Practice management and billing automation system

• US 20020133503A1
• Filed: 08/03/2001
• Published: 09/19/2002
• Est. Priority Date: 08/04/2000
• Status: Active Grant

• Current Assignee: Athenahealth Incorporated
• Original Assignee: Athenahealth Incorporated
• Inventors: Stone, Steve, Park, Ed, Amar, Anshul, Park, Todd
• Granted Patent: US 7,617,116 B2
• Time in Patent Office: Days
• US Class Current: 707/104.1
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 40/20 for the management or administration of healthcare resources or facilities, e.g. managing hospital staff or surgery rooms
• CPC Class Codes: G16H 50/20 for computer-aided diagnosis, e.g. based on medical expert systems

Abstract

A medical practice management system can be used to manage a medical practice. A medical practice management server communicates with a medical practice client user interface over a first network and communicates with a payor server over a second network. The medical practice management server receives information associated with a visit by a patient to the medical practice. Prior to using the information to create a claim, the medical practice management server automatically and repeatedly interacts with the information to ensure correct information by either applying one or more rules to the information or by performing one or more transactions with the payor server. The medical practice management server performs a correcting action in response to finding an error in the information and subsequently uses the information to create an insurance claim.

Claims

1. A method for managing a medical practice comprising:

(a) communicating with a medical practice client user interface over a first communications network;

(b) communicating with a payor server over a second communications network;

(c) receiving information associated with an event related to a patient from at least one of the medical practice client user interface and the payor server;

(d) performing one or more tasks associated with the event;

(e) using at least a portion of the information associated with the event to create an insurance claim following completion of the one or more tasks; and

(f) automatically and repeatedly interacting with the information associated with the event in connection with the performed tasks by at least one of applying one or more rules in a set of rules and performing transactions with the payor server.

2. The method of claim 1 further comprising verifying the information at least one of before, during, and following performing the tasks associated with the event.

3. The method of claim 1 further comprising the steps of:

(g) receiving an error notification; and

(h) performing a correcting action in response thereto.

4. The method of claim 3 wherein the performing the correcting action further comprises transmitting an error message denoting an error to the medical practice.

5. The method of claim 3 wherein the correcting action comprises correcting at least one of a typographical error, a formatting error, and incomplete information.

6. The method of claim 3 further comprising generating the error notification.

7. The method of claim 1 further comprising submitting the claim to the payor server over the second communications network.

8. The method of claim 1 further comprising updating the rules in the set of rules.

9. The method of claim 2 wherein the performing of the tasks before the patient visit further comprises the steps of at least one of

receiving a request for an appointment,

searching for the patient in a patient information database,

receiving insurance information,

receiving referral information, and

receiving a proposed schedule appointment.

10. The method of claim 9 wherein the receiving insurance information further comprises the steps of parsing the insurance information and determining whether the patient is eligible.

11. The method of claim 9 wherein the receiving referral information further comprises defining a referral rule category, an appointment type class, and an intersection of the referral rule category and the appointment type class.

12. The method of claim 2 wherein the tasks performed during the event further comprise at least one of performing check-in tasks and performing check-out tasks.

13. The method of claim 2 wherein the performing of the tasks following the event further comprise the steps of at least one of

receiving a claim,

scrubbing the claim,

signing a status to the claim,

submitting the claim to the payor server,

triggering an alarm upon not receiving a response from the payor server,

performing claim follow-up tasks, and

posting payments.

14. The method of claim 1 wherein the transactions performed with the payor server further comprises at least one of

claim submittals,

claim receipt acknowledgements,

claim status checks,

patient eligibility determinations,

authorization and referral requests and grants, and

remittance advice.

16. The medical practice management system of claim 15 further comprising a patient information database and an insurance information database.

17. The medical practice management system of claim 15 wherein the rules engine further comprises a rules database to store the set of rules.

18. The medical practice management system of claim 15 wherein the workflow processing engine further comprises a verifier to verify the information at least one of before, during, and following performing the tasks associated with the event.

19. The medical practice management system of claim 15 wherein the workflow processing engine communicates with a central billing office to generate and submit a claim to the payor server.

15. A medical practice management system comprising:

a medical practice client user interface for communicating with a patient;

a payor server for communicating with a payor organization; and

a medical practice management server computer in communication with the medical practice client user interface over a first communications network and the payor server over a second communications network to receive information associated with an event related to a patient from at least one of the medical practice client user interface and the payor server,

the medical practice management server computer comprising

a workflow processing engine performing one or more tasks associated with the event,

a rules engine in communication with the workflow processing engine for repeatedly and automatically interacting with the information associated with the event by applying one or more rules in a set of rules to the information in connection with the performance of the one or more of the tasks, and

an intelligent transactions relationship module in communication with the workflow processing engine and the payor server for repeatedly and automatically interacting with the information associated with the event by performing transactions with the payor server in connection with the performance of the one or more tasks.

20. A medical practice management system comprising:

(a) means for communicating with a medical practice client user interface over a first communications network;

(b) means for communicating with a payor server over a second communications network;

(c) means for receiving information associated with an event related to a patient from at least one of the medical practice client user interface and the payor server;

(d) means for performing one or more tasks associated with the event;

(e) means for using at least a portion of the information associated with the event to create an insurance claim following completion of the one or more tasks; and

(f) means for automatically and repeatedly interacting with the information associated with the event in connection with the performed tasks by at least one of applying one or more rules in a set of rules and performing transactions with the payor server.