Payd

• US 20060293927A1
• Filed: 06/22/2005
• Published: 12/28/2006
• Est. Priority Date: 06/22/2005
• Status: Abandoned Application

• Current Assignee: Vijaykanth Reddy Tummalapally
• Original Assignee: Vijaykanth Reddy Tummalapally
• Inventors: Tummalapally, Vijaykanth Reddy
• Application Number:
  US11/158,603
• Publication Number:
  US 20060293927A1
• Time in Patent Office: Days
• US Class Current: 705/4
• CPC Class Codes: G06Q 40/08 Insurance

Abstract

The invented business method introduces a system and processes which accelerate payment processing to enable a service provider to be paid in the shortest time possible and much earlier than the normal settlement process by introduction of intermediaries, systems and processes not in current use for such purpose and in such mode or method. The first application of this system and method will be for the benefit of medical practitioners having independent practice or shared practice in physician clinics or other facilities. Using this system, physicians can get their due payments within 48 hours of submitting their bills, in an error-free straight-line processing experience. The method and system implementation includes an evaluation of the medical practice; conducting a sizing exercise to define two-month business volumes of the medical practice; and establishing billing, coding, and audit procedures. The key role in this method/system is played by the entity/entities who will implement, maintain and administer this system/method and therefore will have ownership and responsibility for the whole process. For ease of understanding the flow of transactions, these process owners will be named as “Claim Accelerators”. In a normal transaction cycle, the medical practitioner will send the claims data to the Claims Accelerator, who will use established procedures, systems and methods to verify/validate the sanctity of the claim and simultaneously take two actions: file the insurance claim and pay the doctor. In essence, the doctor does not have to manage billing and collections. He will get paid by the Claim Accelerator, and does not have to wait months for processing of his claims.

Claims

1. An electronic insurance claim acceleration system and business method which facilitates faster insurance payment to doctors, shortening the time-span of medical claim/receipt to 48 hours in an error-free straight-line claim experience within a controlled performing environment. The system and method comprises of:

a) Audit procedures for medical practice

b) Verification of the financials of a medical practice

c) Configured cost-effective fee structures.

d) Standard terms and conditions for claim acceleration.

e) Operating procedures for submission of claims, processing of claims, error-identification, and payment/collections.

f) Audit procedures for off-site locations

g) Databases implemented for optimal knowledge parameters.

h) Software for enabling billing and claim management.

i) Hardware and server of pre-defined configuration

j) Rules for use of FTP, data security, and encryption

k) Standard data sharing forms and patient statements in electronic format.

l) Check lists for data sufficiency

m) Check lists for acception/rejection criteria

n) Process for establishing electronic wire transfer arrangements with insurance companies.

o) Communication policy for coding and other data dissemination to doctors and other participants in the process.

2. The system and method of claim 1, further including an onsite analysis of the medical practice to review major areas of healthcare operations, including administrative systems, clinical management, patient care services, medical records documentation and incident reporting processes.

3. The system and method of claim 1, further including a mechanism of establishing a revolving credit limit equal to two times the monthly insurance payments with financial institutions.

4. The system and method of claim 1, further including submission of claims through electronic medium to the appropriate insurance company within a short time span of 24 hours.

9. The system and method in claim 1, further including a method that can be implemented for Real-time payment system, by use of which the risk can be managed and payments could be processed in real-time.

5. A method to analyze risk factors in evaluating medical practice.

6. The method of claim 5, further including basic parameters that could be used in measuring efficiency of billing and coding systems in medical practice.

7. The method of claim 5, further including a method to maintain compliance and reduce the risk factors, by evaluating 30 medical charts per doctor, and creating formatted reports of findings.

8. The method of claim 5, further including a quarterly formatted analysis based on the prior findings with a sampling of 30 medical charts per physician.

10. A method to record, monitor and report on data encompassing Healthcare Patient Quality and Cost Indicators such as drug usage, frequency of use, reactions, patient populations, trends, costs, etc.

11. The method in claim 10, further including a method to record, monitor and report on data encompassing Treatment Profiles showing the effective treatment for a disease based on the data.