System and user interface for use in billing for services and goods

• US 20030018496A1
• Filed: 12/05/2001
• Published: 01/23/2003
• Est. Priority Date: 06/29/2001
• Status: Abandoned Application

• Current Assignee: Siemens Medical Solutions USA Incorporated (Siemens AG)
• Original Assignee: Siemens Medical Solutions Health Services Corporation (Siemens AG)
• Inventors: Miklowcic, Geraldine, Stanley, Starr, Hambright, Lynn, Cole, Douglas J., Conti, Nicholas
• Application Number:
  US10/005,137
• Publication Number:
  US 20030018496A1
• Time in Patent Office: Days
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 30/04 Billing or invoicing
• CPC Class Codes: G06Q 40/02 Banking, e.g. interest calculation or account maintenance credit or loans G06Q40/03

Abstract

A system consolidates records of services from multiple customer accounts, encounters, cases or visits into one account to facilitate comprehensive billing and reimbursement compatible with selected contract (e.g., Medicare health plan) rules for disparate services provided to a customer. A method determines payment for provision of multiple different services based on predetermined reimbursement rules. The method involves receiving a record identifying a service provided to a specific entity and automatically creating a reimbursement record. The reimbursement record groups an item identifying the provided service together with an item identifying an other service provided to the specific entity based on predetermined service record allocation rules. A reimbursement amount for the identified provided service and the other service provided to the specific entity is calculated based on a reimbursement contract. Predetermined allocation rules are automatically applied for identifying a reimbursement record indicating a group of services provided to the specific entity on separate occasions to be billed together on a single bill.

Claims

1. A method for determining payment for provision of multiple different services based on predetermined reimbursement rules, comprising the steps of:

receiving a record identifying a service provided to a specific entity;

automatically creating a reimbursement record grouping an item identifying said provided service together with an item identifying an other service provided to said specific entity based on predetermined service record allocation rules; and

calculating a reimbursement amount for said identified provided service and said other service provided to said specific entity based on a reimbursement contract.

2. A method according to claim 1, wherein

said step of automatically creating a reimbursement record comprises creating a reimbursement record without manual intervention from received records identifying different types of services provided to said specific entity on separate occasions.

3. A method according to claim 2, wherein

said different types of services comprise an outpatient service and an inpatient service.

4. A method according to claim 1, wherein

said predetermined service record allocation rules comprise at least one of, (a) rules determining whether said provided service as well as said other service qualify for reimbursement under at least one reimbursement contract, and (b) rules in a reimbursement contract.

5. A method according to claim 1, wherein

said reimbursement contract comprises a healthcare policy covering said specific entity and said specific entity comprises a patient.

6. A method according to claim 1 implemented as a program of instructions contained on a storage medium and executable by a machine.

7. A user interface supporting a method for determining payment for provision of multiple different services based on predetermined reimbursement rules, comprising the steps of:

generating a first user selectable menu icon for initiating display of a reimbursement record, said reimbursement record showing

a group of items including an item identifying a service provided to a specific entity together with an item identifying an other service provided to said specific entity based on predetermined service record allocation rules; and

calculated reimbursement amounts for said identified provided service and said other service provided to said specific entity based on a reimbursement contract.

8. A method according to claim 7, including the step of

generating a second user selectable menu icon for initiating display of a bill including said reimbursement amount for said provided service and said other service.

9. A method for use in billing for provision of multiple different services based on predetermined reimbursement rules, comprising the steps of:

receiving a record identifying a service provided to an entity;

applying predetermined allocation rules for identifying a reimbursement record indicating a group of services to be billed together on a single bill, said group of services having been provided to said entity;

updating said identified reimbursement record to incorporate a record item representing said identified provided service;

calculating a reimbursement amount for said identified provided service based on predetermined reimbursement rules; and

preparing a bill including said group of services and said identified provided service for communication to a payer.

10. A method according to claim 9, wherein

said predetermined allocation rules comprise rules for determining said identified provided service as well as said group of services qualify for reimbursement under at least one of (a) a single reimbursement contract and (b) a common set of reimbursement contracts.

11. A method according to claim 9, wherein

said predetermined allocation rules comprise rules in a reimbursement contract.

12. A method according to claim 9, wherein

said predetermined allocation rules identify a reimbursement record to incorporate a record item representing said identified provided service based on the type of said identified provided service.

13. A method according to claim 12, wherein

said type of said identified provided service comprises at least one of, (a) an inpatient service, (b) an outpatient service and (c) an emergency service.

14. A method according to claim 9, including the step of

identifying and prioritizing at least one of (a) reimbursement contracts and (b) policies, comprising predetermined reimbursement rules and

selecting said predetermined reimbursement rules from said prioritized and identified predetermined reimbursement rules for calculating reimbursement for said identified provided service.

15. A method according to claim 9, wherein

said reimbursement record indicates said group of services are reimbursable according to rules in a single reimbursement contract and including the step of

determining whether said identified service is also reimbursable according to rules in said single reimbursement contract.

16. A method according to claim 9, wherein

said specific entity comprises at least one of, (a) a patient, (b) a company, (c) an individual person and (d) a group of people and including the step of

searching for other services also provided to said specific entity.

18. A method according to claim 17, including the step of

preparing a bill including said reimbursement amount for said identified service and additional service for communication to a payer.

19. A method according to claim 17, wherein

said specific entity comprises at least one of, (a) a patient, (b) a company, (c) an individual person and (d) a group of people.

20. A method according to claim 17, including the steps of

identifying and prioritizing at least one of, (a) reimbursement contracts and (b) policies associated with reimbursement contracts, applicable for reimbursing for said identified service and additional service and

selecting said single reimbursement contract from one of, (i) said prioritized reimbursement contracts and (ii) said reimbursement contracts associated with said prioritized policies.

21. A method according to claim 17, including the step of

searching for other services also provided to said specific entity.

22. A method according to claim 17, including the step of

sorting said identified service and additional service by date service is performed.

24. A method according to claim 23, including the step of

preparing a bill including said reimbursement amount for said identified service and one other service for communication to a payer.

25. A method according to claim 23, wherein

said reimbursement record indicates services provided to said entity within a specific period and wherein said updating step comprises

updating said reimbursement record to incorporate said record item representing said identified provided service in response to determination said identified provided service was provided within said specific period.

26. A method according to claim 23, including the step of

preparing a bill including said reimbursement amount for said identified service and one other service for communication to a payer.

27. A method according to claim 23, including the step of

determining said identified provided service as well as said group of services qualify for reimbursement under at least one of (a) a single reimbursement contract and (b) a common set of reimbursement contracts.

17. A method for determining payment for provision of multiple different services based on predetermined reimbursement rules, comprising the steps of:

receiving a record identifying a service provided to a specific entity;

searching for a record of an additional service provided to said specific entity;

determining whether said identified service as well as said additional service provided to said specific entity qualify for reimbursement under a single reimbursement contract;

creating a record indicating said identified service and additional service provided to said specific entity qualify for reimbursement under a single reimbursement contract; and

calculating a reimbursement amount for said identified service and additional service provided to said specific entity based on said single reimbursement contract.

23. A method for determining payment for provision of multiple different services based on predetermined reimbursement rules, comprising the steps of:

receiving a record identifying a service provided to a specific entity;

searching for a reimbursement record indicating at least one other service provided to said specific entity;

determining whether said identified service as well as said at least one other service provided to said specific entity qualify for reimbursement under a single reimbursement contract;

updating said reimbursement record to incorporate a record item representing said identified provided service in response to determination of said qualification; and

calculating a reimbursement amount for said identified service and one other service provided to said specific entity based on said single reimbursement contract.