Universal charge routing system for medical billing

• US 10,242,158 B2
• Filed: 12/17/2013
• Issued: 03/26/2019
• Est. Priority Date: 02/27/2004
• Status: Active Grant

• Current Assignee: Epic Systems Corporation
• Original Assignee: Epic Systems Corporation
• Inventors: Lipsky, Mark Robert, Keresztes, Alexandre Sena, Li, Dazhi, Shou, Biao, Harjono, Herman, Shukla, Jagdeesh, Baldock, Brandon Jon, Fu, Ting-Sheng, Ma, Tin-Hang Andrew, Upadhyaya, Nishant
• Primary Examiner(s): Kanaan, Maroun P
• Application Number:
  US14/109,370
• Publication Number:
  US 20140108038A1
• Time in Patent Office: 1,925 Days
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 30/04 Billing or invoicing
• CPC Class Codes: G16H 15/00 ICT specially adapted for medical reports, e.g. generation or transmission thereof
• CPC Class Codes: G16H 40/20 for the management or administration of healthcare resources or facilities, e.g. managing hospital staff or surgery rooms

Abstract

A medical charge router receives charge information from a variety of sources and converts it to a standard charge format for automated processing and routing to one of multiple billing programs.

Claims

1. A medical billing computer system, comprising:

a billing computer processor executing instructions stored in a non-transient memory, the instructions including steps for implementing

a billing input receiving charges including charge data from a billing terminal computer system for at least one of a hospital service area, a medical laboratory, and a professional office of a physician, each charge being an electronic record including a bill for medical services, the bill including an amount to be billed based on a code describing a medical procedure, the bill being formatted by an originating charge source, the bill for medical services including charge data;

at least one input translator generating one or more universal charges having a common fauna based on the received charge data, the universal charge including the medical procedure code, wherein generating one or more universal charges includes implementing a translation routine for each received charge based on a billing format used by the originating charge source;

a destination rule engine analyzing the charge data of the universal charges to assign a destination to the universal charges based on the charge data, the destination identifying a billing program; and

at least one output translator receiving the generated universal charges including assigned destinations from the destination rule engine and converting the universal charges to a billing program format identified in the destination.

2. The medical billing computer system of claim 1 wherein the destination rule engine is configured to determine the destination based on a type of medical service identified in the charge data.

3. The medical billing computer system of claim 1 wherein the charge data is selected from the group consisting of:

patient information, procedure information, charge code information, department information, time information, place of service, cost information, and provider information.

4. The medical billing computer system of claim 1 wherein the common format of the universal charges provides a field for information about a destination billing program and wherein the destination vile engine inserts an identified destination into the universal charge from which it is derived.

5. The medical billing computer system of claim 1 wherein the destination rule engine includes a rule editor receiving commands from a user to edit the rules of the rule editor.

6. The medical billing computer system of claim 1 wherein the billing programs require data in different billing program formats.

7. The medical billing computer system of claim 1 wherein the billing programs require data in billing program formats different from the universal charge format.

8. The medical billing computer system of claim 1 wherein the billing computer processor instructions further include steps for implementing a work-queue rule engine analyzing the charge data of the universal charges to detect charges that require human review and enrolling the charge data in a work-queue for review by a human operator before forwarding the charge data to an output translator.

9. The medical billing computer system of claim 8 wherein the work-queue rule engine includes an editor for the work-queue rules.

10. The medical billing computer system of claim 1 wherein the billing computer processor instructions further include steps for implementing an error pool and wherein the destination rule engine further identifies universal charges that cannot be processed by the destination rule engine and enrolls the charge data of any erroneous universal charges in an error pool for editing by a human operator without forwarding the charge data of the erroneous universal charges to an output translator.

11. The medical billing computer system of claim 1 wherein the billing computer processor instructions further include steps for implementing a modification rule engine configured to apply one or more logical rules to the universal charges to modify the charge data of at least one universal charge before forwarding the universal charge to an output translator.

12. The medical billing computer system of claim 11 wherein the billing computer processor instructions further include steps for implementing a log file storing in a searchable database modification made by the modification rule engine to the universal charges.

13. The medical billing computer system of claim 11 wherein the modification rule engine is configured to generate a change correction message based on the modification to the charge data to the charge sources.

14. The medical billing computer system of claim 11 wherein each modification rule includes a test section receiving charge data and testing it for a predetermined test condition and a macro section receiving charge data and modifying it according to a macro script dependant on the test condition, wherein the modification rule engine includes an editor for a user to edit test sections and macro sections.

15. The medical billing computer system of claim 11 wherein the modification is a replacement of a portion of the charge data with different charge data.

16. The medical billing computer system of claim 11 wherein the modification is an addition of charge data.

17. The medical billing computer system of claim 11 wherein the modification is a removal of charge data.

18. The medical billing computer system of claim 11 wherein the modification is an editing of charge data.

19. The medical billing computer system of claim 11 wherein the modification is a creation of a new charge.

20. The medical billing computer system of claim 19 wherein the new charge is intended to be received by a different billing program than the charge from which it was created.

21. The medical billing computer system of claim 11 wherein the modification is based on information from different universal charges.

22. The medical billing computer system of claim 1 wherein the billing computer processor instructions further include steps for implementing an administrative data processor collecting data on a flow of charges through the billing system to create a report providing data fields selected from the group consisting of:

charges received, charges successfully transmitted, oldest time stamp of a charge, oldest time stamp of a service provided, an indication of charges in a queue, aging of charges in the queue, and number of charges in an error pool.

23. The medical billing computer system of claim 1 wherein the billing computer processor instructions further include steps for implementing a charge tracking engine configured to determine whether the received charge is associated with at least one additional charge and holding the charge until the at least one additional charge is received.

24. The medical billing computer system of claim 1, wherein the billing computer processor instructions further include steps for propagating changes to charge data by generating a plurality of charge correction messages to be transmitted to the charge source and the identified at least one destination billing program based on the charge tracking data.

25. The medical billing computer system of claim 1, wherein generating one or more universal charges having a common format based on the received charge data, includes generating at least two universal charges for a single received charge splitting the amount of the bill for medical services between two destination billing programs based on the medical procedure code of the received charge.