Healthcare administration transaction method and system for the same

• US 20060047539A1
• Filed: 08/31/2004
• Published: 03/02/2006
• Est. Priority Date: 08/31/2004
• Status: Abandoned Application

• Current Assignee: Medrule Business Solutions Incorporated
• Original Assignee: Medrule Business Solutions Incorporated
• Inventors: Huang, Paul
• Application Number:
  US10/929,780
• Publication Number:
  US 20060047539A1
• Time in Patent Office: Days
• US Class Current: 705/4
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 40/67 for remote operation

Abstract

A healthcare transaction method, comprising: providing a healthcare worker access to a remote central server through a user interface, and providing a payer connection to the server; receiving information from the healthcare professional through the user interface; and providing the healthcare worker automated claim assessment, claim optimization, and claim submission to the payer, based on regularly updated rules; wherein the user interface comprises a data entry device that receives data directly from the healthcare worker, and transmits it to the remote central server. A healthcare system is also disclosed.

Claims

1. A healthcare transaction method, comprising:

providing a healthcare worker access to a remote central server through a user interface, and providing a payer connection to the server;

receiving information from the healthcare professional through the user interface; and

providing the healthcare worker automated claim assessment, claim optimization, and claim submission to the payer, based on regularly updated rules;

wherein the user interface comprises a data entry device that receives data directly from the healthcare worker, and transmits it to the remote central server.

2. The method of claim 1 wherein at least one modified treatment code and an associated reimbursement value is suggested at the user interface for selection by the healthcare worker.

3. The method of claim 1 wherein the healthcare worker is provided a real-time interconnection between the user interface and the payer.

4. The method of claim 1 wherein the user interface comprises a handheld device that receives data directly from the healthcare worker, and wirelessly transmits it directly to a wireless telecommunications network that is connected to the remote central server.

5. The method of claim 1 wherein the user interface comprises a handheld device that receives data directly from the healthcare worker, and wirelessly transmits it directly to a wireless LAN network that is connected to the remote central server.

6. The method of claim 1 wherein the user interface comprises a transceiver that receives manually-input data directly from the healthcare worker, and wirelessly transmits it directly to a wireless network that is connected to the remote central server.

7. The method of claim 6 wherein the handheld device is a pen that applies ink as it receives data.

8. The method of claim 6 wherein the handheld device is a digital recorder.

9. The method of claim 1 wherein the remote central server performs real-time, rules-based eligibility determinations.

10. The method of claim 1 wherein the remote central server performs real-time rules-based referral authorizations.

11. The method of claim 1 wherein the user interface allows integrated access to all of a patient'"'"'s books of business.

12. The method of claim 1 wherein the remote central server provides rules-based healthcare worker management based on encounter data collected through the user interface.

13. The method of claim 1 wherein the remote central server provides rules-based healthcare worker monitoring based on encounter data collected through the user interface.

14. The method of claim 1 wherein the remote central server provides rules-based advertising to the user interface.

15. The method of claim 1 wherein the remote central server provides rules-based selection of a pharmacy, and sends a prescription to the pharmacy.

16. The method of claim 1 wherein the remote central server provides integrated registration, scheduling, and self-service patient check-in through an application service provider over the Internet.

17. A healthcare transaction method, comprising:

providing a healthcare worker access to a remote central server through at least one user interface, and providing at least one payer connection to the server;

receiving information from the healthcare professional directly from the at least one user interface; and

providing the healthcare professional automated claim handling and claim submission to the at least one payer, based on regularly updated rules;

wherein the at least one user interface comprises a handheld device that receives data directly from the healthcare professional, and wirelessly transmits it directly to a wireless telecommunications network that is connected to the remote central server.

18. The method of claim 17 wherein the handheld device is a pen that applies ink as it receives data.

19. The method of claim 18 wherein the pen transmits data to a telecommunications-to-server gateway that is in communication with the remote central server.

20. The method of claim 19 wherein the server is part of a rules-based application service provider expert system that integrates (1) patient scheduling and check-in;

(2) automated patient eligibility checks;

(3) automated rules-based, pre-adjudicated claim creation and submission;

(4) automated requests for referral authorization;

(5) tangible measurement of practice group financial status based on rules created based on the automatic collection of patient encounter data; and

(5) creation of an additional stream of payer and third-party revenues.

21. A healthcare transaction system, comprising:

a workstation at a physician practice with access to a remote central server, and a payer with connection the server; and

at least one workstation at the physician practice automated claim assessment, claim optimization, and claim submission to the payer, based on regularly updated rules;

wherein the server receives patient information from the healthcare professional through the user interface; and

wherein the user interface comprises a data entry device that receives data directly from the healthcare worker, and transmits it to the remote central server.