Automated system and method for reviewing medical and financial claim records and for identifying missing devices and/or services associated with medical and financial procedures

• US 20040024749A1
• Filed: 08/01/2002
• Published: 02/05/2004
• Est. Priority Date: 08/01/2002
• Status: Abandoned Application

• Current Assignee: Omega Systems, Inc.
• Original Assignee: Omega Systems, Inc.
• Inventors: Kusens, Bruce
• Application Number:
  US10/209,710
• Publication Number:
  US 20040024749A1
• Time in Patent Office: Days
• US Class Current: 707/3
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/02 Banking, e.g. interest calculation or account maintenance credit or loans G06Q40/03
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records
• CPC Class Codes: G16H 15/00 ICT specially adapted for medical reports, e.g. generation or transmission thereof
• CPC Class Codes: G16H 40/67 for remote operation

Abstract

This invention relates to a method and system that identifies pass-through items, medications and/or sub-procedures that are typically associated with the performance of medical procedures yet not listed on corresponding medical claim records. The invention includes the steps of storing a database of medical records on a first computer data storage medium, storing a database of event codes on a second computer data storage medium, and electronically transmitting the database of records to the second computer data storage medium. Each event code corresponds to a pass-through item, medication or sub-procedure. The invention analyzes a particular medical procedure and determines if an event code should be listed on the record corresponding to that particular medical procedure. If not, the invention transmits a report identifying the missing event code, and in one embodiment, generates a new record with the proper event code now properly listed. The transfer of claim record information, and any subsequent reports listing omitted event codes can be performed either automatically or at the user'"'"'s request, via an intranet or Internet connection and allows the user to quickly determine which medical procedures listed in the claim records have omitted associated medical devices or sub-procedures, which, if listed, would be reimbursable to the medical facility.

Claims

1. A method for reviewing a record for a claim to determine the possible omission of products and/or services routinely associated with the claim, said method comprising the steps of:

providing a record having one or more claims;

searching a database of records wherein each said one or more claims is associated with one or more products and/or services; and

identifying any product and/or service which are routinely associated with the claim that does not appear on the record.

2. The method of claim 1 further comprising the step of preparing a report listing said identified products and/or services not appearing on the record.

3. The method of claim 1 further comprising the step of generating a second record including identified products and/or services not appearing on the record.

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

storing said database of records on a first computer data storage medium;

storing a database of event codes on a second computer data storage medium; and

electronically transmitting said database of records to said second computer data storage medium prior to said step of identifying any product and/or service which is routinely associated with the claim that does not appear on the record.

5. The method of claim 4 wherein the step of electronically transmitting said database of records is performed upon a request by a user.

6. The method of claim 4 wherein the step of electronically transmitting said database of records is performed automatically.

7. The method of claim 4 wherein said step of electronically transmitting said database of records to said second computer data storage medium is performed over the Internet.

8. The method of claim 4 further comprising the step of preparing a report listing said identified products and/or services not appearing on the record.

9. The method of claim 8 comprising the step of electronically transmitting the report from the second computer data storage medium to the first computer data storage medium.

10. A method of automatically reviewing medical claim records to determine the existence of omitted products and/or services routinely used in medical procedures, said method comprising the steps of:

providing a patient medical claim record, said record identifying medical procedures performed;

providing a database of event codes wherein each of said event codes identifies products and/or services routinely used in conjunction with each said medical procedure; and

identifying said products and/or services listed in the database that has been omitted from the patient medical claim record.

11. The method of claim 10 further comprising the step of preparing a report listing said identified products and/or services omitted during the performance of each said medical procedure.

12. The method of claim 11 further comprising the steps of:

verifying if the identified products and/or services were used in the corresponding medical procedure; and

if the identified products and/or services were used in the corresponding medical procedure,

generating a second record including event codes corresponding to the identified products and/or services not appearing on the record.

13. The method of claim 10 wherein said event code identifies a pass-through device typically associated with a given medical procedure.

14. The method of claim 10 wherein said event code identifies a pass-through drug or biological typically associated with a given medical procedure.

15. The method of claim 10 wherein said event code identifies a subordinate procedure typically associated with a given medical procedure.

16. The method of claim 10 further comprising the steps of:

storing said patient medical claim record on a first computer data storage medium;

storing said database of event codes on a second computer data storage medium; and

electronically transmitting said patient medical claim record to said second computer data storage medium prior to said step of identifying said products and/or services listed in the database that have been omitted from the patient medical claim record.

17. The method of claim 16 wherein the step of electronically transmitting said one or more claim records is performed upon a request by a user.

18. The method of claim 16 wherein the step of electronically transmitting said patient medical claim record is performed automatically.

19. The method of claim 16 wherein said step of electronically transmitting said patient medical claim record to said second computer data storage medium is performed over the Internet.

20. The method of claim 16 further comprising the step of preparing a report listing said identified products and/or services omitted during the performance of each said medical procedure.

21. The method of claim 20 further comprising the step of electronically transmitting the report from the second computer data storage medium to the first computer data storage medium.

22. The method of claim 20 further comprising the steps of:

verifying if the identified products and/ore services were used in the corresponding medical procedure; and

if the identified products and/or services were used in the corresponding medical procedure,

generating a second record including event codes corresponding to the identified products and/or services not appearing on the record.

23. A computer program stored in a computer readable medium, embodying instructions to perform a method of automatically reviewing medical claim records to determine the existence of omitted products and/or services routinely used in medical procedures, said method comprising the steps of:

comparing a patient medical claim record, said record identifying medical procedures performed, with a database of event codes, wherein each of said event codes identifies products and/or services routinely used in conjunction with each said medical procedure; and

identifying said products and/or services listed in the database that has been omitted from the patient medical claim record.

24. The computer program of claim 23 wherein said event code identifies a pass-through device typically associated with a given medical procedure.

25. The computer program of claim 23 wherein said event code identifies a pass-through drug or biological typically associated with a given medical procedure.

26. The computer program of claim 23 wherein said event code identifies a subordinate procedure typically associated with a given medical procedure.

27. The computer program of claim 23 further comprising the step of electronically transmitting said patient medical claim record from a first computer data storage medium to a second computer data storage medium prior to said step of identifying said products and/or services listed in the database that have been omitted from the patient medical claim record.

28. The computer program of claim 27 wherein the step of electronically transmitting said patient medical claim record is performed upon a request by a user.

29. The computer program of claim 27 wherein the step of electronically transmitting said patient medical claim record is performed automatically.

30. The computer program of claim 27 wherein said step of electronically transmitting said patient medical claim record to said second computer data storage medium is performed over the Internet.

31. A system of automatically reviewing medical claim records to determine the existence of omitted products and/or services routinely used in medical procedures, said system comprising:

means for providing a patient medical claim record, said record identifying medical procedures performed;

a database of event codes wherein each of said event codes identifies products and/or services routinely used in conjunction with each said medical procedure; and

means for identifying said products and/or services listed in the database that has been omitted from the patient medical claim record.

32. The system of claim 31 further comprising means for preparing a report listing said identified products and/or services omitted during the performance of each said medical procedure.

33. The system of claim 31 further comprising means for generating a second record reflecting identified products and/or services not appearing on the record.

34. The system of claim 31 wherein said event code identifies a pass-through device typically associated with a given medical procedure.

35. The system of claim 31 wherein said event code identifies a pass-through drug or biological typically associated with a given medical procedure.

36. The system of claim 31 wherein said event code identifies a subordinate procedure typically associated with a given medical procedure.

37. The system of claim 31 further comprising:

means for storing said patient medical claim record on a first computer data storage medium;

means for storing said database of event codes on a second computer data storage medium; and

means for electronically transmitting said patient medical claim record to said second computer data storage medium.

38. The system of claim 37 wherein said means for electronically transmitting said patient medical claim record to said second computer data storage medium is the Internet.

39. The system of claim 38 comprising means for preparing a report listing said identified products and/or services omitted during the performance of each said medical procedure.

40. The system of claim 39 further comprising means for electronically transmitting the report from the second computer data storage medium to the first computer data storage medium.

41. A method for creating a rule governing the association of a medical procedure with an associated event code, said event code representing a device and/or procedure routinely used in the medical procedures, the method comprising the steps of:

selecting a medical procedure; and

associating one or more event codes with said medical procedure, each said event code corresponding to a device an/or procedure routinely used in said medical procedure.

42. The method of claim 41 wherein said step of associating one or more event codes with said medical procedure comprises the steps of:

examining prior records listing said one or more medical procedures and their associated event codes; and

statistically determining which event codes are most often associated with a given medical procedure.