Method and system for tracking treatment of patients in a health services environment

• US 20070255592A1
• Filed: 03/20/2007
• Published: 11/01/2007
• Est. Priority Date: 04/28/2006
• Status: Active Grant

• Current Assignee: MDI Technologies, Inc. (ResMed Incorporated)
• Original Assignee: Medical Developments International Ltd., Inc.
• Inventors: Green, Jason Reinis, Wood, Raymond Michael, Snyder, Robert John
• Granted Patent: US 8,126,739 B2
• Time in Patent Office: Days
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 10/109 Time management, e.g. calendars, reminders, meetings or time accounting
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records
• CPC Class Codes: G16H 40/20 for the management or administration of healthcare resources or facilities, e.g. managing hospital staff or surgery rooms

Abstract

Methods and systems for tracking treatment of patients are presented. An exemplary method for tracking treatment of patients includes scheduling appointments for a patient with service providers based on requests for services and generating appointment information corresponding to each of the scheduled appointments; capturing service information corresponding to claims received from the service providers for payment of charges associated with services rendered by the service providers to the patient; and establishing for the patient an episode of care pertaining to treatment of a specified ailment and associating with the established episode of care at least one of the requests for services, the scheduled appointments, and the received claims for the patient that correspond to the treatment of the specified ailment.

Claims

1. A method for tracking treatment of patients, comprising:

scheduling appointments for a patient with service providers based on requests for services and generating appointment information corresponding to each of the scheduled appointments;

capturing service information corresponding to claims received from the service providers for payment of charges associated with services rendered by the service providers to the patient; and

establishing for the patient an episode of care pertaining to treatment of a specified ailment and associating with the established episode of care at least one of the requests for services, the scheduled appointments, and the received claims for the patient that correspond to the treatment of the specified ailment.

2. The method of claim 1, further comprising:

automatically identifying candidate appointments that correspond to a particular received claim based on a degree of similarity between the service information associated with the particular received claim and the appointment information associated with the scheduled appointments;

flagging the particular received claim for resolution when none of the candidate appointments corresponds to the particular received claim; and

presenting the particular received claim for payment when at least one of the candidate appointments corresponds to the particular received claim.

3. The method of claim 1, wherein the step of establishing an episode of care further comprises:

assigning a unique identifier to the established episode of care.

4. The method of claim 1, wherein the step of establishing an episode of care further comprises:

selecting at least one of a predefined service provider specialty, procedure, or afflicted body part associated with the treatment of the specified ailment.

5. The method of claim 4, wherein the step of establishing an episode of care further comprises:

editing the predefined service provider specialty, procedure, or afflicted body part corresponding to a previously established episode of care.

6. The method of claim 1, further comprising:

associating with a previously established episode of care at least one of the requests for services, the scheduled appointments, and the received claims for the patient that correspond to treatment of an ailment specified for the previously established episode of care.

7. The method of claim 1, further comprising:

editing a previously established episode of care by changing the requests for services, the scheduled appointments, or the received claims associated with the previously established episode of care.

8. A recording medium on which the method for tracking treatment of patients as claimed in claim 1 is recorded as a program code that can be executed by a processing device.

9. A system for tracking treatment of patients, comprising:

a scheduling module configured to schedule appointments for a patient with service providers based on requests for services and generate appointment information corresponding to each of the scheduled appointments;

a claim intake module configured to receive claims from the service providers for payment of charges associated with services rendered by the service providers to the patients and capture service information corresponding to each of the received claims; and

an episode of care module configured to establish for the patient an episode of care pertaining to treatment of a specified ailment and associate with the established episode of care at least one of the requests for services, the scheduled appointments, and the received claims for the patient that correspond to the treatment of the specified ailment.

10. The system of claim 9, further comprising:

an adjudication module configured to automatically identify candidate appointments that correspond to a particular received claim based on a degree of similarity between the service information associated with the particular received claim and the appointment information associated with the scheduled appointments, wherein the adjudication module is further configured to present the particular received claim for payment when at least one of the candidate appointments corresponds to the particular received claim and flag the particular received claim for resolution when none of the candidate appointments corresponds to the particular received claim.

11. The system of claim 9, wherein the episode of care module is further configured to assign a unique identifier to the established episode of care.

12. The system of claim 9, wherein the episode of care module is further configured to enable a user to select at least one of a predefined service provider specialty, procedure, or afflicted body part associated with the treatment of the specified ailment.

13. The system of claim 12, wherein the episode of care module is further configured to enable a user to edit the predefined service provider specialty, procedure, or afflicted body part corresponding to a previously established episode of care.

14. The system of claim 9, wherein the episode of care module is further configured to enable a user to associate with a previously established episode of care at least one of the requests for services, the scheduled appointments, and the received claims for the patient that correspond to treatment of an ailment specified for the previously established episode of care.

15. The system of claim 9, wherein the episode of care module is further configured to enable a user to edit a previously established episode of care by changing the requests for services, the scheduled appointments, or the received claims associated with the previously established episode of care.

16. A system for tracking treatment of patients, comprising:

means for scheduling appointments for a patient with service providers based on requests for services and generating appointment information corresponding to each of the scheduled appointments;

means for capturing service information corresponding to claims received from the service providers for payment of charges associated with services rendered by the service providers to the patient; and

means for establishing for the patient an episode of care pertaining to treatment of a specified ailment and associating with the established episode of care at least one of the requests for services, the scheduled appointments, and the received claims for the patient that correspond to the treatment of the specified ailment.

17. The system of claim 16, further comprising:

means for automatically identifying candidate appointments that correspond to a particular received claim based on a degree of similarity between the service information associated with the particular received claim and the appointment information associated with the scheduled appointments;

means for flagging the particular received claim for resolution when none of the candidate appointments corresponds to the particular received claim; and

means for presenting the particular received claim for payment when at least one of the candidate appointments corresponds to the particular received claim

18. The system of claim 16, further comprising:

means for associating with a previously established episode of care at least one of the requests for services, the scheduled appointments, and the received claims for the patient that correspond to treatment of an ailment specified for the previously established episode of care.

19. The system of claim 16, further comprising:

means for editing a previously established episode of care by changing the requests for services, the scheduled appointments, or the received claims associated with the previously established episode of care.

20. The system of claim 16, further comprising:

means for generating a report comprising appointment information and service information associated with the established episode of care.