{"id":4565,"date":"2015-02-04T17:42:25","date_gmt":"2015-02-04T16:42:25","guid":{"rendered":"https:\/\/www.journal.topaze.com\/?p=4565"},"modified":"2019-03-22T13:56:44","modified_gmt":"2019-03-22T12:56:44","slug":"gestion-des-regles-de-calcul-de-la-complementaire","status":"publish","type":"post","link":"https:\/\/www.journal.topaze.com\/pedicurepodologue\/blog\/2015\/02\/04\/gestion-des-regles-de-calcul-de-la-complementaire\/","title":{"rendered":"Gestion des r\u00e8gles de calcul de la compl\u00e9mentaire."},"content":{"rendered":"<h4>Principe :<\/h4>\n<p>Dans certains cas, la facturation est en dehors du cadre classique 60% caisse et 40% mutuelle. Le patient malgr\u00e9, la mutuelle, doit payer une partie de la part compl\u00e9mentaire de la facture.<\/p>\n<p>Pour d\u00e9terminer la somme \u00e0 rembourser par le patient, il y a les r\u00e8gles de calcul. La r\u00e8gle est mentionn\u00e9e sur la carte d&rsquo;assur\u00e9 mutuelle du patient et se renseigne dans la partie compl\u00e9mentaire de la fiche \u00ab\u00a0patient\u00a0\u00bb\u00a0(voir ci-dessous)\u00a0:<\/p>\n<p><a href=\"https:\/\/www.journal.topaze.com\/wp-content\/uploads\/sites\/14\/2015\/02\/Compl1.jpg\"><img decoding=\"async\" alt=\"Compl1\" src=\"https:\/\/www.journal.topaze.com\/wp-content\/uploads\/sites\/14\/2015\/02\/Compl1.jpg\" \/><\/a><\/p>\n<p>La r\u00e8gle de calcul associ\u00e9e est mentionn\u00e9e sur la carte d&rsquo;assur\u00e9 mutuelle du patient.<\/p>\n<p>C\u2019est dans la colonne \u00ab\u00a0Auxiliaire M\u00e9dical\u00a0\u00bb qu\u2019on trouve l\u2019information du % du ticket mod\u00e9rateur qui permettra de configurer cette r\u00e8gle de calcul :<\/p>\n<p><a href=\"https:\/\/www.journal.topaze.com\/wp-content\/uploads\/sites\/14\/2015\/02\/Compl2.jpg\"><img decoding=\"async\" alt=\"Compl2\" src=\"https:\/\/www.journal.topaze.com\/wp-content\/uploads\/sites\/14\/2015\/02\/Compl2.jpg\" \/><\/a><\/p>\n<p>Selon le pourcentage indiqu\u00e9 dans cette colonne, la configuration de ces r\u00e8gles de calcul se fera de cette mani\u00e8re\u00a0:<\/p>\n<ul>\n<li>Si dans cette colonne il y\u2019a 100% ou plus, dans Topaze, on choisira 052, car les autres r\u00e8gles de calcul sont destin\u00e9es \u00e0 une gestion du ticket mod\u00e9rateur inf\u00e9rieure \u00e0 100%.<\/li>\n<\/ul>\n<ul>\n<li>Param\u00e8tre de calcul du ticket mod\u00e9rateur (Montant de la part mutuelle), dans le cas de formule diff\u00e9rent de 052 (Voir liste ci-dessous)\u00a0:<\/li>\n<\/ul>\n<p><a href=\"https:\/\/www.journal.topaze.com\/wp-content\/uploads\/sites\/14\/2015\/02\/Compl3.jpg\"><img decoding=\"async\" class=\"alignnone size-full wp-image-4568\" alt=\"Compl3\" src=\"https:\/\/www.journal.topaze.com\/wp-content\/uploads\/sites\/14\/2015\/02\/Compl3.jpg\" \/><\/a><\/p>\n<h4>\u00a0Mode de calcul des autres formules :<\/h4>\n<h5>Formule 050 :<\/h5>\n<p style=\"padding-left: 30px;\">Voici les pourcentages de la r\u00e8gle de calcul \u00e0 appliquer :<\/p>\n<ul>\n<li>Le patient r\u00e8gle 05% du TM : mettre\u00a0<b>95<\/b>%<\/li>\n<li>Le patient r\u00e8gle 10% du TM\u00a0: mettre\u00a0<b>90<\/b>%<\/li>\n<li>Le patient r\u00e8gle 15% du TM\u00a0: mettre\u00a0\u00a0<b>85<\/b>%<\/li>\n<li>Le patient r\u00e8gle 20% du TM\u00a0: mettre\u00a0<b>80<\/b>%<\/li>\n<li>Le patient r\u00e8gle 25% du TM\u00a0: mettre\u00a0\u00a0<b>75<\/b>%<\/li>\n<li>Le patient r\u00e8gle 30% du TM\u00a0: mettre\u00a0\u00a0<b>70<\/b>%<\/li>\n<\/ul>\n<h5>\u00a0Formule 02A:<\/h5>\n<p style=\"padding-left: 30px;\">Il se calcul qu\u2019\u00e0 partir d&rsquo;un pourcentage &gt; 60% \u00a0(%RO). Ce pourcentage est donn\u00e9 sur l&rsquo;attestation compl\u00e9mentaire ou en contactant l&rsquo;organisme AMC.<\/p>\n<p style=\"padding-left: 30px;\">Voici comment le calcul s&rsquo;effectue :<\/p>\n<p>&nbsp;<\/p>\n<p>Part Total de l&rsquo;AMC \u00a0&#8211; \u00a0{ [Montant de l&rsquo;acte &#8211; (Montant de l&rsquo;acte * % TR affich\u00e9) ] }<\/p>\n<p><a href=\"https:\/\/www.journal.topaze.com\/wp-content\/uploads\/sites\/14\/2015\/02\/Calcul02A.jpg\"><img decoding=\"async\" class=\"alignnone size-medium wp-image-4582\" alt=\"Calcul02A\" src=\"https:\/\/www.journal.topaze.com\/wp-content\/uploads\/sites\/14\/2015\/02\/Calcul02A-300x300.jpg\" \/><\/a><\/p>\n<p style=\"padding-left: 30px;\"><strong>POUR INFO\u00a0:<\/strong> Si le % est inf\u00e9rieur ou \u00e9gal \u00e0 60 % le patient r\u00e8gle toute la partie mutuelle<\/p>\n<h5><\/h5>\n<h5><\/h5>\n<h5>Formule 021 :<\/h5>\n<p style=\"padding-left: 30px;\">Voici comment le calcul s&rsquo;effectue :<\/p>\n<p style=\"padding-left: 30px;\">Montant total de l&rsquo;acte multipli\u00e9 par le \u00a0% TR affich\u00e9.<\/p>\n<p style=\"padding-left: 60px;\"><a href=\"https:\/\/www.journal.topaze.com\/wp-content\/uploads\/sites\/14\/2015\/02\/Calcul021.jpg\"><img decoding=\"async\" class=\"alignnone size-full wp-image-4587\" alt=\"Calcul021\" src=\"https:\/\/www.journal.topaze.com\/wp-content\/uploads\/sites\/14\/2015\/02\/Calcul021.jpg\" \/><\/a><\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Info :<\/strong> Pour comprendre ces r\u00e8gles une bulle d&rsquo;information existe en laissant le pointeur de la souris sur la case r\u00e8gle de calcul :<\/p>\n<p><a href=\"https:\/\/www.journal.topaze.com\/wp-content\/uploads\/sites\/14\/2015\/02\/Bulle-Regle.jpg\"><img decoding=\"async\" class=\"alignnone size-full wp-image-4570\" alt=\"Bulle-Regle\" src=\"https:\/\/www.journal.topaze.com\/wp-content\/uploads\/sites\/14\/2015\/02\/Bulle-Regle.jpg\" \/><\/a><\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Principe : Dans certains cas, la facturation est en dehors du cadre classique 60% caisse et 40% mutuelle. Le patient malgr\u00e9, la mutuelle, doit payer une partie de la part compl\u00e9mentaire de la facture. Pour d\u00e9terminer la somme \u00e0 rembourser par le patient, il y a les r\u00e8gles de calcul. La r\u00e8gle est mentionn\u00e9e sur [&hellip;]<\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[473],"tags":[3,4,6,7,9,11,27,187,200,373,374],"class_list":["post-4565","post","type-post","status-publish","format-standard","hentry","category-techniques","tag-kinesitherapeute","tag-toutes-professions-paramedicales","tag-orthoptiste","tag-orthophoniste","tag-infirmier","tag-sage-femme","tag-podologue-pedicure","tag-mutuelle","tag-complementaire","tag-formule","tag-regle-de-calcul"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v24.1 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Gestion des r\u00e8gles de calcul de la compl\u00e9mentaire. - Pedicurepodologue<\/title>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Gestion des r\u00e8gles de calcul de la compl\u00e9mentaire. - Pedicurepodologue\" \/>\n<meta property=\"og:description\" content=\"Principe : Dans certains cas, la facturation est en dehors du cadre classique 60% caisse et 40% mutuelle. Le patient malgr\u00e9, la mutuelle, doit payer une partie de la part compl\u00e9mentaire de la facture. Pour d\u00e9terminer la somme \u00e0 rembourser par le patient, il y a les r\u00e8gles de calcul. 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