This feature allows you to be precise with your billing procedures.

Here are some details on how this feature works:

If you create a Medication parameter, it will use the PRN Billing Feature regardless of Picker type (Numeric, initial)

Here, Hydro 10 was created with a "Numeric" Picker type:

The total volume of drug used will show on the billing report no matter if a numeric value or initials are entered on the flowsheet.  As you can see below in the first cell initials were used and the second was numeric value. On the billing report below you can see the total volume was recorded no matter which was used on the flowsheet. 


Hydro 2 was created with the picker type marked as "Initials". This medication will have the same behavior as the above screenshots of Hydro 10. The picker type does not affect PRN Billing if the parameter is a "Medication"


If you create a parameter under "Procedure", the PRN Billing Feature will only work if the picker type is set to Initial. If picker type is set to "Numeric", you will only see one "unit" on the billing PDF (and sent to your EMR, if you're integrated) regardless of what you enter in that cell.

Anesthetic time was created as a Parameter with the Numeric picker setting:

Anesthetic time initials were created as a Parameter with the Initials setting:

When entering numbers or initials in a cell, the behavior will be different on the billing sheet:

Regardless of what was entered on the flowsheet, the Numeric picker means that Anesthetic Time will always show "1" on the billing sheet. Anesthetic Time Initials will show the precise billing number if a number is entered.

Here is a video of this feature:

One more example:

When the PRN billing feature in Smart Flow is used for medications, it matters how the medication is chosen to be displayed on the patient’s flowsheet. Simply putting “0.5” in a cell does not necessarily result in a half dose being billed to the client. It all depends on how the medication is displayed. 

Let’s take 2 mg/ml Hydromorphone for Barney, our 10kg patient. This drug is set to send billing per ml.

The DVM has chosen to dose Barney at 0.1 mg/kg.

This gives us a total dose of 1mg to be given, which is a total volume of 0.5ml.

On the first example, we have displayed the dose to be given in total mg. You’ll see by the first example that we completed the first treatment as initials. This triggered the billing in Smart Flow at one unit, therefore we see 0.5ml on the bill.

Then we completed the next treatment as 0.5. This indicates to Smart Flow that we gave 0.5 total mg. Smart Flow does the math, and on the next line of billing, we see 0.25ml.

On the next line, we chose the same dose of hydro but chose to have it display as total volume in ml on the treatment sheet. This time, when we execute the treatment as 0.5, Smart Flow sends the number of 0.5ml of hydro to the bill.

On the final example, we kept the original dose of hydro but chose to display it on the treatment sheet as a dosage of 0.1mg/kg. This time when we execute the treatment as 0.5, Smart Flow calculates the dosage as 0.5mg/kg, which would equal 5mg (or 2.5ml), so Smart Flow sends 2.5ml to the bill.

PRN billing can be a very useful tool, particularly if you want to be able to titrate treatments within a dose range for your patients. It allows the medical record to be accurate and the bill to be adjusted automatically with no additional effort from the technician. It does, however, require those executing treatments to understand how their entry into the cell must correlate with how the medication is displayed on the flowsheet.

For the example above, if we want to indicate that we only gave a half dose of hydromorphone to Barney each time, we would need to enter the values in the cell as follows:

For the total mg, we should enter 0.5. 0.5 mg is half of the 1 mg dose, and 0.25ml would show up on the billing.

For the total volume in ml display, we should enter 0.25 - as that is the volume in mls we gave. 0.25ml will show up on the billing.

And lastly, for when the dosage is displayed on the treatment sheet, we should enter 0.05 - for the number of mg/kg. When Smart Flow does the math, the billing charge will be 0.25ml.