospital bills is a problem to obtain a satisfactory healthcare income, especially in higher revenue units as the Surgical Center (SC) requiring strategies to minimize it. Objectives: to map, describe and validate the audit process and billing accounts in a large, general, and private hospital; calculate the percentage of technical glosses generated by nurses and anesthesiologists in the SC; verify which was (were) the more glossed item (s)generated by the accounting group; identify the positive aspects and difficulties related to the registration of materials, drugs, equipment, gas, taxes, debit posting and also to propose an educational activity focusing on healthcare income for the SC team of professionals. Method: This is a quantitative, exploratory and descriptive, retrospective, documentary study, single case study mode. Visits to the Internal Audit Sector and Glosses Resources were performed to map the processes and data were described, documented and illustrated in flowcharts. Concomitantly, data collected from medical records of 383 patients treated at SC, were related to three typical months to calculate and analyze technical glosses. Further, members of the SC team were enrolled at a nonprobability sampling .They answered a questionnaire to identify the positive aspects and difficulties regarding the register of healthcare service and grants obtained for the proposed educational activities. Results: The audit and healthcare income processes, the gloss resource existing in the institution have been mapped and validated by audit specialists in the area of internal and external hospital bills. The profits related to care of 383 patients amounted to R $ 5,623,968.17 (100%), of which R $ 164,892.29 (2.93%) for technical glosses, 2.01% related to the category \"nursing professionals\" and 0.92% for the category \"anesthesiologist.\" The mean glossed value corresponded to R $ 430.53 (SD = R $ 573.07) and the mean percentage of glossed value to 3.56% (SD = 4.55). The items of the accounting group \"materials\" were the most glossed(67.7%) followed by accounting group \"drugs\" (13.2%), \"equipment\" (8.1%), \"gas\" (4.2%) and \"fees\" (6.8%). As for glossed items with a great impact on the accounting group \"material\", the \"disposable apron\" (12.7%) was pointed out; in the group \"drugs\" the item \"solution\" (38.7%); the group \"equipment\" item \"capnography\" (31.3%); in the group \"gas\" the item \"oxygen\" (75.9%) and in the group \"fees\" item \"antisepsis\" (44.1%). The highest percentage of glossed items in the accounting group \"material\", 74.0% was generated by the category \"nursing professionals\" being higher than the percentage of the category \"anesthesiologist\" (38.4%). In the accounting groups \"drugs\", \"equipment\" and \"gas\" the category \"anesthesiologist\" presented more glossed items when compared to the category \"nursing professionals\": 35.9% and 8.2%, 18% and 6.0 % and 7.8% and 3.5%, respectively. The category \"nursing professionals\" accounted for 82.15% of glossed items and the category \"anesthesiologists\" by 17.85% which, in turn, had the highest percentage of glossed items per patient (1.83%) when compared to the category \"nursing professionals\" (0.81%). Most of nurses and assistants / technicians comprehended what healthcare income was and they understand their role in this process; all the anesthesiologists said they had no knowledge of the healthcare income. To improve this process the anesthesiologists´ proposals focused on to implement an Anesthesia Record Form at the end of each surgery procedure \"and\" to develop this form.\" Among the proposals of the nurses it was highlighted the \"computerized clinical documentation system\" and registration of the materials used during the surgical procedure through \"optical scanning\". In addition to these suggestions, nursing assistants / technicians indicated the use of a printed material, created by the hospital pharmacy containing the materials available in the operating room in which only the number of materials used must be reported. The knowledge of the difficulties and positive aspects in the healthcare documentation process mentioned by the components of the surgical team, subsidized the proposition of an educational activity, with emphasis on healthcare income process to reduce the occurrence of technical glosses in hospital bills in the SC. Conclusion: The results will favor the search for alternatives to reduce the occurrence of technical glosses and consequently, improving the healthcare income process on the SC. However, professionals need to be aware and committed to the adequacy of the healthcare documentation considering that inadequacy of its records will bring financial losses to the health organization and affect them direct or indirectly.