Enterprise billing system for medical billing

• US 20060173778A1
• Filed: 02/01/2005
• Published: 08/03/2006
• Est. Priority Date: 02/01/2005
• Status: Abandoned Application

• Current Assignee: Epic Systems Corporation
• Original Assignee: Epic Systems Corporation
• Inventors: Baldock, Brandon Jon, Joshi, Kiran Subhash, Kulas, Michael Paul, Untono, Meiskye, Yau, Kin Man, Lipsky, Mark Robert, Shou, Biao, Ma, Tin-Hang Andrew, Harjono, Herman
• Application Number:
  US11/048,528
• Publication Number:
  US 20060173778A1
• Time in Patent Office: Days
• US Class Current: 705/40
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 20/102 Bill distribution or payments
• CPC Class Codes: G06Q 30/04 Billing or invoicing

Abstract

An enterprise medical billing system receives patient identifying and charge information from a variety of sources, associates the charge data with a guarantor, provides a consolidated statement to the guarantor, and allocates portions of a received payment to the variety of sources based on a series of configurable payment rules.

Claims

1. A medical billing system for receiving charges from a plurality of charge sources and producing a consolidated statement for charges incurred for at least two billing programs, the medical billing system comprising:

an enterprise registration system for associating charges with a known guarantor and forwarding the charge data and known guarantor to the billing programs;

a consolidated statement program for receiving charge data from each of the at least first and second billing programs and for producing a single billing statement for the known guarantor; and

a payment posting program receiving payment from the known guarantor and allocating the payment to each of the at least first and second billing systems based on rules stored in a rule engine.

2. The medical billing system of claim 1 wherein the enterprise registration system assigns a unique visit identifier to each patient visit and associates stored data with the unique visit identifier to identify the patient, the guarantor, and account data for each of the at least first and second billing system.

3. The medical billing system of claim 1 wherein the rule engine allocates payments based on at least one of an oldest outstanding bill first rule, a predefined allocation rule, and a user selectable payment rule.

4. The medical billing system as defined in claim 1, further comprising a charge router for receiving charge data from the enterprise registration system, determining which of the first and second billing computers should receive the charge, translating the charge into a format used by the selected billing system and forwarding the charge to the selected billing system.

5. The medical billing system as defined in claim 1 wherein the payment posting program comprises at least one of a guarantor payment posting program and an insurance payment posting program.

6. The medical billing system as defined in claim 1, wherein the guarantor payment posting program allocates shares of a payment received from the known guarantor to the at least first and second billing systems as determined by the rule engine and the insurance payment posting program allocates shares based on the coverage data provided by the insurance company.

7. The medical billing system as defined in claim 1, further comprising an insurance billing program for providing a separate bill from each of the at least first and second billing systems to an insurance provider based on the coverage data.

8. The medical billing program as defined in claim 1, wherein the enterprise registration system places the guarantor in a queue for billing when charges are incurred against an account in the name of the guarantor.

9. The medical billing program as defined in claim 1, wherein the rules are configurable by a user.

10. A medical billing system for a medical enterprise comprising at least two medical practices having independent billing computer systems, the medical billing system comprising:

at least one registration computer for registering patient visits and receiving charges for the medical practices;

an enterprise computer system storing guarantor data and coverage data for the medical practices; and

at least one common data link connecting the registration computer, the independent billing computer systems, and the enterprise computer system wherein the enterprise computer system communicates with each of the registration computer and independent billing computer systems and is programmed to;

(i) receive patient identifying data and charge data from the registration computer;

(ii) associate a guarantor with the patient identifying data and charge data for each patient visit, and route appropriate charges to each of the independent billing systems;

(iii) consolidate the charges from each of the independent billing systems into a single statement for each guarantor; and

(iv) allocate a payment received from the guarantor to each of the independent billing systems based on rules provided in a rule engine.

11. The medical billing system of claim 10 wherein the enterprise registration system is further programmed to store each patient visit under a unique identifier and associate the guarantor data and the charge data with the unique identifier.

12. The medical billing system of claim 10, wherein the enterprise registration system is further programmed to route the charges received at the billing computers to the independent billing systems.

13. The medical billing system of claim 10, wherein the medical practices include at least one of a hospital and a physician office.

14. The medical billing system of claim 10, wherein each of the medical practices provides a billing statement to an insurance company and the enterprise computer system is further programmed to allocate funds from a payment from the insurance company to each of the medical practice billing systems.

15. The medical billing system of claim 10, wherein the enterprise registration system provides a data structure including a unique patient visit identifier, a guarantor for the patient visit, a coverage, and an account associated with the guarantor for each of the medical practices.

16. The medical billing system of claim 10, wherein the enterprise registration system provides a billing queue identifying the guarantors who have outstanding charges in a guarantor account.

17. The medical billing system of claim 10, wherein the enterprise computing system is further programmed to allocate a payment received from an insuring entity to at least one of the independent billing systems based on at least one of an insurance entity guideline and a configurable rule provided in a rule engine.

18. A method for producing a single statement for medical expenses incurred from at least two medical practices having independent billing computer systems, the method comprising the following steps:

identifying a guarantor for the medical charges as the charges are incurred;

associating the identified guarantor with the incurred charges and guarantor account data for each of the independent billing computer systems;

routing each charge incurred against the identified guarantor to one of the independent billing computer systems based on the type of charge;

periodically compiling a single statement for the guarantor; and

upon receipt of payment from the guarantor, allocating payment to each of the independent billing computer systems.

19. The method as recited in claim 18, further comprising the steps of associating the identified guarantor with a billing cycle queue when the charges are incurred, retrieving the identified guarantor from the billing cycle queue, and retrieving charge data from the guarantor accounts.

20. The method as recited in claim 18, further comprising the steps of associating insurance coverage data with the identified guarantor, and providing individual statements from each of the independent billing computers to the insurance provider.

21. The method as recited in claim 20, further comprising the step of collecting a single payment from the insurance provider and allocating the payment to the independent billing computers.

22. The method as recited in claim 18, further comprising the step of providing a secure interface for the guarantor to access the statement.

23. A method for producing a single statement for medical expenses incurred from at least two medical practices having independent billing computer systems, the method comprising the following steps:

providing a database identifying a guarantor for a patient and account data for the guarantor for each of the independent billing computer systems;

associating the identified guarantor with the incurred charges and guarantor account data for each of the independent billing computer systems as charges are incurred;

periodically compiling a single statement for the guarantor based on charges incurred; and

upon receipt of payment from the guarantor, allocating payment to each of the independent billing computer systems based on the type of charges incurred.

24. The method as recited in claim 23, further comprising the step of routing the charges to the independent billing computer systems after the charges are incurred, and consolidating the charges from the independent billing system computers.

25. The method as recited in claim 23, further comprising the step of automatically routing charges incurred to the independent billing computer systems based on the type of charge incurred.

26. The method as recited in claim 23, further comprising the step of allocating payment to the independent billing computers based on at least one configurable rule.