System for monitoring payment for provision of services to an entity
First Claim
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1. A system for grouping records of charges associated with provision of healthcare to a patient to support payment monitoring, comprising:
- an acquisition processor for acquiring data related to charges for at least one encounter of a particular patient with a healthcare provider organization;
a source of rules for use in processing acquired charge data; and
a data processor using said acquired charge related data for creating a record grouping charges for provision of services associated with said at least one encounter and indicating an expected reimbursable amount value for said grouped charges, said charges being grouped using said rules to provide a reimbursable amount value expected from a payer organization.
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Abstract
A system for grouping records of charges associated with provision of services to an entity to support reimbursement monitoring includes an acquisition processor for acquiring data related to charges for services provided to the entity. A data processor is coupled to the acquisition processor and to a source of rules. The data processor groups the charges using the rules to provide a reimbursable amount value and creates a record containing data representing the grouped charges and the reimbursable amount value.
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Citations
21 Claims
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1. A system for grouping records of charges associated with provision of healthcare to a patient to support payment monitoring, comprising:
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an acquisition processor for acquiring data related to charges for at least one encounter of a particular patient with a healthcare provider organization;
a source of rules for use in processing acquired charge data; and
a data processor using said acquired charge related data for creating a record grouping charges for provision of services associated with said at least one encounter and indicating an expected reimbursable amount value for said grouped charges, said charges being grouped using said rules to provide a reimbursable amount value expected from a payer organization. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11)
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12. A system for monitoring payment for provision of healthcare to a patient, comprising:
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an acquisition processor for acquiring data related to charges for at least one encounter of a particular patient with a healthcare provider organization;
a data processor using said acquired charge related data for creating a record grouping charges for provision of services associated with said at least one encounter and indicating an expected reimbursable amount for said grouped charges, said charges being grouped in response to date of charge accrual and predetermined rules to provide a reimbursable amount value expected from a payer organization; and
a payment monitor for monitoring payments received for provision of services to patients by comparing said expected reimbursable amount in said created record with an amount identified in a received payment remittance. - View Dependent Claims (13, 14, 15, 16)
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17. A method for grouping records of charges associated with provision of healthcare to a patient to support payment monitoring, comprising the activities of:
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acquiring data related to charges for at least one encounter of a particular patient with a healthcare provider organization;
applying rules for grouping said charges to provide a reimbursable amount value expected from a payer organization, using said acquired charge related data; and
creating a record grouping charges for provision of services associated with said at least one encounter and indicating said expected reimbursable amount value for said grouped charges. - View Dependent Claims (18)
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19. A system for grouping records of charges associated with provision of services to an entity to support reimbursement monitoring, comprising:
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an acquisition processor for acquiring data related to charges for services provided to the entity;
a source of rules for use in processing the acquired charge data; and
a data processor, coupled to the acquisition processor and rules source, for grouping the charges using the rules to provide a reimbursable amount value and creating a record containing data representing the grouped charges and the reimbursable amount value.
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20. A method for monitoring payment for provision of healthcare to a patient, comprising the activities of:
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acquiring data related to charges for at least one encounter of a particular patient with a healthcare provider organization;
generating a record grouping charges for provision of services associated with said at least one encounter and indicating an expected reimbursable amount for said grouped charges, said charges being grouped in response to date of charge accrual and predetermined rules to provide a reimbursable amount value expected from a payer organization using said acquired charge related data; and
monitoring payments received for provision of services to patients by comparing said expected reimbursable amount in said created record with an amount identified in a received payment remittance.
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21. A method for grouping records of charges associated with provision of services to an entity to support reimbursement monitoring, comprising the activities of:
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acquiring data related to charges for services provided to the entity;
applying rules to the acquired charge data for grouping the charges to provide a reimbursable amount value; and
creating a record containing data representing the grouped charges and the expected reimbursable amount value.
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Specification